Expiratory Rib Cage Compression in Mechanically Ventilated Patients

NCT01525121 | Completed

• 1 other identifier: MTC_MV
• Study Type: interventional
• Target: 20
• Locations: 1 country
• Sites: 1

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.

Conditions

Pulmonary Infection

Keywords

mechanical ventilation; chest physiotherapy; critical care; pneumonia; Mechanically ventilated patients with pulmonary infection.

Outcome Measures

Primary Outcomes (1)

• Sputum Volume (mL)

  Day 1

Secondary Outcomes (1)

• Respiratory Mechanics

  Day 1

Study Arms (2)

Expiratory Rib Cage Compression

EXPERIMENTAL

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

Control

NO INTERVENTION

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.

Interventions

Expiratory Rib Cage Compression 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.

Also known as: Manual thoracic compression

Expiratory Rib Cage Compression

Eligibility Criteria

• Age: 19 Years - 90 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

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

You may not qualify if:

• 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.

Sponsors & Collaborators

• Centro Universitário Augusto Motta: lead

Study Sites (1)

Centro Universitário Augusto Motta

Rio de Janeiro, Rio de Janeiro, 21041-010, Brazil

Location

Related Publications (1)

• 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.

  PMID: 24106324 DERIVED

MeSH Terms

Conditions

Pneumonia

Condition Hierarchy (Ancestors)

Respiratory Tract Infections; Infections; Lung Diseases; Respiratory Tract Diseases

Study Officials

• Fernando S Guimarães, PhD

  Centro Universitário Augusto Motta

  STUDY CHAIR

• Sara LS Menezes, PhD

  Centro Universitário Augusto Motta

  PRINCIPAL INVESTIGATOR

• Agnaldo J Lopes, PhD

  Centro Universitário Augusto Motta

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: INVESTIGATOR
• Purpose: TREATMENT
• Intervention Model: CROSSOVER
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Associate Professor

Study Record Dates

• First Submitted: January 28, 2012
• First Posted: February 2, 2012
• Study Start: July 1, 2008
• Primary Completion: June 1, 2009
• Study Completion: June 1, 2009
• Last Updated: February 2, 2012

Record last verified: 2012-02

Locations

BR (1)