Hypersecretive Mechanically Ventilated Patients
Conditions
Keywords
Mechanical ventilation, Oscillation and Lung Expansion, High-frequency chest wall oscillation, Electrical impedance tomography
Brief summary
Although mechanical ventilation (MV) is life-saving, it is associated with several complications. The establishment of an artificial airway impairs the cough reflex and mucociliary function, leading to the accumulation of secretions in the tracheobronchial tree. This increases the risk of pneumonia and lung atelectasis. Usual care for mechanically ventilated patients includes airway suctioning via the tracheostomy tube, which clears only a limited portion of the airway and is ineffective at removing peripheral airway secretions. To address this, airway clearance guidelines recommend various airway clearance techniques (ACTs) for mechanically ventilated patients to enhance mucus removal. However, the lack of standardized, effective evaluation criteria makes selecting the optimal ACT a challenge.
Detailed description
The aim of this randomized cross-over study was to compare the effectiveness of oscillation and lung expansion (OLE) versus high-frequency chest wall oscillation (HFCWO) on lung aeration and ventilation distribution, as assessed by EIT, in medically complex, hypersecretive patients with tracheostomy tubes requiring long-term mechanical ventilation (MV).
Interventions
The OLE device (MetaNeb system) is a newer, noninvasive physiotherapy tool that combines mechanical and pharmacological interventions (aerosols) to help mobilize endobronchial secretions.
High-frequency chest wall oscillation (HFCWO) is an airway clearance technique that uses external forces applied to the chest via an inflatable vest connected to a device that generates vibrations at varying frequencies and pressures.
Sponsors
Capital Medical University
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Eligible participants were patients aged ≥18 years with airway hypersecretion, admitted to the ICU, * Requiring more than 48 hours of MV.
Exclusion criteria
* Malignant arrhythmia * Acute myocardial ischemia * Pneumothorax, pulmonary bulla, barotrauma, or other lung diseases, * Hemorrhagic disease or coagulation abnormalities with bleeding tendencies * Skin trauma on the chest * Pulmonary embolism * Presence of a permanent or temporary pacemaker * Untreated spinal and rib fractures * Any condition deemed inappropriate for study inclusion by the researchers.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| End-expiratory lung impedance (EELI) | at the end of treatment (T1) and at 1 hour (T2), 2 hours (T3), 4 hours (T4) |
Secondary
| Measure | Time frame |
|---|---|
| Tidal impedance variation (TV) | at the end of treatment (T1) and at 1 hour (T2), 2 hours (T3), 4 hours (T4) |
| sputum volume | at the end of treatment (T1) and at 1 hour (T2), 2 hours (T3), 4 hours (T4) |
| Respiratory rate | at the end of treatment (T1) and at 1 hour (T2), 2 hours (T3), 4 hours (T4) |
| center of ventilation (COV) | at the end of treatment (T1) and at 1 hour (T2), 2 hours (T3), 4 hours (T4) |
Countries
China
Contacts
Primary ContactJingyi Ge
Outcome results
None listed