Ventilator Hyperinflation and Manual Rib Cage Compression

Pulmonary Atelectasis Clinical Trial

Official title:

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

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03630484
• Other study ID #: VHI + Rib Cage Compression
• Status: Completed
• Phase: N/A
• Start date: November 28, 2014
• Est. completion date: July 11, 2017

Study information

• Verified date: August 2018
• Source: Brazilian Institute of Higher Education of Censa
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

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.

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.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 30
• Est. completion date: July 11, 2017
• Est. primary completion date: December 5, 2014
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 90 Years

Eligibility

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

Related Conditions & MeSH terms

• Pulmonary Atelectasis

Intervention

Other:
• Expiratory Rib Cage Compression
Compression was performed in 6 sets of 6 cycles, with 1 cycle interval. Ventilatory mode and parameters were maintained.
• 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.

Locations

Country	Name	City	State
n/a

Sponsors (1)

Lead Sponsor	Collaborator
Brazilian Institute of Higher Education of Censa

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	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
Primary	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
Primary	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
Primary	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