Immediate and long‐term effects of manual chest compression and decompression maneuver on patients receiving invasive mechanical ventilation

Abstract

Background It has been reported that the manual chest compression and decompression (MCCD) maneuver can increase lung volume in patients receiving invasive mechanical ventilation (IMV), but some important questions related to this maneuver require answers: how long the effects of MCCD on lung volume remain, and whether there are effects on other respiratory and hemodynamic variables. Methods Patients receiving IMV support in an intensive care unit (ICU) with signs of hypoventilation, hypoexpansion, or atelectasis were eligible to receive the MCCD maneuver. Immediately before the maneuver, respiratory and hemodynamic parameters were collected. Then, 20 MCCD maneuvers were performed while measured the same parameters. After 10 min, all parameters were measured again. The primary outcome was the tidal volume (Vt) during the MCCD maneuver and after 10 min compared to the previous Vt. Results Of the 255 patients who were mechanically ventilated in the study period, 105 patients composed the final cohort. The MCCD increased inspiratory tidal volume (iVt), expiratory tidal volume (eVt), and chest dynamic compliance (Cdyn) during the application of the maneuver, but after 10 min, these parameters returned to their basal levels. The MCCD maneuver did not change the peak pressure, respiratory rate, peripheral oxygen saturation (SpO2), heart rate, or blood pressure. There was no difference in increased iVt in patients with sedation, respiratory comorbidity, or obesity. Further, there was no association between the iVt response to the MCCD and the admission diagnosis, and no correlation with the ICU length of stay, IMV duration, or APACHE II score. Implications of Physiotherapy Practice We concluded that MCCD increased iVt, eVt, and Cdyn during the application of the maneuver, but this effect was not observed after 10 min. Randomized controlled trials should be performed in the future to investigate the mechanism involved in increasing Vt and the possible impact of the MCCD maneuver on ICU outcomes.

Pulmonary expansion manoeuvres compared to usual care on ventilatory mechanics, oxygenation, length of mechanical ventilation and hospital stay, extubation, atelectasis, and mortality of patients in mechanical ventilation: A randomized clinical trial

“…The sample did not include patients with preexisting atelectasis. However, one of the indications for lung expansion manoeuvres is the prevention of atelectasis [ 13 , 15 , 16 ]. Additionally, the study was designed to simulate clinical practice by performing lung expansion manoeuvres to prevent lung collapse in all patients on mechanical ventilation, even without an atelectasis diagnosis.…”

“…Several studies have assessed manual manoeuvres' effectiveness for lung expansion [12][13][14][15][16][17][18][19]. However, it is essential to highlight the low methodological quality and the limited outcomes investigated in these studies.…”

“…Soft manual compression was performed on the lower costal region of both thoraxes during the expiratory phase of the ventilatory cycle, followed by a rapid release of the compression at the beginning of the inspiratory phase. The manoeuvre was performed every two ventilation cycles, with a total duration of five minutes [12][13][14][15][16][17].…”

“…Other techniques for lung expansion induce a reduction in pleural pressure. Passive manual manoeuvres are among these strategies and include compression-decompression [12][13][14][15][16][17] and chest block techniques [18,19]. Manual manoeuvres are commonly used in clinical practice in countries with few financial and instrumental resources [20].…”