Comparative study between alveolar recruitment maneuvers, chest compression and decompression maneuvers and breath stacking maneuvers in patients undergoing mechanical ventilation

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