• Fagevik OlsénMonikaMDepartment of Gastrosurgical Research and Education, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden. Department of Physical Therapy, Sahlgrenska University Hospital and Sahlgrenska Academy, Gothenburg University, Gothen, Maria Carlsson, Erik Olsén, and Elisabeth Westerdahl.
• Department of Gastrosurgical Research and Education, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden. Department of Physical Therapy, Sahlgrenska University Hospital and Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden. monika.fagevik-olsen@vgregion.se.
• Respir Care. 2015 Oct 1; 60 (10): 141814231418-23.

BackgroundBreathing exercises with positive expiratory pressure (PEP) are used to improve pulmonary function and airway clearance. Different PEP devices are available, but there have been no studies that describe the pressure generated by different resistors. The purpose of this study was to compare pressures generated from the proprietary resistor components of 4 commercial flow-dependent PEP valves with all other parameters kept constant.MethodsResistors from 4 flow-regulated PEP devices (Pep/Rmt system, Wellspect HealthCare; Pipe P breathing exerciser, Koo Medical Equipment; Mini-PEP, Philips Respironics [including resistors by Rüsch]; and 15-mm endo-adapter, VBM Medizintechnik) were tested randomly by a blinded tester at constant flows of 10 and 18 L/min from an external gas system. All resistors were tested 3 times.ResultsResistors with a similar diameter produced statistically significant different pressures at the same flow. The differences were smaller when the flow was 10 L/min compared with 18 L/min. The differences were also smaller when the diameter of the resistor was increased. The pressures produced by the 4 resistors of the same size were all significantly different when measuring 1.5- and 2.0-mm resistors at a flow of 10 L/min and 2.0-mm resistors at a flow of 18 L/min (P < .001). There were no significant differences between any of the resistors when testing sizes of 4.5 and 5.0 mm at either flow. The Mini-PEP and adapter resistors gave the highest pressures.ConclusionsPressures generated by the different proprietary resistor components of 4 commercial PEP devices were not comparable, even though the diameter of the resistors is reported to be the same. The pressures generated were significantly different, particularly when using small-diameter resistors at a high flow. Therefore, the resistors may not be interchangeable. This is important information for clinicians, particularly when considering PEP for patients who do not tolerate higher pressures.Copyright © 2015 by Daedalus Enterprises.

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