Pulmonary Atelectasis
Conditions
Keywords
Ventilator Hyperinflation, Expiratory Rib Cage Compression, Physical Therapy, Mechanical Ventilation
Brief summary
This is a randomized crossover trial to evaluate the effects of thoracic compression applied alone or in association with hyperinflation maneuver with the ventilator. In addition, the mobilized volume and peak expiratory flow resulting from both maneuvers will be evaluated.
Detailed description
Ventilator hyperinflation is widely used in hypersecretive patients. It consists of increasing alveolar ventilation by facilitating the coughing mechanism so that the secretions of the peripheral airways are mobilized into the central airways so that they can be removed by tracheal aspiration or cough. Thoracic compression consists of manually compressing the rib cage during expiration, in order to increase expiratory flow, mobilize and remove pulmonary secretions. A randomized crossover clinical trial was performed with 30 patients submitted to isolated compression or associated with ventilator hyperinflation, with a 6 hour interval. Patients were evaluated through compliance and resistance of the respiratory system.
Interventions
Compression was performed in 6 sets of 6 cycles, with 1 cycle interval. Ventilatory mode and parameters were maintained.
OTHERCompression + Ventilator Hyperinflation
Mechanical ventilator hyperinflation was performed by increasing the inspiratory pressure to every 5 cmH2O until the total pressure reached 40 cmH2O, remaining the same. In Expiratory Rib Cage Compression associated with ventilator hyperinflation, thoracic compression maneuver was performed at the end of inspiration, at the exact moment of cycling.
Sponsors
Brazilian Institute of Higher Education of Censa
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 90 Years
Healthy volunteers
No
Inclusion criteria
* patients under mechanical ventilation * diagnosis of pulmonary infection * hypersecretive
Exclusion criteria
* haemodynamic instability (heart rate \> 130 bpm and mean arterial pressure \< 60 mmHg) * acute bronchospasm * acute respiratory distress syndrome * untreated pneumothorax
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Static compliance of respiratory system | Baseline (before), immediately after ventilator hyperinflation or rib cage compression and five minutes after aspiration | Compliance was assessed through the occlusion maneuver at the end of inspiration, considering tidal volume, plateau pressure and PEEP. Three measurements were taken at each moment, the mean being used. |
| Total Resistance of respiratory system | Baseline (before), immediately after ventilator hyperinflation or rib cage compression and five minutes after aspiration | The total resistance of the respiratory system was evaluated through the occlusion maneuver at the end of the inspiration, considering the resistive pressure, measured by the difference between the maximum plateau pressure. Three measurements were taken at each moment, the mean being used. |
| Airway Resistance | Baseline (before), immediately after ventilator hyperinflation or rib cage compression and five minutes after aspiration | The airway resistance was assessed by means of the occlusion maneuver at the end of the inspiration, considering the rapid fall of the pressure immediately after the occlusion, measured by the difference between the maximum pressure and P1. Three measurements were taken at each moment, the mean being used. |
| Peak expiratory flow | Baseline (before), immediately after ventilator hyperinflation or rib cage compression and five minutes after aspiration | The peak expiratory flow was evaluated through passive expiration, being considered the greatest value of the flow in the expiratory phase. |
Outcome results
None listed