Expiratory Rib Cage Compression in Mechanically Ventilated Patients

NCT ID: NCT01525121

Last Updated: 2012-02-02

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 20 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2008-07-31
• Study Completion Date: 2009-06-30

Brief Summary

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.

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.

Conditions

Pulmonary Infection

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: CROSSOVER
• Primary Study Purpose: TREATMENT
• Blinding Strategy: SINGLE

Study Groups

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.

Group Type: EXPERIMENTAL

Expiratory Rib Cage Compression

Intervention Type: OTHER

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.

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.

Group Type: NO_INTERVENTION

No interventions assigned to this group

Interventions

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.

Intervention Type: OTHER

Other Intervention Names

Manual thoracic compression

Eligibility Criteria

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.

• Minimum Eligible Age: 19 Years
• Maximum Eligible Age: 90 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Centro Universitário Augusto Motta

OTHER

Sponsor Role: lead

Responsible Party

Fernando Silva Guimaraes

Associate Professor

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Fernando S Guimarães, PhD

Role: STUDY_CHAIR

Centro Universitário Augusto Motta

Sara LS Menezes, PhD

Role: PRINCIPAL_INVESTIGATOR

Centro Universitário Augusto Motta

Agnaldo J Lopes, PhD

Role: PRINCIPAL_INVESTIGATOR

Centro Universitário Augusto Motta

Locations

Centro Universitário Augusto Motta

Rio de Janeiro, Rio de Janeiro, Brazil

Countries

Brazil

References

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.

Reference Type: DERIVED

PMID: 24106324 (View on PubMed)

Other Identifiers

MTC_MV

Identifier Type: -

Identifier Source: org_study_id