The effect of expiratory rib cage compression before endotracheal suctioning on the vital signs in patients under mechanical ventilation

Mitra Payami Bousarri, Yadolah Shirvani, Saeed Agha-Hassan-Kashani, Nouredin Mousavi Nasab, Mitra Payami Bousarri, Yadolah Shirvani, Saeed Agha-Hassan-Kashani, Nouredin Mousavi Nasab

Abstract

Background: In patients undergoing mechanical ventilation, mucus production and secretion is high as a result of the endotracheal tube. Because endotracheal suction in these patients is essential, chest physiotherapy techniques such as expiratory rib cage compression before endotracheal suctioning can be used as a means to facilitate mobilizing and removing airway secretion and improving alveolar ventilation. As one of the complications of mechanical ventilation and endotracheal suctioning is decrease of cardiac output, this study was carried out to determine the effect of expiratory rib cage compression before endotracheal suctioning on the vital signs in patients under mechanical ventilation.

Materials and methods: This study was a randomized clinical trial with a crossover design. The study subjects included 50 mechanically ventilated patients, hospitalized in intensive care wards of Valiasr and Mousavi hospitals in Zanjan, Iran. Subjects were selected by consecutive sampling and randomly allocated to groups 1 and 2. The patients received endotracheal suctioning with or without rib cage compression, with a minimum of 3 h interval between the two interventions. Expiratory rib cage compression was performed for 5 min before endotracheal suctioning. Vital signs were measured 5 min before and 15 and 25 min after endotracheal suctioning. Data were recorded on a data recording sheet. Data were analyzed using paired t-tests.

Results: There were statistically significant differences in the means of vital signs measured 5 min before with 15 and 25 min after endotracheal suctioning with rib cage compression (P < 0. 01). There was no significant difference in the means of diastolic pressure measured 25 min after with baseline in this stage). But on the reverse mode, there was a significant difference between the means of pulse and respiratory rate 15 min after endotracheal suctioning and the baseline values (P < 0.002). This effect continued up to 25 min after endotracheal suctioning just for respiratory rate (P = 0.016). Moreover, there were statistically significant differences in the means of vital signs measured 5 min before and 15 min after endotracheal suctioning between the two methods (P ≤ 0001).

Conclusions: Findings showed that expiratory rib cage compression before endotracheal suctioning improves the vital signs to normal range in patients under mechanical ventilation. More studies are suggested on performing expiratory rib cage compression before endotracheal suctioning in patients undergoing mechanical ventilation.

Keywords: Endotracheal suctioning; expiratory rib cage compression; mechanical ventilation; vital signs.

Conflict of interest statement

Conflict of Interest: None declared.

References

    1. Black JM, Hawks JH. 7th ed. Philadelphia: Elsevier; 2005. Medical-Surgical Nursing: Clinical management for positive outcomes; pp. 1887–90.
    1. Woodrow P. London: Routledge Taylor and Fransis Group; 2006. Intensive care nursing: A Framework for practice; pp. 48–9. 54.
    1. Holloway NM. California: Addison Wesley Pub Co; 1996. Nursing the critically Ill Adults; p. 401. 619.
    1. Stone K. The effect of hyperinflation and endotracheal suctioning on cardiopulmonary homodynamic. Nurs Resh. 1992;40:446–50.
    1. Potter PA, Perry AG. 6th ed. Philadelphia: Mosby; 2007. Basic nursing: Essentials for practice; p. 663.
    1. Uzieblo M, Welsh R, Pursel SE, Chmielewski GW. Incidence and significance of lobar atelectasis in thoracic surgical patients. Am Surg. 2000;66:476–80.
    1. Smeltzer S, Bare B. 12th ed. Philadelphia: J.B. Lippincott Company; 2010. Textbook of Medical- surgical nursing; pp. 466–7. (608-13). 620-1.
    1. Glass CA, Grap MJ. Ten tips for safer suctioning. Am J Nurs. 1995;5:51–3.
    1. Miyagawa T, Ishikawa A. Physical therapy for respiratory disturbances: New perspectives of chest physical therapy. Jpn J Phys Ther. 1993;27:678–85.
    1. Takekawa Y. Nursing care for patients under mechanical ventilation. J Jpn Soc Respir Care. 2002;11:346–52.
    1. Watts J. Thoracic compression for asthma. Chest. 1994;86:505.
    1. Unoki T, Kawasaki Y, Mizutani T, Fujino Y, Yanagisawa Y, Ishimatsu S, et al. Effects of expiratory rib- cage compression on oxygenation, ventilation, and airway-secretion removal in patients receiving mechanical ventilation. Respir Care. 2005;50:1430–7.
    1. Kohan M, Najaf Yarandi A, Peyrovi H, Hoseini F. The effects of expiratory rib cage compression before endotracheal suctioning on arterial blood gases in patients Under Mechanical Ventilation. Iran Journal of Nursing. 2007;20:37–49.
    1. Shiri H, Nickravan M. 12th ed. Tehran: Nourdanesh Publication; 2010. Critical care in ICU.
    1. Nazmiyeh H, Mirjalili M, Emami Maibodi R. Comparison of the effects of open and closed endotracheal suction on cardiovascular and ventilation parameters for patients undergoing Mechanical ventilation. J Rafsenjan Univ Med Sci. 2010;9:97–106.
    1. Zolfaghari M, Nikbakhat Nasrabadi A, Karimi RA, Haghani H. Effect of open and closed system endotracheal suctioning on vital signs of ICU patients. Hayat. 2008;14:13–20.
    1. Kennel WB. Elevated systolic blood pressure as a cardiovascular risk factor. Am J Cardiol. 2000;5:251–5.
    1. Van der Touw T, Mudaliar Y, Nayyar V. Cardio respiratory effects of manually compressing the rib cage during tidal expiration in mechanically ventilated patients recovering from acute severe asthma. Crit Care Med. 1998;26:1361–7.
    1. Shamszadeh AM. 1st ed. Tehran: Salemi Publication; 1995. Mechanical ventilation; p. 238.

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