Efetividade e segurança da técnica de higiene brônquica: hiperinsuflação manual com compressão torácica

Abstract

Objectives:To evaluate the effects of the manual hyperinflation with thoracic compression (MHTC) maneuver on the clearance of secretions, pulmonary mechanics, hemodynamics and oxygenation in mechanically ventilated patients.Methods: This was a controlled, crossover study that included twenty patients who were under invasive ventilation for more than 48 hours. Four hours after the last airway suctioning procedure, the patients underwent the study interventions, Suction alone or MHTC plus Suction, in sequence at four hour intervals. The sequence order for the procedures was established by randomization. Data were collected before, during and 5, 15, 30 and 60 minutes after each intervention. The suctioned secretions were collected and weighed.Results: No significant differences between the procedures were found regarding tidal volume, plateau pressure and pulmonary compliance (p>0.05).The hemodynamic variables showed increased pressures and heart rate during the procedures and returned to baseline values five minutes after the end of the procedure (p≤0.001). No significant hemodynamic differences were seen between the interventions (p>0.05).For the duration of the study, oxygen saturation was 99% with only two exceptions during the MHTC + Suction procedure, where saturation was 98% (p<0.05). No significant differences were observed between the techniques regarding the weight of the suctioned secretion.Conclusion: The results suggest that MHTC, as performed in this study, adds no benefit with respect to oxygenation optimization, pulmonary mechanics and clearance of secretions. However, the MHTC maneuver did not result in hemodynamic changes when compared to the suctioning procedure alone.

Hiperinsuflação manual combinada com compressão torácica expiratória para redução do período de internação em UTI em pacientes críticos sob ventilação mecânica

“…In a previous study involving patients in whom MH was used in combination with significant differences were found between the control and study groups regarding the length of ICU stay (6.8 days vs. 7.4 days), duration of MV (5.2 days vs. 6.1 days), or ICU mortality (0% for both) in trauma patients. (11) The replacement of MH by a vibration step did not improve those variables in a nonrandomized study involving 17 [14][15][16][17][18] 16 [12][13][14][15][16][17][18][19][20] 16 [8][9][10][11][12][13][14][15][16][17][18][19][20][21] 16 [11][12][13][14][15][16][17][18][19][20][21] RP: respiratory physiotherapy group; C: control group; and APACHE II: Acute Physiology and Chronic Health Evaluation II. the effect size for ICU discharge or successful weaning from MV being greater than 0.45.…”

“…Airway suctioning included disconnecting the patient from the ventilator, followed by tracheal instillation of 1 mL of saline solution, (13,14) four sets of six cycles being performed with a manual resuscitation bag (Adult Lifesaver Manual Resuscitator; Hudson RCI, Temecula, CA, USA) in order to ventilate patients with 100% oxygen (flow rate = 15 L/min) and airway suctioning being performed for 15 s in order to remove secretions. This procedure was performed six times a day.…”

Lung hyperinflation by mechanical ventilation versus isolated tracheal aspiration in the bronchial hygiene of patients undergoing mechanical ventilation

“…( 2 , 4 ) Lung secretion buildup can cause increased airway resistance and partial or total airway obstruction, with consequent alveolar hypoventilation and the development of atelectasis and hypoxemia and increased effort needed to breathe. ( 5 , 6 ) The care of these patients includes tracheal aspiration, which is used to facilitate the removal of secretions from the airway. However, when applied alone, tracheal aspiration can be ineffective and may clear only a small portion of the airway.…”

Effects of manual hyperinflation in preterm newborns under mechanical ventilation

“…The physical therapy of patients under mechanical ventilation admitted to intensive care units (ICU) includes respiratory physical therapy procedures such as postural drainage, chest vibration, cough, tracheal aspiration and manual hyperinflation (MH), aiming to decrease sputum retention, in order to prevent its complications, to improve oxygenation and to promote the expansion of collapsed areas. ( 7 - 9 )…”