Comparative analysis between the alveolar recruitment maneuver and breath stacking technique in patients with acute lung injury

Abstract

Objective To compare the effectiveness of the alveolar recruitment maneuver and the breath stacking technique with respect to lung mechanics and gas exchange in patients with acute lung injury. Methods Thirty patients were distributed into two groups: Group 1 - breath stacking; and Group 2 - alveolar recruitment maneuver. After undergoing conventional physical therapy, all patients received both treatments with an interval of 1 day between them. In the first group, the breath stacking technique was used initially, and subsequently, the alveolar recruitment maneuver was applied. Group 2 patients were initially subjected to alveolar recruitment, followed by the breath stacking technique. Measurements of lung compliance and airway resistance were evaluated before and after the use of both techniques. Gas analyses were collected before and after the techniques were used to evaluate oxygenation and gas exchange. Results Both groups had a significant increase in static compliance after breath stacking (p=0.021) and alveolar recruitment (p=0.03), but with no significant differences between the groups (p=0.95). The dynamic compliance did not increase for the breath stacking (p=0.22) and alveolar recruitment (p=0.074) groups, with no significant difference between the groups (p=0.11). The airway resistance did not decrease for either groups, i.e., breath stacking (p=0.91) and alveolar recruitment (p=0.82), with no significant difference between the groups (p=0.39). The partial pressure of oxygen increased significantly after breath stacking (p=0.013) and alveolar recruitment (p=0.04), but there was no significant difference between the groups (p=0.073). The alveolar-arterial O2 difference decreased for both groups after the breath stacking (p=0.025) and alveolar recruitment (p=0.03) interventions, and there was no significant difference between the groups (p=0.81). Conclusion Our data suggest that the breath stacking and alveolar recruitment techniques are effective in improving the lung mechanics and gas exchange in patients with acute lung injury.

Effects of the breath stacking technique after upper abdominal surgery: a randomized clinical trial

“…A manutenção da inspiração máxima causa um aumento da pressão transpulmonar, recrutando alvéolos colapsados e contribuindo para o aumento da Pao 2 e da expansão pulmonar. (17)(18)(19) A técnica de BS já foi aplicada em pacientes com doenças neuromusculares, (20)(21)(22)(23)(24) lesão pulmonar aguda, (25) obesidade, (13,26) no pós-operatório de cirurgia cardíaca (19) e abdominal, (27) em pacientes traqueostomizados (28) e em crianças, (20) com resultados promissores no que tange à função pulmonar e mecânica respiratória.…”

“…Sustaining maximum inspiration causes an increase in transpulmonary pressure, recruiting collapsed alveoli and contributing to the increase in Pao 2 and lung expansion. 17 - 19 BS has already been applied in patients with neuromuscular diseases, 20 - 24 acute lung injury, 25 obesity, 13 , 26 during the postoperative period of cardiac 19 and abdominal 27 surgery, in tracheostomized patients, 28 and in children, 20 showing promising results on lung function and respiratory mechanics.…”

Implementation of Postoperative Respiratory Care for Pediatric Orthopedic Patients

“…This device provides resistance to exhalation during spontaneous breathing, resulting in "stacking" of spontaneous inhalations to recruit additional lung volume; however, it does not require coordination or effort. Although less well studied, breath-stacking was safe and effective in adult studies, [8][9][10][11] and 2 small studies have demonstrated efficacy in children. 12,13 We developed a portable breathstacking device by attaching an anesthesia mask to a 1-way valve, with a disposable in-line manometer.…”