Ventilator Hyperinflation and Manual Rib Cage Compression

Comparison Between Ventilator Hyperinflation and Manual Rib Cage Compression: Randomized Crossover Trial

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.

Study Overview

• Status: Completed
• Conditions: Pulmonary Atelectasis
• Intervention / Treatment: Other: Expiratory Rib Cage Compression; Other: Compression + Ventilator Hyperinflation

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.

• Study Type: Interventional
• Enrollment (Actual): 30
• Phase: Not Applicable

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 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

Exclusion Criteria:

• haemodynamic instability (heart rate > 130 bpm and mean arterial pressure < 60 mmHg)
• acute bronchospasm
• acute respiratory distress syndrome
• untreated pneumothorax

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Expiratory Rib Cage Compression; Expiratory rib cage compression was performed in 6 sets of 6 cycles, with 1 cycle interval. Ventilatory mode and parameters were maintained.	Other: Expiratory Rib Cage Compression; Compression was performed in 6 sets of 6 cycles, with 1 cycle interval. Ventilatory mode and parameters were maintained.
Active Comparator: Compression + Ventilator Hyperinflation; Expiratory rib cage compression was performed in 6 sets of 6 cycles, with 1 cycle interval. Ventilator hyperinflation was performed by increasing the inspiratory pressure to every 5 cmH2O until the total pressure reached 40 cmH2O, remaining the same.	Other: Compression + Ventilator Hyperinflation; Mechanical ventilator hyperinflation was performed by increasing the inspiratory pressure to every 5 cmH2O until the total pressure reached 40 cmH2O, remaining the same. In Expiratory Rib Cage Compression associated with ventilator hyperinflation, thoracic compression maneuver was performed at the end of inspiration, at the exact moment of cycling.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Static compliance of respiratory system	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.	Baseline (before), immediately after ventilator hyperinflation or rib cage compression and five minutes after aspiration
Total Resistance of respiratory system	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.	Baseline (before), immediately after ventilator hyperinflation or rib cage compression and five minutes after aspiration
Airway Resistance	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.	Baseline (before), immediately after ventilator hyperinflation or rib cage compression and five minutes after aspiration
Peak expiratory flow	The peak expiratory flow was evaluated through passive expiration, being considered the greatest value of the flow in the expiratory phase.	Baseline (before), immediately after ventilator hyperinflation or rib cage compression and five minutes after aspiration

Collaborators and Investigators

• Sponsor: Brazilian Institute of Higher Education of Censa
• Investigators: Principal Investigator: LUCIANO M CHICAYBAN, MSc, Brazilian Institute of Higher Education of Censa

Study record dates

Study Major Dates

• Study Start (Actual): November 28, 2014
• Primary Completion (Actual): December 5, 2014
• Study Completion (Actual): July 11, 2017

Study Registration Dates

• First Submitted: August 6, 2018
• First Submitted That Met QC Criteria: August 9, 2018
• First Posted (Actual): August 15, 2018

Study Record Updates

• Last Update Posted (Actual): August 15, 2018
• Last Update Submitted That Met QC Criteria: August 9, 2018
• Last Verified: August 1, 2018

More Information

Terms related to this study

• Keywords: Physical Therapy; Mechanical Ventilation; Ventilator Hyperinflation; Expiratory Rib Cage Compression
• Additional Relevant MeSH Terms: Respiratory Tract Diseases; Lung Diseases; Pulmonary Atelectasis
• Other Study ID Numbers: VHI + Rib Cage Compression

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No