Comparison of bronchial hygiene techniques in mechanically ventilated patients: a randomized clinical trial

Abstract

Objective To compare the effects of vibrocompression and hyperinflation with mechanical ventilator techniques alone and in combination (hyperinflation with mechanical ventilator + vibrocompression) on the amount of aspirated secretion and the change in hemodynamic and pulmonary parameters. Methods A randomized clinical trial with critically ill patients on mechanical ventilation conducted in the intensive care unit of a university hospital. The patients were randomly allocated to receive one of the bronchial hygiene techniques for 10 minutes (vibrocompression or hyperinflation with mechanical ventilator or hyperinflation with mechanical ventilator + vibrocompression). Afterwards, the patients were again randomly allocated to receive either the previous randomly allocated technique or only tracheal aspiration. The weight of aspirated secretions (in grams), ventilatory mechanics and cardiopulmonary data before and after the application of the techniques were analyzed. The tracheal reintubation frequency and time and mortality on mechanical ventilation were also evaluated. Results A total of 93 patients (29 vibrocompression, 32 hyperinflation with mechanical ventilator and 32 hyperinflation with mechanical ventilator + vibrocompression) on mechanical ventilation for more than 24 hours were included. The hyperinflation with mechanical ventilator + vibrocompression group was the only one that presented a significant increase in aspirated secretions compared to tracheal aspiration alone [0.7g (0.1 - 2.5g) versus 0.2g (0.0 - 0.6g), p value = 0.006]. Conclusion Compared to tracheal aspiration alone, the combination of hyperinflation with mechanical ventilator + vibrocompression techniques was most efficient for increasing the amount of aspirated secretions.

Maneuvers and strategies in respiratory physical therapy: time to revisit the evidence

“…Regarding the safety of the maneuvers, 5 these were repeated in 4-5 consecutive cycles, which seemed not to cause adverse effects, such as hemodynamic instability, patient discomfort, or increased airway resistance. This corroborates the studies by Sarmento et al 13 and Naue et al, 15 who compared different bronchial hygiene techniques, combined and isolated, and concluded that the techniques were safe and that, when combined, they appeared to be more efficient in reducing the frequency of aspiration and the duration of mechanical ventilation.…”

Ventilator versus manual hyperinflation in adults receiving mechanical ventilation: A systematic review

“…We included nine studies that compared manual hyperinflation with usual care, two randomized crossover trial (Choi & Jones, 2005; Hodgson et al., 2000) and seven randomized controlled trial (Barker & Adams, 2002; Blattner et al., 2008; Maa et al., 2005; Malekzadeh et al., 2016; Patman et al., 2000, 2009; Paulus et al., 2011; Table 1). There were four studies comparing hyperinflation performed using the mechanical ventilator with usual care, three randomized crossover trial (Assmann et al., 2016; Chicayban, 2019; Lemes et al., 2009) and one randomized controlled trial (Naue et al., 2019; Table 2). Four more studies that compared that compared manual hyperinflation with that performed using the mechanical ventilator, with three randomized crossover trials (Berney & Denehy, 2002; Dennis et al., 2012; Savian et al., 2006) and one randomized controlled trial (Ahmed et al., 2010; Table 3).…”

“…According to the PEDro scale, 10 studies were classified as of high methodological quality (Assmann et al., 2016; Blattner et al., 2008; Chicayban, 2019; Choi & Jones, 2005; Hodgson et al., 2000; Lemes et al., 2009; Naue et al., 2019; Patman et al., 2000, 2009; Paulus et al., 2011) and seven of moderate quality (Ahmed et al., 2010; Barker & Adams, 2002; Berney & Denehy, 2002; Dennis et al., 2012; Maa et al., 2005; Malekzadeh et al., 2016; Savian et al., 2006). As noted, most of the selected studies were classified as of high methodological quality (PEDro scale > 5 points).…”

“…Three studies demonstrated increased secretion elimination when hyperinflation with a mechanical ventilator was performed compared to only tracheal aspiration (Assmann et al., 2016), vibration and aspiration (Naue et al., 2019) and lateral positioning (Lemes et al., 2009). It is noteworthy that in the study by Naue et al.…”

“…There were four studies comparing hyperinflation performed using the mechanical ventilator with usual care, three randomized crossover trial (Assmann et al, 2016;Chicayban, 2019;Lemes et al, 2009) and one randomized controlled trial (Naue et al, 2019;Table 2). Four more studies that compared that compared manual hyperinflation with that performed using the mechanical ventilator, with three randomized crossover trials (Berney & Denehy, 2002;Dennis et al, 2012;Savian et al, 2006) and one randomized controlled trial (Ahmed et al, 2010; Table 3).…”