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The aim of the current study is to compare the effects of ventilator hyperinflation and vibrocompression on lung compliance in mechanically ventilated patients.
Lower respiratory infections remained the world's most deadly communicable disease, ranked as the 4th leading cause of death.
The aim of mechanical ventilation is to reduce the ventilatory work and maintain gas exchange, but it also has deleterious effects on mucociliary transport and coughing ability. These effects provoke the stasis of secretions in the airways and bronchial obstruction, with hypoventilation, atelectasis, and consequent hypoxemia. This set of factors also favors microorganism multiplication and, thus, an increased incidence of ventilator-associated pneumonia (VAP), impaired gas exchange, pulmonary infection and fibrosis, and progressive reduction of lung compliance. To reverse or reduce these deleterious effects, bronchial hygiene techniques are used by physical therapists in several ICUs around the world. Among these techniques, tracheal aspiration, vibrocompression (VB), and hyperinflation with mechanical ventilation are commonly employed.
Lung compliance is inversely proportional to elastance. This elastic resistance is due to the elastic property of lung tissue or parenchyma and the surface elastic force. Any changes occurring to these forces could lead to changes in compliance. Compliance determines 65% of the work of breathing. If the lung has low compliance, it requires more work from breathing muscles to inflate the lungs. In specific pathologies, continuous monitoring of the lung compliance curve is useful to understand the condition's progression and to decide on therapeutic settings needed for ventilator management So, the current study will help to determine the effects of ventilator hyperinflation and vibrocompression on lung compliance and sputum production in mechanically ventilated patients.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Study Group (A) | Active Comparator | The patients in the study group (A) will be treated with ventilator hyperinflation in addition to a traditional chest physical therapy program (percussion, postural drainage, and suction) for 4 successive sessions at a rate of one session per day. |
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| Study Group (B) | Active Comparator | The patients in the study group (B) will be treated with vibrocompression in addition to a traditional chest physical therapy program (percussion, postural drainage, and suction) for 4 successive sessions at a rate of one session per day. |
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| Control Group (C) | Active Comparator | The patients in the control group (C) will be treated with a traditional chest physical therapy program (percussion, postural drainage, and suction) for 4 successive sessions at a rate of one session per day. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Ventilator Hyperinflation | Other | In ventilator hyperinflation volume control mode, the ventilator will be set to eight breaths per minute, and the tidal volume will be increased to deliver hyperinflation breaths that are 15 ml/kg, as will be calculated using the predicted body weight. Tidal volume will be increased in 150-ml increments until a peak airway pressure of 40 cmH2O is achieved. Once this pressure is reached, eight mechanical breaths will be delivered to the patient. After this, the ventilator will be reset to pretreatment variables, and the patient will be rested for 30 s. The sequence will be repeated. The treatment will consist of five sets of eight ventilator hyperinflation breaths. |
| Measure | Description | Time Frame |
|---|---|---|
| Static Compliance | Static compliance (ml/cmH2O). | Before, after treatment at Day 1 and Day 4 |
| Airway Resistance | Airway Resistance (cmH2O/l/s). | Before, after treatment at Day 1 and Day 4 |
| Sputum Volume in ml | Airway suction will be carried out immediately after treatment or during treatment if indicated and will be measured as sputum volume in ml. | Immediately after treatment at Day 1 and Day 4 |
| Peak Expiratory Flow and Peak Inspiratory Flow | Peak Expiratory Flow (l/min) and Peak Inspiratory Flow (l/min) | Before, after treatment at Day 1 and Day 4 |
| Measure | Description | Time Frame |
|---|---|---|
| Oxygen Saturation (SPO2) | Peripheral oxygen saturation (SPO2) in percentage | Before, after treatment at Day 1 and Day 4 |
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Inclusion Criteria:
Exclusion Criteria:
Patients will be excluded if they have the following conditions or diseases:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Nadia H Mohamed, MSc | Contact | +201148709641/+201220058803 | nadia93hassan@gmail.com |
| Name | Affiliation | Role |
|---|---|---|
| Nadia H Mohamed, MSc | Cairo University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Kasr AL Ainy | Recruiting | Cairo | Egypt |
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| Vibrocompression | Other | Vibrocompression will be performed by the physical therapist to produce vibration and will be combined with compression of the patient's chest in the expiratory phase. Every vibrocompression will be interrupted at the end of each expiratory phase to allow free inspiration. |
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| Traditional Chest Physical Therapy Program | Other | Percussion, Postural Drainage, and Suction |
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