News Release

Breathe easy: Combination of airway devices helps stroke patients

American Stroke Association meeting report

Peer-Reviewed Publication

American Heart Association

PHOENIX, Feb. 14 – Two devices that help clear secretions from the lungs can improve the respiratory health of hospitalized stroke patients, researchers reported today at the American Stroke Association's 28th International Stroke Conference. The American Stroke Association is a division of the American Heart Association.

Stroke is the third leading cause of death in the United States, and respiratory or pulmonary-complications are one of the most common causes of death while stroke patients are hospitalized, says lead author J. David Rhodes, R.N., B.S.N., a clinical and research nurse coordinator at the Comprehensive Stroke Center of the University of Alabama Medical Center at Birmingham.

Many strokes affect swallowing and breathing functions and interfere with the ability to clear normal lung secretions. This can lead to pneumonia, or to air sacs collapsing in the lungs. All these conditions can result in hypoxemia – less life-sustaining oxygen in the bloodstream.

"Clearly, we need to do more toward improving our patients' pulmonary outcomes," Rhodes says. "In our analysis, we proved that our intervention helped clear airways and improve the level of oxygen in the bloodstream (oxygenation)."

In this study, Birmingham researchers tested a combination of a vibrating vest and a mechanical cough-assist device. The air-filled vest vibrates at a high frequency, which loosens secretions lodged in the lungs and creates a friction between the air and mucus. This helps move secretions from the lower lungs to the upper airways.

This is followed by applying the cough-assist device. It consists of a mask that fits over the face and a mechanism that pushes a big breath of air into the lungs, then rapidly sucks it out, bringing mucus along with it. Both treatments last five to 10 minutes.

"These two devices have been approved by the U.S. Food and Drug Administration for a number of years," Rhodes says. "Both devices are effective in patients, such as those with cystic fibrosis, who can not effectively cough up their secretions and keep their airways clear."

In what Rhodes calls "a clinical quality-improvement project," the stroke team at UAB treated 10 stroke patients between the ages of 21 and 85 with two types of treatment to improve respiratory function. The two treatments were the vest/cough-assist combination and the conventional method of loosening secretions by thumping the back and turning the patient over. Nurses administered the treatments and respiratory therapists measured patients' responses using a bedside pulmonary function test.

Every four hours, each patient received a medicated mist solution to relax their constricted airways. They alternately received treatment with the vest/cough-assist device or the conventional method.

Before and after each of the two treatments, respiratory therapists measured several lung functions. They were: forced vital capacity – the amount of air breathed in and forced out of lungs; tidal volume – the amount of air inhaled in any breath; minute ventilations – the amount of air inhaled in one minute; and oxygen saturation – the percent of oxygen in the blood.

Each patient received treatment for at least three days and treatment continued until it was no longer needed or they were discharged from the hospital.

The vest and cough-assistance combination had significant advantages over the conventional approach in two areas. It increased the mean average forced vital capacity of the patients from 0.60 to 0.69 liters and their minute ventilations from 7.31 liters to 8.0 liters. The treatment also produced a positive, but not statistically significant improvement in oxygen saturation – an increase from 97.9 percent to 98.2 percent.

"Conversely, the conventional treatment alone did not significantly improve any of the pulmonary functions that we measured," Rhodes says.

Because the vest/cough-assist approach improved lung function and reduced the amount of time nurses had to spend clearing patients' airways, Rhodes envisions it as a boon for both stroke units and patients.

"This is a new tool that health care providers can use that may decrease a stroke patient's length of stay in the hospital, decrease the cost of care, and eventually decrease disease and death," he says.

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Co-authors are Nancy V. Lemons, R.N.; Della J. Coupland, R.N.; Sean C. Orr, M.D.; Rodney D. Soto, M.D.; and Camilo R. Gomez, M.D.

Abstract P322

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