Ventilator Hyperinflation and Manual Rib Cage Compression

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

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.

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.

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