Expiratory Rib Cage Compression in Mechanically Ventilated Patients

Expiratory Rib Cage Compression Does Not Improve Secretion Clearance and Respiratory Mechanics in Mechanically Ventilated Patients

This is a randomized crossover study, designed to evaluate if the manual expiratory rib cage compression technique improves respiratory mechanics and is effective in secretion removal in mechanically ventilated patients.

Study Overview

• Status: Completed
• Conditions: Pulmonary Infection
• Intervention / Treatment: Other: Expiratory Rib Cage Compression

Detailed Description

Chest physiotherapy is an essential component of the multidisciplinary approach in critical care settings. In this context, a number of devices and manual techniques have been used to remove pulmonary secretions and re-expand collapsed areas. This study was designed to evaluate whether manual rib cage compression improves airway clearance and respiratory mechanics in mechanically ventilated patients. In a randomized crossover trial, 20 mechanically ventilated patients underwent thoracic manual compression and control intervention (normal ventilation) at the same day. The main outcomes were sputum production and the changes in respiratory mechanics.

• Study Type: Interventional
• Enrollment (Actual): 20
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Brazil
  • Rio de Janeiro, Brazil, 21041-010
    • Centro Universitário Augusto Motta

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 19 years to 90 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• patients under mechanical ventilation
• diagnosis of pulmonary infection
• hypersecretive (defined as the interval between tracheal suctioning < 2 hours)

Exclusion Criteria:

• haemodynamic instability (defined by heart rate > 130 bpm and mean arterial pressure < 60 mmHg)
• use of vasopressor drugs
• absence of respiratory drive
• acute bronchospasm
• acute respiratory distress syndrome
• atelectasis (identified by an independent radiologist that was not participating in the study)
• untreated pneumothorax
• lung haemorrhage.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Expiratory Rib Cage Compression; This a crossover study, so all subjects performed both, control and experimental interventions. The patients were kept in supine at 30 degree head-up position. Ventilatory mode was changed to volume-controlled, with a tidal volume of 8mL/kg, inspiratory flow of 60 Lpm and positive end expiratory pressure (PEEP) of 5 cmH2O. A first tracheal suctioning was done, and the mucus was discarded. Then, a series of two minutes of bilateral expiratory rib-cage compressions ensued. Aiming to minimize inter-therapist variability, the maneuver was applied by the same registered and trained physiotherapist. Control intervention followed the same sequence, but instead of the compressive maneuver they were kept on normal ventilation with the parameters described above.	Other: Expiratory Rib Cage Compression; The therapist hands were positioned on the lower ribs, and the force was applied every two breaths only during the expiration, synchronizing the maneuver rate with the patient's respiratory rate. Then, the patients underwent a suctioning procedure, and a hyperinflation maneuver consisting of a 10 minutes period under pressure support ventilation of 35 cmH2O was done. In control intervention instead of the compressive maneuver the patients were kept on normal ventilation.; Other Names: Manual thoracic compression
No Intervention: Control; This a crossover study, so all subjects performed both, control and experimental interventions. The patients were kept in supine at 30 degree head-up position. Ventilatory mode was changed to volume-controlled, with a tidal volume of 8mL/kg, inspiratory flow of 60 Lpm and positive end expiratory pressure (PEEP) of 5 cmH2O. A first tracheal suctioning was done, and the mucus was discarded. Then, a series of two minutes of bilateral expiratory rib-cage compressions ensued. Aiming to minimize inter-therapist variability, the maneuver was applied by the same registered and trained physiotherapist. Control intervention followed the same sequence, but instead of the compressive maneuver they were kept on normal ventilation with the parameters described above.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Sputum Volume (mL)	Day 1

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Respiratory Mechanics	Static and effective compliance of the respiratory system Total resistance of the respiratory system	Day 1

Collaborators and Investigators

• Sponsor: Centro Universitário Augusto Motta
• Investigators: Principal Investigator: Agnaldo J Lopes, PhD, Centro Universitário Augusto Motta; Study Chair: FERNANDO S GUIMARAES, PhD, Centro Universitário Augusto Motta; Principal Investigator: Sara LS Menezes, PhD, Centro Universitário Augusto Motta

Publications and helpful links

General Publications

• Guimaraes FS, Lopes AJ, Constantino SS, Lima JC, Canuto P, de Menezes SL. Expiratory rib cage Compression in mechanically ventilated subjects: a randomized crossover trial [corrected]. Respir Care. 2014 May;59(5):678-85. doi: 10.4187/respcare.02587. Epub 2013 Oct 8. Erratum In: Respir Care. 2014 Jul;59(7):e107.

Study record dates

Study Major Dates

• Study Start: July 1, 2008
• Primary Completion (Actual): June 1, 2009
• Study Completion (Actual): June 1, 2009

Study Registration Dates

• First Submitted: January 28, 2012
• First Submitted That Met QC Criteria: February 1, 2012
• First Posted (Estimate): February 2, 2012

Study Record Updates

• Last Update Posted (Estimate): February 2, 2012
• Last Update Submitted That Met QC Criteria: February 1, 2012
• Last Verified: February 1, 2012

More Information

Terms related to this study

• Keywords: critical care; mechanical ventilation; pneumonia; chest physiotherapy; Mechanically ventilated patients with pulmonary infection.
• Additional Relevant MeSH Terms: Infections
• Other Study ID Numbers: MTC_MV