Manual compression of the abdomen to assess expiratory flow limitation during mechanical ventilation

Effects of Sitting Position and Applied Positive End-Expiratory Pressure on Respiratory Mechanics of Critically Ill Obese Patients Receiving Mechanical Ventilation*

“…In addition, MCA has been validated both during spontaneous (20) and MV (41) to reliably detect and quantify EFL. Assessment of EFL during MV provides critical information to set the ventilator.…”

Assessment of Factors Related to Auto-PEEP

“…The diagnosis of flow limitation with the manual compression of the abdominal maneuver is simple, does not require any device (apart from the availability of the flow-volume loop), and has been validated in spontaneously breathing subjects and in sedated mechanically ventilated subjects. [15][16][17] We measured auto-PEEP after a reasonably long endexpiratory pause (4 min) in order to reach an unambiguously stable value of auto-PEEP when trapped gas gradually decompresses into the central airways. 1 Therefore, auto-PEEP measurements should be reliable even in patients with severe inhomogeneous lung disease and long time constants.…”

“…14 After the occlusion maneuvers, the presence of flow limitation was assessed with manual compression of the abdomen. [15][16][17] Briefly, the investigator put one hand gently on the abdominal wall of the subject with the palm on the umbilicus oriented perpendicularly to the axis between the xiphoid process and the pubis. After a short period, which allowed for recognition of the expiratory phase, the investigator exerted firm but gentle compression of the abdomen in an antero-posterior direction as soon as the insufflation was finished.…”

It's Time to Reappraise the Impact of Auto-PEEP

“…6,7,13,14 The use of manual compression of the abdomen to detect expiratory flow limitation in patients receiving mechanical ventilation is more complicated, and one study has been conducted to validate its use. 15 Critically ill patients suffer from pathophysiological conditions that may cause abdominal distention, rapid changes of body fluid in the abdomen, and intra-abdominal infections. Therefore, whether increased intra-abdominal pressure transmits accordingly into the pleural space is questionable.…”

“…According to the waterfall theory, 16 applying external PEEP in these patients will unload the burden of the inspiratory muscles and facilitate weaning. 4,15 However, the misuse of external PEEP without the existence of expiratory flow limitation may result in increased alveolar pressure at end inspiration, thereby inducing acute lung injury. Second, the impact of weighted factors regarding the development of auto-PEEP in patients receiving mechanical ventilation needs to be taken into account.…”