Chest Physiotherapy Effects on Intracranial Pressure

University of Santiago de Compostela

Status: Completed

Conditions: Acute Brain Injury

Treatments: Procedure: rapid thoracic compression technique; Procedure: inferior limb passive mobilization

Study type: Interventional

Funder types: Other

Identifiers

NCT03609866

Usantiago Doct

Details and patient eligibility

About

The investigators will study the effects of a chest physiotherapy technique (rapid thoracic compression) on the intracranial pressure of individuals with acute cerebral injury and with need of intubated mechanical ventilation

Full description

Patients with acute brain injury often require invasive mechanical ventilation connection, increasing the risk of developing complications such as respiratory secretions retention. Thethoracic compression is a manual chest physiotherapy technique that can improve clearance of secretions in these patients. Although today the scientific evidence is contradictory, the manual abdomino-thoracic compression may be associated with increased intracranial pressure in patients with acute brain injury.

Objectives: The aim of this work to study the effects of manual thoracic compression technique in intracranial pressure in mechanically ventilated patients. Furthermore, the effects of the technique in different volumes and flows recorded by the ventilator and the relationship between the pressure applied in the intervention group and the different variables will also be studied.

Methodology: It will be a randomized clinical trial, single-blind in the application of the techniques. Patients with acute brain injury in invasive mechanical ventilation will be included, randomized into two groups. In the control group, a technique of passive inferior limbs mobilization will be applied and in the intervention group it will be performed the manual thoracic compression technique. The data of the primary variable, intracranial pressure will be collected with a monitoring system and continuous recording (Integra Camino).

A descriptive analysis of the values collected from the variables in the study will be performed, studying the measures of central tendency. In the presence of normal distribution will be presented mean and standard deviation, and median and interquartile range in case of non-observation of normal distribution. The normality of the samples will be verified with the Kolmogorov-Smirnov test. The verification of the hypothesis in study will be assessed using the Student T test for independent samples in case of sample normality and by the Wilcoxon test otherwise. A multiple linear regression analysis will be performed: considering as a dependent variable the differences in intracranial pressure, difference or volume / minute gain and expiratory flow and between the covariates, the type of technique, the pressure applied in the technique under study, the type of brain injury, age, sex, etc.

Enrollment: 50 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• intubated patients for 48 hours in vc, pc, vcrp
• hemodynamically stable (MAP>60mmHg)
• respiratory stability (PEEP<15cmH2O and FiO2<60%)
• ICP stable (0<icp<20mmHg)
• RASS of 5
• informed consent signed

Exclusion criteria

• thoracic fractures
• abdominal injuries that limits local pressure
• systemic or local changes that undergoes with abdominal volume increase
• inferior limbs fractures that contraindicates passive mobilization techniques

Trial design

Primary purpose: Basic Science

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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50 participants in 2 patient groups

control

Active Comparator group

Description:

will be performed inferior limbs passive mobilization

Treatment:

Procedure: inferior limb passive mobilization

experimental

Experimental group

Description:

rapid thoracic compression technique will be applied

Treatment:

Procedure: rapid thoracic compression technique