Clinical Trial Details
— Status: Completed
Administrative data
| NCT number |
NCT02739841 |
| Other study ID # |
VHI-hemodynamic responses |
| Secondary ID |
|
| Status |
Completed |
| Phase |
N/A
|
| First received |
|
| Last updated |
|
| Start date |
April 2016 |
| Est. completion date |
April 2017 |
Study information
| Verified date |
June 2024 |
| Source |
Khon Kaen University |
| Contact |
n/a |
| Is FDA regulated |
No |
| Health authority |
|
| Study type |
Interventional
|
Clinical Trial Summary
The purpose of this study is to explore acute hemodynamic responses to VHI technique in
critical traumatic patients with pulmonary complications in the intensive care unit.
Description:
The World Health Organization reported that Thailand ranked third for number of road
fatalities at 38.1 per 100,000 inhabitants in 2010. Most of these cases were admitted to the
intensive care unit (ICU) for respiratory interventions such as intubation and mechanical
ventilation that can lead to a common problem of pulmonary complications such as pneumonia
and atelectasis.
Evidence supports the effectiveness of chest physical therapy technique (CPT) to improve
alveolar collapse and remove pulmonary secretion. A previous study has shown that the
positive airway pressure technique reduced work of breathing (WOB) and re-inflated lung
atelectasis. The use of positive pressure devices has been part of physiotherapy intervention
since intermittent positive pressure breathing was introduced in clinical practice. In
intensive care settings, the use of positive pressure by physiotherapists includes manual
hyperinflation (bagging or bag squeezing), which has been shown to increase oxygenation and
mobilize excessive bronchial secretions, and to re-inflate collapsed areas.
Manual hyperinflation technique (MHI) is provided for use in patients with lung atelectasis.
Several studies demonstrated the short-term effects of increased oxygenation and pulmonary
compliance, improved lung collapse, and removed pulmonary secretions. To apply MHI technique,
patients were disconnected from the ventilator which lead to the adverse effect of losing
positive end expiratory pressure (PEEP) corresponding to loss of functional residual
capacity, decreased oxygenation, and shear stress of distal lung units.
An alternative method of performing pulmonary hyperinflation uses the mechanical ventilator.
Although there is evidence that positive pressure interventions such as continuous positive
airway pressure (CPAP) and intermittent positive pressure breathing IPPB) can improve lung
expansion and mobilize secretions in the airway, there are few studies examining
ventilator-induced hyperinflation as a physiotherapy intervention in intensive care.
A previous study showed that the ventilator hyperinflation technique (VHI) was as effective
as MHI to improve pulmonary complications such as secretion retention and lung atelectasis.
Especially, VHI technique using applied by the mechanical ventilator, patient was not
disconnected from the ventilator and therefore did not result in loss of PEEP and its adverse
effect.
Atelectasis is a common pulmonary complication in acute trauma patients maintained on
ventilator support who would benefit from VHI but even though recent studies indicate that
VHI technique is an improvement on the MHI technique there are relatively few study of the
hemodynamic responses to VHI. There is controversy in hemodynamic responses to VHI,
Ventilator hyperinflation technique (VHI) is especially valuable in treating patients in the
ICU because other techniques such as percussion and postural drainage may not be possible
because of wounds, broken bones or surgical drains. However, the technique is very rarely
used by physical therapists in the ICU, possibly because they are concerned that increasing
in the intra-thoracic pressure by uses VHI to inflate lung will result in dangerous changes
in heart rate and blood pressure; that any such changes may persist after the treatment
leading to complications such as pulmonary edema and, lastly, the positive pressure to the
patient may precipitate episodes of cardiac arrhythmia.
Recent study demonstrated that heart rate and blood pressure were changed after VHI in ICU
patients but the condition of patients in their study were mixed, not only traumatic
patients. Previous study showed that basal heart and blood pressure were increased in
patients underwent traumatic conditions. The hemodynamic responses to VHI were required for
safety and increasing physiotherapist's confidences to use this technique in ICU. Therefore,
the purpose of this study is to explore acute hemodynamic responses to VHI technique in
critical traumatic patients with pulmonary complications in the intensive care unit.
