Expiratory rib cage compression in mechanically ventilated adults: systematic review with meta-analysis

Lúcia Faria Borges, Mateus Sasso Saraiva, Marcos Ariel Sasso Saraiva, Fabrício Edler Macagnan, Adriana Kessler, Lúcia Faria Borges, Mateus Sasso Saraiva, Marcos Ariel Sasso Saraiva, Fabrício Edler Macagnan, Adriana Kessler

Abstract

Objective:: To review the literature on the effects of expiratory rib cage compression on ventilatory mechanics, airway clearance, and oxygen and hemodynamic indices in mechanically ventilated adults.

Methods:: Systematic review with meta-analysis of randomized clinical trials in the databases MEDLINE (via PubMed), EMBASE, Cochrane CENTRAL, PEDro, and LILACS. Studies on adult patients hospitalized in intensive care units and under mechanical ventilation that analyzed the effects of expiratory rib cage compression with respect to a control group (without expiratory rib cage compression) and evaluated the outcomes static and dynamic compliance, sputum volume, systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, peripheral oxygen saturation, and ratio of arterial oxygen partial pressure to fraction of inspired oxygen were included. Experimental studies with animals and those with incomplete data were excluded.

Results:: The search strategy produced 5,816 studies, of which only three randomized crossover trials were included, totaling 93 patients. With respect to the outcome of heart rate, values were reduced in the expiratory rib cage compression group compared with the control group [-2.81 bpm (95% confidence interval [95%CI]: -4.73 to 0.89; I2: 0%)]. Regarding dynamic compliance, there was no significant difference between groups [-0.58mL/cmH2O (95%CI: -2.98 to 1.82; I2: 1%)]. Regarding the variables systolic blood pressure and diastolic blood pressure, significant differences were found after descriptive evaluation. However, there was no difference between groups regarding the variables secretion volume, static compliance, ratio of arterial oxygen partial pressure to fraction of inspired oxygen, and peripheral oxygen saturation.

Conclusion:: There is a lack of evidence to support the use of expiratory rib cage compression in routine care, given that the literature on this topic offers low methodological quality and is inconclusive.

Conflict of interest statement

Conflicts of interest: None

Figures

Figure 1
Figure 1
Flowchart of included studies. RCT - randomized clinical trial; ERCC - expiratory rib cage compression.
Figure 2
Figure 2
(A) Analysis of dynamic compliance after ERCC and PEEP-ZEEP(13) and after ERCC followed by tracheal suctioning.(6) (B) Analysis of heart rate after ERCC followed by tracheal suctioning(12) and after ERCC and PEEP-ZEEP.(13) ERCC - expiratory rib cage compression; PEEP-ZEEP - positive end-expiratory pressure-zero end-expiratory pressure.

References

    1. Damasceno MP, David CM, Souza PC, Chiavone PA, Cardoso LT, Amaral JL, Tasanato E, Silva NB, Luiz RR, Grupo de Ventilação Mecânica do Fundo AMIB Ventilação mecânica no Brasil: aspectos epidemiológicos. Rev Bras Ter Intensiva. 2006;18(3):219–228.
    1. Volsko TA. Airway clearance therapy: finding the evidence. Respir Care. 2013;58(10):1669–1670.
    1. França EE, Ferrari F, Fernandes P, Cavalcanti R, Duarte A, Martinez BP, et al. Fisioterapia em pacientes críticos adultos: recomendações do Departamento de Fisioterapia da Associação de Medicina Intensiva Brasileira. Rev Bras Ter Intensiva. 2012;24(1):6–22.
    1. Ciesla ND. Chest physical therapy for patients in the intensive care unit. Phys Ther. 1996;76(6):609–625.
    1. Jerre G, Silva TJ, Beraldo MA, Gastaldi A, Kondo C, Leme F, et al. III Consenso Brasileiro de Ventilação Mecânica - Fisioterapia no paciente sob ventilação mecânica. J Bras Pneumol. 2007;33(Suppl 2):S142–S150.
    1. Unoki T, Kawasaki Y, MizutaniI 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(11):1430–1437.
    1. Piccin VS, Calciolari C, Yoshizaki K, Gomes S, Albertini-Yagi C, Dolhnikoff M, et al. Effects of different mechanical ventilation strategies on the mucociliary system. Intensive Care Med. 2011;37(1):132–140.
    1. Guimarães FS, Lopes AJ, Constantino SS, Lima JC, Canuto P, de Menezes SL. Expiratory rib cage compression in mechanically ventilated subjects: a randomized crossover trial. Respir Care. 2014;59(5):678–685. [corrected] Erratum in Respir Care. 2014;59(7):e107.
    1. Robinson KA, Dickersin K. Development of a highly sensitive search strategy for the retrieval of reports of controlled trials using PubMed. Int J Epidemiol. 2002;31(1):150–153.
    1. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group Reprint-preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Phys Ther. 2009;89(9):873–880.
    1. Higgins JP, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions. The Cochrane Collaboration: [March 2011]. 2011. Version 5.1.0.
    1. Bousarri MP, Shirvani Y, Agha-Hassan-Kashani S, Nasab NM. The effect of expiratory rib cage compression before endotracheal suctioning on the vital signs in patients under mechanical ventilation. Iran J Nurs Midwifery Res. 2014;19(3):285–289.
    1. Santos FR, Schneider LC, Jr, Forgiarini LA, Jr, Veronezi J. Efeitos da compressão torácica manual versus a manobra de PEEP-ZEEP na complacência do sistema respiratório e na oxigenação de pacientes submetidos à ventilação mecânica invasiva. Rev Bras Ter Intensiva. 2009;21(2):155–161.
    1. Nozawa E, Sarmento GJ, Vega JM, Costa D, Silva JE, Feltrim MI. Perfil de fisioterapeutas brasileiros que atuam em unidades de terapia intensiva. Fisioter Pesqui. 2008;15(2):177–182.
    1. Berney S, Haines K, Denehy L. Physiotherapy in critical care in Australia. Cardiopulm Phys Ther J. 2012;23(1):19–25.
    1. Gonçalves EC, Souza HC, Tambascio J, Almeida MB, Basile A, Filho, Gastald AC. Effects of chest compression on secretion removal, lung mechanics, and gas exchange in mechanically ventilated patients: a crossover, randomized study. Intensive Care Med. 2016;42(2):295–296.
    1. Clinkscale D, Spihlman K, Watts P, Rosenbluth D, Kollef MH. A randomized trial of conventional chest physical therapy versus high frequency chest wall compressions in intubated and non-intubated adults. Respir Care. 2012;57(2):221–228.
    1. Cerqueira ML, Neto, Moura AV, Cerqueira TC, Aquim EE, Reá-Neto A, Oliveira MC, et al. Acute effects of physiotherapeutic respiratory maneuvers in critically ill patients with craniocerebral trauma. Clinics (São Paulo) 2013;68(9):1210–1214.
    1. Berti JS, Tonon E, Ronchi CF, Berti HW, Stefano LM, Gut AL, et al. Hiperinsuflação manual combinada com compressão torácica expiratória para redução do período de internação em UTI em pacientes críticos sob ventilação mecânica. J Bras Pneumol. 2012;38(4):477–486.
    1. Unoki T, Mizutani T, Toyooka H. Effects of expiratory rib cage compression combined with endotracheal suctioning on gas exchange in mechanically ventilated rabbits with induced atelectasis. Respir Care. 2004;49(8):896–901.
    1. Unoki T, Mizutani T, Toyooka H. Effects of expiratory rib cage compression and/or prone position on oxygenation and ventilation in mechanically ventilated rabbits with induced atelectasis. Respir Care. 2003;48(8):754–762.
    1. Martí JD, Bassi G, Rigol M, Saucedo L, Ranzani OT, Esperatti M, et al. Effects of manual rib cage compressions on expiratory flow and mucus clearance during mechanical ventilation. Crit Care Med. 2013;41(3):850–856.
    1. Stiller K. Physiotherapy in intensive care: towards an evidence-based practice. Chest. 2000;118(6):1801–1813.
    1. Yazdannik AR, Haghighat S, Saghaei M, Eghbal M. Comparing two levels of closed system suction pressure in ICU patients: evaluating the relative safety of higher values of suction pressure. Iran J Nurs Midwifery Res. 2013;18(2):117–122.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe