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

Abstract

Objective: Although manual hyperinflation (MH) is widely used for pulmonary secretion clearance, there is no evidence to support its routine use in clinical practice. Our objective was to evaluate the effect that MH combined with expiratory rib cage compression (ERCC) has on the length of ICU stay and duration of mechanical ventilation (MV). Methods: This was a prospective randomized controlled clinical trial involving ICU patients on MV at a tertiary care teaching hospital between January of 2004 and January of 2005. Among the 49 patients who met the study criteria, 24 and 25 were randomly assigned to the respiratory physiotherapy (RP) and control groups, respectively. Of those same patients, 6 and 8, respectively, were later withdrawn from the study. During the 5-day observation period, the RP patients received MH combined with ERCC, whereas the control patients received standard nursing care. Results: The two groups were similar in terms of the baseline characteristics. The intervention had a positive effect on the duration of MV, as well as on the ICU discharge rate and Murray score. There were significant differences between the control and RP groups regarding the weaning success rate on days 2 (0.0% vs. 37.5%), 3 (0.0% vs. 37.5%), 4 (5.3% vs. 37.5%), and 5 (15.9% vs. 37.5%), as well as regarding the ICU discharge rate on days 3 (0% vs. 25%), 4 (0% vs. 31%), and 5 (0% vs. 31%). In the RP group, there was a significant improvement in the Murray score on day 5. Conclusions: Our results show that the use of MH combined with ERCC for 5 days accelerated the weaning process and ICU discharge.Keywords: Physical therapy modalities; Ventilator weaning; Length of stay. ResumoObjetivo: Embora a hiperinsuflação manual (HM) seja largamente usada para a remoção de secreções pulmonares, não há evidências para sua recomendação como rotina na prática clínica. O objetivo do estudo foi avaliar o efeito da HM combinada com compressão torácica expiratória (CTE) na duração de internação em UTI e no tempo de ventilação mecânica (VM) em pacientes sob VM. Métodos: Ensaio clínico prospectivo, randomizado e controlado com pacientes de UTI sob VM em um hospital acadêmico terciário entre janeiro de 2004 e janeiro de 2005. Dentre os 49 pacientes que preencheram os critérios do estudo, 24 e 25 foram randomicamente alocados nos grupos fisioterapia respiratória (FR) e controle, respectivamente, sendo que 6 e 8 foram retirados do estudo. Durante o período de observação de 5 dias, os pacientes do grupo FR receberam HM combinada com CTE, enquanto os controles receberam o tratamento padrão de enfermagem. Resultados: Os dois grupos apresentaram características basais semelhantes. A intervenção teve efeito positivo na duração de VM, alta da UTI e escore de Murray. Houve diferenças significativas entre os grupos controle e FR em relação à taxa de sucesso no desmame nos dias 2 (0,0% vs. 37,5%), 3 (0,0% vs. 37,5%), 4 (5,3 vs. 37,5%) e 5 (15,9% vs. 37,5%), assim como à taxa de alta da UTI nos dias 3 (0% vs. 25%), 4 (0% vs. 31%) e 5 (0% vs. 3...

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

“…( 20 ) Comparison of the two techniques reveals similar results in terms of secretion volume, improvement in respiratory mechanics, and hemodynamic stability. ( 21 , 22 ) However, ventilator hyperinflation has a significant advantage in that it enables monitoring of the pressures, volumes, and flows used during its performance, thereby allowing fine tuning of the technique.…”

“…( 20 ) Quando comparadas as duas técnicas, evidenciam-se resultados semelhantes em relação a volume de secreção, aprimoramento da mecânica respiratória e estabilidade hemodinâmica. ( 21 , 22 ) Entretanto, a realização da técnica com a utilização do ventilador mecânico apresenta uma grande vantagem, que é a monitorização das pressões, volumes e fluxos utilizados durante a técnica, permitindo assim um melhor ajuste da mesma.…”

Experimental study on the efficiency and safety of the manual hyperinflation maneuver as a secretion clearance technique

“…Another point that should be mentioned is that the MH maneuver can be performed in combination with expiratory chest compression in order to maximize the increase in the PEF ( 10 , 29 ) ; however we were not able to investigate the use of that combination, because of the experimental system used. In addition, as previously mentioned, we cannot discard the possibility that the use of a different resuscitator device (a self-inflating resuscitator with larger internal volume bags or a flow-inflating resuscitator) might produce better results.…”

“…The maneuver is widely accepted as effective ( 6 , 7 ) and, in Brazil, is largely embraced as a means of removing retained secretions. ( 8 - 10 ) The rationale for the use of the technique as an aid for secretion removal is that it simulates a cough. ( 11 ) When applied before suctioning, it theoretically moves secretions toward the central airways, ( 12 ) thus increasing the efficacy of the suctioning procedure.…”

Publicações do Jornal Brasileiro de Pneumologia

“…( 35 , 36 ) The use of ventilatory support and extracorporeal membrane oxygenation was the subject of a study conducted in the city of São Paulo ( 37 ) and of an editorial authored by Professor Alan Morris of Salt Lake City, Utah. ( 38 ) There were three publications on weaning from mechanical ventilation: an original article on weaning protocols conducted in the Brazilian state of Rio Grande do Sul, ( 39 ) ; a review article on predictive parameters ( 40 ) ; and an editorial by Professor Martin Tobin of Chicago, Illinois.…”