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Expiratory Rib Cage in Mechanically Ventilated Subjects: A Randomized Crossover Trial.

BACKGROUND: Expiratory rib cage compression (ERCC) has been empirically used by physiotherapists with the rationale of improving expiratory flows and therefore the airway clearance in mechanically ventilated patients. This study evaluates the acute mechanical effects and sputum clearance of an ERCC...

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Published in:Respiratory Care Vol. 59; no. 5; pp. 678 - 686
Main Authors: Guimarães, Fernando S, Lopes, Agnaldo J, Constantino, Sandra S, Lima, Juan C, Canuto, Paulo, de Menezes, Sara Lucia Silveira
Format: research tables/charts randomized controlled trial Journal Article
Published: Mary Ann Liebert, Inc. May2014
Online Access:View this record in EBSCOhost
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      dt: May2014
      vid: 59
      iid: 5
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      pub: Mary Ann Liebert, Inc.
      place: New Rochelle, New York
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        atl: Expiratory Rib Cage in Mechanically Ventilated Subjects: A Randomized Crossover Trial.
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        au:
          Guimarães, Fernando S
          Lopes, Agnaldo J
          Constantino, Sandra S
          Lima, Juan C
          Canuto, Paulo
          de Menezes, Sara Lucia Silveira
        affil: Rehabilitation Sciences Master¿s Program, Augusto Motta University Center, Rio de Janeiro, Brazil,; School of Physiotherapy, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
      sug:
        subj:
          Physical Therapy
          Respiration, Artificial
          Critically Ill Patients
          Human
          Randomized Controlled Trials
          Crossover Design
          Scales
          Descriptive Statistics
          Data Analysis Software
          Male
          Female
          Middle Age
          Aged
          APACHE (Acute Physiology and Chronic Health Evaluation)
          Glasgow Coma Scale
          Effect Size
          Middle Aged: 45-64 years
          Aged: 65+ years
          Male
          Female
      ab: BACKGROUND: Expiratory rib cage compression (ERCC) has been empirically used by physiotherapists with the rationale of improving expiratory flows and therefore the airway clearance in mechanically ventilated patients. This study evaluates the acute mechanical effects and sputum clearance of an ERCC protocol in ventilated patients with pulmonary infection. METHODS: In a randomized crossover study, sputum production and respiratory mechanics were evaluated in 20 mechanically ventilated subjects submitted to 2 interventions. ERCC intervention consisted of a series of manual bilateral ERCCs, followed by a hyperinflation maneuver. Control intervention (CTRL) followed the same sequence, but instead of the compressive maneuver, the subjects were kept on normal ventilation. Static (Cst) and effective (Ceff) compliance and total (Rtot) and initial (Rinit) resistance of the respiratory system were measured pre-ERCC (baseline), post-ERCC or CTRL (POST1), and post-hyperinflation (POST2). Peak expiratory flow (PEF) and the flow at 30% of the expiratory tidal volume (flow 30% VT) were measured during the maneuver. RESULTS: ERCC cleared 34.4% more secretions than CTRL (1 [0.5-1.95] vs 2 [1-3.25], P < .01). Respiratory mechanics showed no differences between control and experimental intervention in POST1 for Cst, Ceff, Rst, and Rinit. In POST2, ERCC promoted an increase in Cst (38.7 ± to10.3 vs 42.2 ± 12 mL/ cm H2O, P = .03) and in Ceff (32.6 ± 9.1 vs 34.8 ± 9.4 mL/cm H2O, P = .04). During ERCC, PEF increased by 16.2 L/min (P < .001), and flow 30% VT increased by 25.3 L/min (P < .001) compared with CTRL. Six subjects (30%) presented expiratory flow limitation (EFL) during ERCC. The effect size was small for secretion volume (0.2), Cst (0.15), and Ceff (0.12) and negligible for Rtot (0.04) and Rinit (0.04). CONCLUSIONS: Although ERCC increases expiratory flow, it has no clinically relevant effects from improving the sputum production and respiratory mechanics in hypersecretive mechanically ventilated patients. The maneuver can cause EFL in some patients.
      pubtype: Academic Journal
      doctype:
        research
        tables/charts
        randomized controlled trial
        Journal Article
      ougenre: Article
    language: English
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