Comparative study between lung expansion maneuvers in patients undergoing mechanical ventilatio
- Conditions
- E02.041Respiration, Artificial
- Registration Number
- RBR-8cykwc3
- Lead Sponsor
- Hospital e Maternidade Galileo
- Brief Summary
Introduction: The Breath Stacking (BS) maneuver has been considered a strategy to improve lung expansion in patients admitted to the Intensive Care Unit. It is defined as respiratory stacking, using a unidirectional valve with the expiratory branch occluded, coupled to an interface such as a mask or mouthpiece to the patient's face. The technique consists of performing consecutive insufflations without exhaling, and subsequently, the expiratory branch is released; it can be performed voluntarily, in which the patient is responsive and oriented and will perform consecutive inspirations until the expiration branch of the mask used is released; as well as in unresponsive and unresponsive patients, using the ventilator coupling or manually using the Artificial Maintenance Breath Unit (AMBU) resuscitation bag. Objective: To compare two methods of performing the Breath Stacking maneuver, using a mechanical ventilator and Airway Maintenance Breathing Unit (AMBU), in patients on mechanical ventilation admitted to the ICU. Subjects and method: This is a quasi-experimental prospective clinical study comprising 32 patients admitted to the ICU of the Hospital e Maternidade Galileo Valinhos-SP, Brazil. The selected subjects were initially submitted to the Breath Stacking technique with a mechanical ventilator (BSV) occluding the expiratory branch of the mechanical ventilator circuit for 20 seconds. The technique was performed six consecutive times with a two-minute interval between maneuvers. After 24 hours, the second technique of Breath Stacking with AMBU (BSA) was performed with 20 seconds of insufflations with the valve closed, being performed 10 consecutive times with 1-minute pauses between applications. The variables analyzed were: Blood pressure (BP), heart rate (HR), respiratory rate (RR), peripheral oxygen saturation (SatO2), tidal volume, static compliance (Cst), maximum airway pressure (PIT) and drive pressure (DP). To analyze the data, the deltas (post-pre) were calculated and the Wilcoxon tests and paired T test were used. p values <0.05 were considered significant. Results: It can be seen that the Breath Stacking maneuver, when analyzing hemodynamic variables, there were no significant changes after application of the techniques, therefore, it was safe with no change in vital signs. In the analysis of pulmonary variables: respiratory rate (RR), SatO2, tidal volume (Vt) and static compliance (Cst), there were no significant variations after application of the techniques. In the variables: Peak Pressure (PIT) (p-0.02) and Driving Pressure (DP) (p-0.03), it can be observed that PIT and DP were better in both others, however, in the BSV group, there was a superiority of the technique in relation to the BSA. Conclusion: The BSV technique compared with BSA was more effective in lung expansion, being a safe and effective maneuver in the respiratory mechanics of patients on invasive mechanical ventilation
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- Recruitment completed
- Sex
- Not specified
- Target Recruitment
- Not specified
Patients with up to 72 hours of admission to the Intensive Care Unit (ICU) using mechanical ventilation (MV); patients of both sexes; aged 18 to 80 years; patients with hemodynamic stability, mean arterial pressure (MAP=60 mmHg), pulmonary gas exchange with partial pressure of oxygen greater than or equal to 60 mmHg (PaO2 = 60 mmHg), inspiratory fraction of oxygen greater than or equal to 60% (FiO2=60 %), positive expiratory pressure less than or equal to 10 cmH2O (PEEP=10 cmH2O), adequate oxygen saturation (SpO2=95%), acid-base balance; sedated or weaned patients; informed consent form signed by the responsible family member
Bronchopleural fistula; pulmonary thromboembolism; patients undergoing postoperative cardiac surgery; thrombocytopenia (<50,000/mm³); severe traumatic brain injury with intracranial hypertension (PIC=20mmHg); flail chest and undrained pneumothorax
Study & Design
- Study Type
- Intervention
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method Expected outcome 1: With this study it will be possible to determine, in a scientific way, which of the techniques has a better effect on pulmonary ventilation or whether both are effective resources in reversing areas of hypoventilation and atelectasis, with consequent improvement in gas exchange without risk of injuries of the lung parenchyma;Found outcome 1: The two techniques studied (BSA and BSV) proved to be beneficial in ventilatory parameters. However, the superiority of BSV compared to BSA was observed, with better peak pressure (PIT) and Drive Pressure values ??in BSV with PIT -0.28±1.08 and Drive Pressure -0.12±0.97, while the BSA with PIT 0.34±1.45 and Drive Pressure 0.53±1.48. Low PIT and DP values ??demonstrate adequate lung distension – indicating that there is protection of the lung parenchyma, thus avoiding hyperinflation and possible injuries caused by barotrauma
- Secondary Outcome Measures
Name Time Method Expected outcome 2: With this study it will be possible to determine, scientifically, whether all the techniques applied (breathstacking maneuver, alveolar recruitment maneuver and thoracic compression and decompression maneuver) are safe in maintaining patients' vital signs;Found outcome 2: When analyzing the vital signs of the present study, there were no significant changes in both techniques, demonstrating that they are safe in maintaining the vital signs of patients undergoing the techniques