Chest compression with a higher level of pressure support ventilation: effects on secretion removal, hemodynamics, and respiratory mechanics in patients on mechanical ventilation

Abstract

OBJECTIVE:To determine the efficacy of chest compression accompanied by a 10-cmH2O increase in baseline inspiratory pressure on pressure support ventilation, in comparison with that of aspiration alone, in removing secretions, normalizing hemodynamics, and improving respiratory mechanics in patients on mechanical ventilation.METHODS:This was a randomized crossover clinical trial involving patients on mechanical ventilation for more than 48 h in the ICU of the Porto Alegre Hospital de Clínicas, in the city of Porto Alegre, Brazil. Patients were randomized to receive aspiration alone (control group) or compression accompanied by a 10-cmH2O increase in baseline inspiratory pressure on pressure support ventilation (intervention group). We measured hemodynamic parameters, respiratory mechanics parameters, and the amount of secretions collected.RESULTS:We included 34 patients. The mean age was 64.2 ± 14.6 years. In comparison with the control group, the intervention group showed a higher median amount of secretions collected (1.9 g vs. 2.3 g; p = 0.004), a greater increase in mean expiratory tidal volume (16 ± 69 mL vs. 56 ± 69 mL; p = 0.018), and a greater increase in mean dynamic compliance (0.1 ± 4.9 cmH2O vs. 2.8 ± 4.5 cmH2O; p = 0.005).CONCLUSIONS:In this sample, chest compression accompanied by an increase in pressure support significantly increased the amount of secretions removed, the expiratory tidal volume, and dynamic compliance. (ClinicalTrials.gov Identifier:NCT01155648 [http://www.clinicaltrials.gov/])

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

“…( 8 ) This technique consists of the administration of high tidal volumes, either by progressively increasing support pressure until a peak pressure of 40cmH 2 O is achieved in the airway or by increasing positive end-expiratory pressure (PEEP). ( 9 ) MVH promotes the expansion of collapsed alveoli, increasing air flow to areas with atelectasis through collateral channels and surfactant renewal in the alveoli. This technique also aims to increase the elastic potential of lung recoil and peak expiratory flow, resulting in the mobilization of lung secretions from the periphery of the lungs to more central regions.…”

Hiperinsuflação pulmonar com ventilador mecânico como manobra de higiene brônquica

“…Em um estudo randomizado cruzado, Naue et al 20 encontraram diferenças na FC, Cdin, VC e secreção pulmonar aspirada. Esse estudo comparou a técnica de hiperinsuflação associada à vibrocompressão versus aspiração.…”

“…pela manobra de vibrocompressão e não pela hiperinsuflação propriamente dita, o que corrobora nossos achados que não mostraram diferença nos parâmetros hemodinâmicos, pulmonares (excetuando a variação de PAM, sem relevância clínica) e na quantidade de secreção pulmonar aspirada, quando comparadas as duas técnicas (ASP isolada versus HVM). Dessa forma, podemos supor que a técnica de hiperinsuflação é mais eficaz quando associada a técnicas que modifiquem a reologia do muco (vibrocompressão), facilitando assim o deslocamento do muco, conforme demonstrado por Naue et al em 2014 20 .…”

Efeitos do instrumento Pulsar ® e da vibrocompressão em crianças no ambiente hospitalar

“…As Manobras de Higiene Brônquica (MHB) são técnicas que visam auxiliar na mobilização e remoção das secreções retidas, prevenir ou reduzir as obstruções por secreção e suas consequências, como hiperinsuflação, atelectasia, alteração da relação ventilação/perfusão e aumento do trabalho respiratório 4,5 . Diante destes efeitos, a remoção das secreções pode prevenir ou reduzir as lesões teciduais provocadas por infecções broncopulmonares 6 .…”