Expiratory Rib Cage Compression in Mechanically Ventilated Patients

Centro Universitário Augusto Motta

Status: Completed

Conditions: Pulmonary Infection

Treatments: Other: Expiratory Rib Cage Compression

Study type: Interventional

Funder types: Other

Identifiers

NCT01525121

MTC_MV

Details and patient eligibility

About

This is a randomized crossover study, designed to evaluate if the manual expiratory rib cage compression technique improves respiratory mechanics and is effective in secretion removal in mechanically ventilated patients.

Full description

Chest physiotherapy is an essential component of the multidisciplinary approach in critical care settings. In this context, a number of devices and manual techniques have been used to remove pulmonary secretions and re-expand collapsed areas. This study was designed to evaluate whether manual rib cage compression improves airway clearance and respiratory mechanics in mechanically ventilated patients. In a randomized crossover trial, 20 mechanically ventilated patients underwent thoracic manual compression and control intervention (normal ventilation) at the same day. The main outcomes were sputum production and the changes in respiratory mechanics.

Enrollment: 20 patients

Sex: All

Ages: 19 to 90 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• patients under mechanical ventilation
• diagnosis of pulmonary infection
• hypersecretive (defined as the interval between tracheal suctioning < 2 hours)

Exclusion criteria

• haemodynamic instability (defined by heart rate > 130 bpm and mean arterial pressure < 60 mmHg)
• use of vasopressor drugs
• absence of respiratory drive
• acute bronchospasm
• acute respiratory distress syndrome
• atelectasis (identified by an independent radiologist that was not participating in the study)
• untreated pneumothorax
• lung haemorrhage.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Crossover Assignment

Masking: Single Blind

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20 participants in 2 patient groups

Expiratory Rib Cage Compression

Experimental group

Description:

This a crossover study, so all subjects performed both, control and experimental interventions. The patients were kept in supine at 30 degree head-up position. Ventilatory mode was changed to volume-controlled, with a tidal volume of 8mL/kg, inspiratory flow of 60 Lpm and positive end expiratory pressure (PEEP) of 5 cmH2O. A first tracheal suctioning was done, and the mucus was discarded. Then, a series of two minutes of bilateral expiratory rib-cage compressions ensued. Aiming to minimize inter-therapist variability, the maneuver was applied by the same registered and trained physiotherapist. Control intervention followed the same sequence, but instead of the compressive maneuver they were kept on normal ventilation with the parameters described above.

Treatment:

Other: Expiratory Rib Cage Compression

Control

No Intervention group

Description:

This a crossover study, so all subjects performed both, control and experimental interventions. The patients were kept in supine at 30 degree head-up position. Ventilatory mode was changed to volume-controlled, with a tidal volume of 8mL/kg, inspiratory flow of 60 Lpm and positive end expiratory pressure (PEEP) of 5 cmH2O. A first tracheal suctioning was done, and the mucus was discarded. Then, a series of two minutes of bilateral expiratory rib-cage compressions ensued. Aiming to minimize inter-therapist variability, the maneuver was applied by the same registered and trained physiotherapist. Control intervention followed the same sequence, but instead of the compressive maneuver they were kept on normal ventilation with the parameters described above.