Hyperinflation using pressure support ventilation improves secretion clearance and respiratory mechanics in ventilated patients with pulmonary infection: a randomised crossover trial

Lemes, Daniela Aires; Zin, Walter A.; Guimarães, Fernando Silva

doi:10.1016/s0004-9514(09)70004-2

Cited by 51 publications

(62 citation statements)

References 20 publications

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“…According to the data from Lemes et al, 20 power calculation indicated that 10 participants would provide sufficient power (80%) to detect a difference of 68% in sputum volume, assuming an SD of 67% and significance of 0.05. …”

Section: Discussionmentioning

confidence: 99%

“…Thus, quantification of expectorated mucus has been used as an important airway clearance marker in most physiotherapy studies including mechanically ventilated patients. 12,20,[25][26][27][28] For a better mechanistic approach, our mucus clearance results are discussed along with the following respiratory mechanics subitems.…”

Section: Mucus Clearancementioning

confidence: 99%

“…10,20,30,31 According to these studies, transitory bronchial constriction, variable secretion distribution patterns in patients' airways, mucociliary activity, and individualized response to the applied intervention could explain the unchanged respiratory resistance observed after the use of airway clearance techniques. Moreover, because of the greatest contribution of the central and intermediate airways to respiratory system resistance, if the secretions displace from the periphery to more proximal airways (but are not completely removed by suctioning), there will be an increase in these resistance parameters.…”

Section: Respiratory System and Airway Resistancementioning

confidence: 99%

“…Although C st has been used by several authors to assess the effect of airway clearance techniques in mechanically ventilated patients, 20,[25][26][27][28] the only study evaluating ERCC as an isolated technique in humans used C eff . 4 The use of this mechanical variable made the interpretation of respiratory mechanics difficult because this parameter is influenced not only by the elastic properties of the respiratory system (which depend on the recruitment or de-recruitment of lung periphery), but also by its resistive and inhomogeneous components (which depend on other factors, such as the patterns of secretion distribution in the airways).…”

Section: Static and Effective Respiratory Compliancementioning

confidence: 99%

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Expiratory Rib Cage Compression in Mechanically Ventilated Subjects: A Randomized Crossover Trial

et al. 2013

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BACKGROUND: Expiratory rib cage compression (ERCC) has been empirically used by physiotherapists with the rationale of improving expiratory flows and therefore the airway clearance in mechanically ventilated patients. This study evaluates the acute mechanical effects and sputum clearance of an ERCC protocol in ventilated patients with pulmonary infection. METHODS: In a randomized crossover study, sputum production and respiratory mechanics were evaluated in 20 mechanically ventilated subjects submitted to 2 interventions. ERCC intervention consisted of a series of manual bilateral ERCCs, followed by a hyperinflation maneuver. Control intervention (CTRL) followed the same sequence, but instead of the compressive maneuver, the subjects were kept on normal ventilation. Static (C st ) and effective (C eff ) compliance and total (R tot ) and initial (R init ) resistance of the respiratory system were measured pre-ERCC (

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Section: Discussionmentioning

confidence: 99%

Section: Mucus Clearancementioning

confidence: 99%

Section: Respiratory System and Airway Resistancementioning

confidence: 99%

Section: Static and Effective Respiratory Compliancementioning

confidence: 99%

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Expiratory Rib Cage Compression in Mechanically Ventilated Subjects: A Randomized Crossover Trial

et al. 2013

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“…Using a different hyperinflation technique (i.e., ventilatorinduced hyperinflation), a recent study showed an improvement in secretion clearance and static compliance of the respiratory system in patients on pressure support ventilation. (27) In the RP group, the improvement in lung injury, as measured by the Murray score, was not followed by an improvement in disease severity, as measured by the APACHE II score. Although previous studies have employed the Murray score (28) and the APACHE II (2,3,29) score, the effect of respiratory physiotherapy interventions on those indexes was not evaluated, further comparisons being therefore impossible.…”

Section: Discussionmentioning

confidence: 90%

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

et al. 2012

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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...

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Justification for Chest Physiotherapy during Ultra‐Protective Lung Ventilation and Extra‐Corporeal Membrane Oxygenation: A Case Study

Cork

Barrett

Ntoumenopoulos

2013

Physiotherapy Res Intl

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Hyperinflation using pressure support ventilation improves secretion clearance and respiratory mechanics in ventilated patients with pulmonary infection: a randomised crossover trial

Abstract: The application of hyperinflation using pressure support ventilation in mechanically ventilated patients with pulmonary infection improves secretion clearance and increases static compliance of the respiratory system.

Cited by 51 publications

References 20 publications

Expiratory Rib Cage Compression in Mechanically Ventilated Subjects: A Randomized Crossover Trial

Expiratory Rib Cage Compression in Mechanically Ventilated Subjects: A Randomized Crossover Trial

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

Justification for Chest Physiotherapy during Ultra‐Protective Lung Ventilation and Extra‐Corporeal Membrane Oxygenation: A Case Study

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