Comparison Between Ventilator Hyperinflation and Manual Rib Cage Compression: Randomized Crossover Trial
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Pulmonary Atelectasis
- Sponsor
- Brazilian Institute of Higher Education of Censa
- Enrollment
- 30
- Primary Endpoint
- Static compliance of respiratory system
- Status
- Completed
- Last Updated
- 7 years ago
Overview
Brief Summary
This is a randomized crossover trial to evaluate the effects of thoracic compression applied alone or in association with hyperinflation maneuver with the ventilator. In addition, the mobilized volume and peak expiratory flow resulting from both maneuvers will be evaluated.
Detailed Description
Ventilator hyperinflation is widely used in hypersecretive patients. It consists of increasing alveolar ventilation by facilitating the coughing mechanism so that the secretions of the peripheral airways are mobilized into the central airways so that they can be removed by tracheal aspiration or cough. Thoracic compression consists of manually compressing the rib cage during expiration, in order to increase expiratory flow, mobilize and remove pulmonary secretions. A randomized crossover clinical trial was performed with 30 patients submitted to isolated compression or associated with ventilator hyperinflation, with a 6 hour interval. Patients were evaluated through compliance and resistance of the respiratory system.
Investigators
Luciano Matos Chicayban
Principal Investigator
Brazilian Institute of Higher Education of Censa
Eligibility Criteria
Inclusion Criteria
- •patients under mechanical ventilation
- •diagnosis of pulmonary infection
- •hypersecretive
Exclusion Criteria
- •haemodynamic instability (heart rate \> 130 bpm and mean arterial pressure \< 60 mmHg)
- •acute bronchospasm
- •acute respiratory distress syndrome
- •untreated pneumothorax
Outcomes
Primary Outcomes
Static compliance of respiratory system
Time Frame: Baseline (before), immediately after ventilator hyperinflation or rib cage compression and five minutes after aspiration
Compliance was assessed through the occlusion maneuver at the end of inspiration, considering tidal volume, plateau pressure and PEEP. Three measurements were taken at each moment, the mean being used.
Total Resistance of respiratory system
Time Frame: Baseline (before), immediately after ventilator hyperinflation or rib cage compression and five minutes after aspiration
The total resistance of the respiratory system was evaluated through the occlusion maneuver at the end of the inspiration, considering the resistive pressure, measured by the difference between the maximum plateau pressure. Three measurements were taken at each moment, the mean being used.
Airway Resistance
Time Frame: Baseline (before), immediately after ventilator hyperinflation or rib cage compression and five minutes after aspiration
The airway resistance was assessed by means of the occlusion maneuver at the end of the inspiration, considering the rapid fall of the pressure immediately after the occlusion, measured by the difference between the maximum pressure and P1. Three measurements were taken at each moment, the mean being used.
Peak expiratory flow
Time Frame: Baseline (before), immediately after ventilator hyperinflation or rib cage compression and five minutes after aspiration
The peak expiratory flow was evaluated through passive expiration, being considered the greatest value of the flow in the expiratory phase.