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| ID | Type | Description | Link |
|---|---|---|---|
| 92079725.0.0000.5208 | Other Identifier | Research Ethics Committee on Human Research, Federal University of Pernambuco - Recife Campus (UFPE/Recife) |
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| Name | Class |
|---|---|
| Universidade Federal de Pernambuco | OTHER |
| Fundação de Amparo à Ciência e Tecnologia de Pernambuco | OTHER |
| Conselho Nacional de Desenvolvimento Científico e Tecnológico | OTHER_GOV |
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The goal of this quasi-experimental study is to investigate how different body positions, performed through Automatic Lateralization Therapy, affect respiratory drive, ventilation, and pulmonary aeration in critically ill adult patients under mechanical ventilation. The main questions this study aims to answer are:
Does combining Automatic Lateralization Therapy, with Flow Bias improve physiological and functional outcomes compared to Automatic Lateralization Therapy, without Flow Bias?
Participants will:
Participate only during their ICU stay, with no need for additional visits after discharge.
Detailed Description:
Critically ill patients under mechanical ventilation frequently develop respiratory complications due to immobility and altered pulmonary mechanics. Automatic Lateralization Therapy has emerged as a promising physiologic intervention to optimize ventilation and reduce respiratory dysfunction in this population. However, its effects on respiratory drive activation remain poorly understood.
Objective:
To evaluate the effects of body lateralization on respiratory drive activation, ventilation, and pulmonary aeration in mechanically ventilated critically ill patients.
Methods and Design:
This is a quasi-experimental, non-randomized physiological intervention study conducted in a controlled ICU environment, following the TREND 2025 Statement Checklist for transparent reporting of non-randomized evaluations. Automatic Lateralization Therapy will be applied with and without Flow Bias, using progressive body tilt angles (0°, 15°, and 30°). Positioning strategies will be personalized based on Electrical Impedance Tomography (EIT) findings to ensure optimal lung recruitment and safety.
Collected data will include:
Clinical and physiological parameters such as respiratory drive (P0.1, estimated Pmus),
Diaphragm and parasternal muscle activity via surface electromyography (sEMG),
Ventilatory mechanics and gas exchange,
Pulmonary aeration and regional ventilation distribution assessed by EIT,
Additional monitoring by lung ultrasound to confirm aeration patterns.
The investigator performing the physiological data analysis will be blinded to the intervention group to minimize bias. Cardiorespiratory safety (e.g., hemodynamic stability, oxygenation) and adverse events will be monitored throughout all procedures.
Expected Outcomes:
The study aims to provide insights into whether body lateralization through Automatic Lateralization Therapy, modulates respiratory drive and improves ventilation efficiency in critically ill patients. It is hypothesized that combining Automatic Lateralization Therapy, with Flow Bias will enhance pulmonary expansion, respiratory drive activation, and gas exchange efficiency compared to Automatic Lateralization Therapy, alone, while maintaining patient safety.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Supine Positioning | Active Comparator | Participants will remain in supine position with 30° head elevation. No lateralization therapy is applied. |
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| Automatic lateralization therapy | Active Comparator | Participants will undergo continuous lateral positioning on an automated bed, with automatic angle and time adjustments. The second sequence will be combined with the Flow Bias intervention. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Automatic Lateralization Therapy | Other | During this phase of analysis and intervention related to lateral positioning, patients will be maintained on a Multicare bed (LINET) and subjected to personalized lateral positioning based on the morphofunctional pattern detected by electrical impedance tomography. This positioning will be performed using automatic lateralization therapy, programmed for unilateral or bilateral application, continuously alternating between angles of 0°, 15°, and 30°, maintained for 20 minutes at each position. The procedure will be conducted in two sequences, with the second sequence combined with the Flow Bias intervention. At each angle, data will be collected on hemodynamic monitoring, respiratory drive, respiratory mechanics, regional distribution of ventilation and aeration, and gas exchange. |
| Measure | Description | Time Frame |
|---|---|---|
| Respiratory drive parameters: Surface electromyography (sEMG) | The respiratory drive parameter will be assessed using surface electromyographic (sEMG) activity of the respiratory muscles, including the diaphragm and parasternal intercostals, expressed in microvolts (µV) (Silva Junior et al., 2023). Data are given in: • µV: Microvolts Measurements will be performed during the first and last 5 minutes of each body angulation. Unilateral: 140 minutes | Bilateral: 370 minutes. Following the sequence: Semi-seated 30°/20 minutes, Supine 0°/5 minutes, 15°/20 minutes, 30°/20 minutes, 15°/20 minutes, Supine 0°/5 minutes, and Semi-seated 30°/20 minutes, totaling 70 minutes per sequence plus 60 minutes of washout between sequences. This results in 140 minutes for patients undergoing Unilateral Lateralization Therapy and 370 minutes for patients undergoing Bilateral Lateralization Therapy. | Unilateral: 140 minutes (2 hour 20 minutes) | Bilateral: 370 minutes (6 hour 10 minutes) |
| Respiratory drive parameter: P0.1 (airway occlusion pressure during the first 100 ms of the inspiratory effort) | The respiratory drive parameter will be assessed by P0.1(airway occlusion pressure during the first 100ms of the inspiratory effort,cmH₂O).P0.1 is the drop in airway pressure within 100 ms after the onset of inspiration and is considered a reliable, fast, and feasible bedside marker.The following values are considered: Normal: 1.5-3.5 cmH₂O; Low: <1.0 cmH₂O(hypostimulated); High:>4.0 cmH₂O (hyperstimulated)(CHEN et al.,2023). Data are given in: cmH₂O: centimeters of water Measurements will be performed during the first and last 5 minutes of each body angulation. Unilateral: 140 minutes | Bilateral: 370 minutes. Following the sequence: Semi-seated 30°/20 minutes, Supine 0°/5 minutes, 15°/20 minutes, 30°/20 minutes, 15°/20 minutes, Supine 0°/5 minutes, and Semi-seated 30°/20 minutes, totaling 70 minutes per sequence plus 60 minutes of washout between sequences. This results in 140 minutes for patients undergoing Unilateral Lateralization Therapy and 370 minutes Bilateral. | Unilateral: 140 minutes (2 hour 20 minutes) | Bilateral: 370 minutes(6 hour 10 minutes) |
| Respiratory drive parameters: Pmus (estimated inspiratory muscle pressure) | The respiratory drive will be assessed using Pmus (estimated inspiratory muscle pressure). Pmus is derived from the airway pressure drop during a brief inspiratory occlusion and reflects inspiratory effort. Reference ranges: Pmus < 5 cmH₂O indicates over-assistance/low drive; Pmus ≤ 10 cmH₂O represents the diaphragmatic protection zone; Pmus > 13-15 cmH₂O indicates excessive effort (Dianti, Bertoni ;Goligher, 2020). Data are given in: •cmH₂O: centimeters of water Measurements will be performed during the first and last 5 minutes of each body angulation. Unilateral: 140 minutes | Bilateral: 370 minutes. Following the sequence: Semi-seated 30°/20 minutes, Supine 0°/5 minutes, 15°/20 minutes, 30°/20 minutes, 15°/20 minutes, Supine 0°/5 minutes, and Semi-seated 30°/20 minutes, totaling 70 minutes per sequence plus 60 minutes of washout between sequences. This results in 140 minutes for patients undergoing Unilateral Lateralization Therapy and 370 minutes for patients undergoing Bilateral |
| Measure | Description | Time Frame |
|---|---|---|
| Mechanical response associated with respiratory drive: Diaphragmatic excursion | Diaphragmatic excursion will be assessed by ultrasonography using a convex transducer placed along the right mid-clavicular line, using the liver as an acoustic window. The procedure follows established ICU protocols and can be performed without ventilator disconnection. In this study, ventilation will remain connected, and diaphragmatic excursion will be quantified in millimeters (mm) (Santana et al., 2020). Data are given in: mm: Millimeters. Measurements will be performed during the first and last 5 minutes of each body angulation. Unilateral: 140 minutes | Bilateral: 370 minutes. Following the sequence: Semi-seated 30°/20 minutes, Supine 0°/5 minutes, 15°/20 minutes, 30°/20 minutes, 15°/20 minutes, Supine 0°/5 minutes, and Semi-seated 30°/20 minutes, totaling 70 minutes per sequence plus 60 minutes of washout between sequences. This results in 140 minutes for patients undergoing Unilateral Lateralization Therapy and 370 minutes for patients undergoing Bilateral. |
| Measure | Description | Time Frame |
|---|---|---|
| Clinical Severity - SAPS 3 (Baseline) | Baseline clinical severity will be assessed using the Simplified Acute Physiology Score 3 (SAPS 3). This score provides a standardized measure of acute illness severity based on physiological, laboratory, and clinical variables collected within the first hours of ICU admission. SAPS 3 generates a total score typically ranging from 0 to 217, with higher scores indicating greater severity and higher predicted mortality risk (Salluh; Soares, 2014). The score will be recorded once before any intervention and used solely for sample characterization and stratification. |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Shirley Lima Campos, PhD | Contact | +5581999413087 | shirley.campos@ufpe.br | |
| Emanuel Fernandes Ferreira da Silva Júnior, MSc | Contact | + 55 81 99703-9934 | emanuel.silvajunior@ufpe.br |
| Name | Affiliation | Role |
|---|---|---|
| Emanuel Fernandes Ferreira da Silva Júnior, MSc | Federal University of Pernambuco (UFPE) - Health-Applied Biology Graduate Program, Federal University of Pernambuco, Recife, Brazil | Principal Investigator |
| Shirley Lima Campos Lima Campos, PhD | Universidade Federal de Pernambuco |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Hospital Geral Otávio de Freitas - Secretaria de Saúde de Pernambuco | Recruiting | Recife | Pernamu | 50670-901 | Brazil |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 25137401 | Background | Salluh JI, Soares M. ICU severity of illness scores: APACHE, SAPS and MPM. Curr Opin Crit Care. 2014 Oct;20(5):557-65. doi: 10.1097/MCC.0000000000000135. | |
| 32623476 | Background | Dianti J, Bertoni M, Goligher EC. Monitoring patient-ventilator interaction by an end-expiratory occlusion maneuver. Intensive Care Med. 2020 Dec;46(12):2338-2341. doi: 10.1007/s00134-020-06167-3. Epub 2020 Jul 4. No abstract available. |
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| ID | Type | URL | Comment |
|---|---|---|---|
| Multicare: Bed for protocol | Study Protocol | View IPD |
Participant characteristics Medical history Clinical measurements Functional results Images (USG) Adverse events
Through study completion
Individual participant data (IPD) access will be granted by the PI after request review for approval via email. It will be shared with researchers and general public of interest on the subject for descriptive analyses related to our sample. A committee of researchers will be in charge of discussing the request before approving the access.
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| ID | Term |
|---|---|
| D016638 | Critical Illness |
| ID | Term |
|---|---|
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| ID | Term |
|---|---|
| D016683 | Supine Position |
| ID | Term |
|---|---|
| D011187 | Posture |
| D009142 | Musculoskeletal Physiological Phenomena |
| D055687 | Musculoskeletal and Neural Physiological Phenomena |
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Quasi-experimental study with a non-randomized physiological interventional design in a single group of critically ill adult patients under mechanical ventilation. Each participant will undergo all intervention conditions, including different body lateralization angles (0°, 15°, 30°) with Automatic Lateralization Therapy with and without Flow Bias. Repeated measures will include respiratory drive, ventilation, and pulmonary aeration assessed by P0.1, estimated Pmus, sEMG, EIT, and ultrasound, allowing each participant to serve as their own control.
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Apart from the participants and the researchers responsible for data analysis, no other role is blinded in the study.
The researchers responsible for carrying out the interventions and conducting the study are not blinded to the intervention conditions.
Blinding is applied only to:
|
|
| Supine Positioning | Other | During this analysis phase, patients will be positioned on a Multicare bed (LINET) in the dorsal decubitus position with the head of the bed elevated to 30°. Data will be collected on hemodynamic monitoring, respiratory drive, respiratory mechanics, degree of lung involvement, regional distribution of ventilation and aeration, and gas exchange. |
|
|
| Unilateral: 140 minutes (2 hour 20 minutes) | Bilateral: 370 minutes (6 hour 10 minutes) |
| Pulmonary ventilation: Ventilation Impedance Change (ΔZ) | ΔZ will be quantified using electrical impedance tomography (EIT). ΔZ represents the sum of impedance changes of all pixels within a predefined region of interest (ROI), corresponding to regional tidal ventilation. ROIs will include right anterior, left anterior, right posterior, and left posterior lung regions, and will also be categorized as dependent or non-dependent lung areas. Data will be expressed in arbitrary units (a.u.). Measurements will be performed during the first and last 5 minutes of each body angulation. Unilateral: 140 minutes | Bilateral: 370 minutes. Following the sequence: Semi-seated 30°/20 minutes, Supine 0°/5 minutes, 15°/20 minutes, 30°/20 minutes, 15°/20 minutes, Supine 0°/5 minutes, and Semi-seated 30°/20 minutes, totaling 70 minutes per sequence plus 60 minutes of washout between sequences. This results in 140 minutes for patients undergoing Unilateral Lateralization Therapy and 370 minutes for patients undergoing Bilateral Lateralization Therapy. | Unilateral: 140 minutes (2 hour 20 minutes) | Bilateral: 370 minutes (6 hour 10 minutes) |
| Pulmonary aeration: End-Expiratory Lung Impedance Change (ΔEELZ) | ΔEELZ will be assessed using electrical impedance tomography (EIT). ΔEELZ corresponds to the aggregate end-expiratory impedance (sum of pixel values) within each ROI, representing changes in end-expiratory lung volume. ROIs will include right anterior, left anterior, right posterior, and left posterior lung regions, grouped as dependent or non-dependent areas. Data will be expressed in arbitrary units (a.u.). Measurements will be performed during the first and last 5 minutes of each body angulation. Unilateral: 140 minutes | Bilateral: 370 minutes. Following the sequence: Semi-seated 30°/20 minutes, Supine 0°/5 minutes, 15°/20 minutes, 30°/20 minutes, 15°/20 minutes, Supine 0°/5 minutes, and Semi-seated 30°/20 minutes, totaling 70 minutes per sequence plus 60 minutes of washout between sequences. This results in 140 minutes for patients undergoing Unilateral Lateralization Therapy and 370 minutes for patients undergoing Bilateral Lateralization Therapy. | Unilateral: 140 minutes (2 hour 20 minutes) | Bilateral: 370 minutes (6 hour 10 minutes) |
| Unilateral: 140 minutes (2 hour 20 minutes) | Bilateral: 370 minutes (6 hour 10 minutes) |
| Mechanical response related to respiratory effort and lung stress: Dynamic transpulmonary driving pressure | Dynamic transpulmonary driving pressure (cmH₂O) will assess the mechanical response to respiratory effort and lung stress. It is derived from the same expiratory occlusion maneuver used for Pmus, applying a correction formula to isolate lung distension. This provides a non-invasive measure of dynamic lung stress during ventilation. Recent studies have targeted values between 15 and 20 cmH₂O (Dianti et al., 2022). Data are given in: cmH₂O: centimeters of water Measurements will be performed during the first and last 5 minutes of each body angulation. Unilateral: 140 minutes | Bilateral: 370 minutes. Following the sequence: Semi-seated 30°/20 minutes, Supine 0°/5 minutes, 15°/20 minutes, 30°/20 minutes, 15°/20 minutes, Supine 0°/5 minutes, and Semi-seated 30°/20 minutes, totaling 70 minutes per sequence plus 60 minutes of washout between sequences. This results in 140 minutes for patients undergoing Unilateral Lateralization Therapy and 370 minutes for patients undergoing Bilateral. | Unilateral: 140 minutes (2 hour 20 minutes) | Bilateral: 370 minutes (6 hour 10 minutes) |
| Driving Pressure (cmH₂O) | Driving pressure will be assessed using ventilator-derived parameters during mechanical ventilation to estimate lung stress under different body angulations and lateralization strategies. Driving pressure will be calculated as the difference between plateau pressure (Pplat) and positive end-expiratory pressure (PEEP), according to the formula: Driving Pressure = Pplat - PEEP. Data will be expressed in: cmH₂O (centimeters of water). Measurements will be performed during the first and last 5 minutes of each body angulation. Unilateral: 140 minutes | Bilateral: 370 minutes. Following the sequence: Semi-seated 30°/20 minutes, Supine 0°/5 minutes, 15°/20 minutes, 30°/20 minutes, 15°/20 minutes, Supine 0°/5 minutes, and Semi-seated 30°/20 minutes, totaling 70 minutes per sequence plus 60 minutes of washout between sequences. This results in 140 minutes for patients undergoing Unilateral Lateralization Therapy and 370 minutes for patients undergoing Bilateral Lateralization Therapy. | Unilateral: 140 minutes (2 hour 20 minutes) | Bilateral: 370 minutes (6 hour 10 minutes) |
| Respiratory System Compliance (mL/cmH₂O) | Respiratory system compliance will be evaluated using ventilator-derived parameters to assess lung distensibility during different body angulations and lateralization strategies under mechanical ventilation. Respiratory system compliance will be calculated as the ratio between tidal volume (VT) and driving pressure, according to the formula: Compliance = VT/ (plateau press - PEEP). Data will be expressed in: cmH₂O (centimeters of water). Measurements will be performed during the first and last 5 minutes of each body angulation. Unilateral: 140 minutes | Bilateral: 370 minutes. Following the sequence: Semi-seated 30°/20 minutes, Supine 0°/5 minutes, 15°/20 minutes, 30°/20 minutes, 15°/20 minutes, Supine 0°/5 minutes, and Semi-seated 30°/20 minutes, totaling 70 minutes per sequence plus 60 minutes of washout between sequences. This results in 140 minutes for patients undergoing Unilateral Lateralization Therapy and 370 minutes for patients undergoing Bilateral Lateralization Therapy. | Unilateral: 140 minutes (2 hours and 20 minutes) Bilateral: 370 minutes (6 hours and 10 minutes) |
| Airway Resistance (cmH₂O/L/s) | Airway resistance will be measured using ventilator-derived parameters to evaluate airflow resistance during mechanical ventilation across different body angulations and lateralization strategies. Calculated as the difference between peak inspiratory pressure (Ppeak) and plateau pressure (Pplat) divided by inspiratory flow, according to the formula: Airway Resistance = (Ppeak - Pplat) / Inspiratory Flow Data will be expressed in: cmH₂O (centimeters of water). Measurements will be performed during the first and last 5 minutes of each body angulation. Unilateral: 140 minutes | Bilateral: 370 minutes. Following the sequence: Semi-seated 30°/20 minutes, Supine 0°/5 minutes, 15°/20 minutes, 30°/20 minutes, 15°/20 minutes, Supine 0°/5 minutes, and Semi-seated 30°/20 minutes, totaling 70 minutes per sequence plus 60 minutes of washout between sequences. This results in 140 minutes for patients undergoing Unilateral Lateralization Therapy and 370 minutes for patients undergoing Bilateral | Unilateral: 140 minutes (2 hours and 20 minutes) Bilateral: 370 minutes (6 hours and 10 minutes) |
| Arterial pH | Arterial pH measured from arterial blood gas (ABG) analysis at predefined time points: baseline (prior to the first intervention), immediately after completion of Sequence 1, and immediately after completion of Sequence 2. Unit: pH units. | Baseline; immediately after Sequence 1; immediately after Sequence 2. Unit: pH units. |
| Partial pressure of oxygen (PaO₂) | Arterial PaO₂ measured via arterial blood gas at baseline, immediately after Sequence 1, and immediately after Sequence 2. Values obtained from arterial blood samples analyzed by standard blood gas analyzer. Unit: mmHg. | Baseline; immediately after Sequence 1; immediately after Sequence 2. |
| Partial pressure of carbon dioxide (PaCO₂) | Arterial PaCO₂ measured via arterial blood gas at baseline, immediately after Sequence 1, and immediately after Sequence 2. Unit: mmHg. | Baseline; immediately after Sequence 1; immediately after Sequence 2. |
| Bicarbonate (HCO₃-) | Arterial bicarbonate (HCO₃-) concentration obtained from arterial blood gas analysis at baseline, immediately after Sequence 1, and immediately after Sequence 2. Unit: mEq/L. | Baseline; immediately after Sequence 1; immediately after Sequence 2. |
| Lactate | Arterial lactate concentration obtained from arterial blood gas or arterial blood sample at baseline, immediately after Sequence 1, and immediately after Sequence 2. Unit: mmol/L. | Baseline; immediately after Sequence 1; immediately after Sequence 2. |
| Base Excess (BE) | Base excess determined from arterial blood gas analysis at baseline, immediately after Sequence 1, and immediately after Sequence 2. Unit: mEq/L. | Baseline; immediately after Sequence 1; immediately after Sequence 2. |
| PaO₂/FiO₂ ratio | PaO₂/FiO₂ ratio calculated from arterial PaO₂ and the fraction of inspired oxygen (FiO₂) at baseline, immediately after Sequence 1, and immediately after Sequence 2. FiO₂ will be recorded at the time of each arterial blood gas sampling. Ratio (unitless). | Baseline; immediately after Sequence 1; immediately after Sequence 2. |
| Pulmonary Severity - LUS Score (Lung Ultrasound Score) | Pulmonary severity will be assessed using lung ultrasound (LUS), quantified by the Lung Ultrasound Score (LUS Score). Assessments will occur at three predefined time points: baseline (prior to the first intervention), immediately after the completion of Sequence 1, and immediately after the completion of Sequence 2. Pulmonary aeration will be classified according to standardized LUS Score criteria Mongodi, Silvia et al. Anesthesiology, 2021. Score 0: Normal lung pattern; up to two isolated B-lines. Score 1: Up to four B-lines, indicating mild loss of aeration. Score 2: More than four B-lines or confluent B-lines, indicating moderate loss of aeration. Score 3: Consolidations with coarse artifacts and pleural irregularities, indicating severe loss of aeration. Outcome Units: Ordinal scale (0 to 3 per region) and total summed score. | Baseline, immediately after Sequence 1, and immediately after Sequence 2. |
| Hemodynamic Instability Events | Number of hemodynamic instability episodes defined by sustained Mean Arterial Pressure (MAP) < 60 mmHg or > 120 mmHg, each lasting more than 10 minutes, recorded throughout the intervention period. Unit: Number of events | At any time during the intervention and immediately after completion. |
| Psychomotor Agitation - Richmond Agitation-Sedation Scale (RASS Score) | Psychomotor agitation or sedation will be assessed using the Richmond Agitation-Sedation Scale (RASS) during each predefined body position and angulation throughout the therapy sequence. The RASS score ranges from -5 (unarousable) to +4 (combative), with higher positive scores indicating greater agitation and more negative scores indicating deeper levels of sedation. During each body position and angulation within the intervention sequence, assessed at the end of each positioning period, including: Semi-seated 30° (20 minutes) Supine 0° (5 minutes) Lateralization 15° (20 minutes) Lateralization 30° (20 minutes) Lateralization 15° (20 minutes) Supine 0° (5 minutes) Semi-seated 30° (20 minutes), for a total of 70 minutes per sequence, with a 60-minute washout period between sequences. | Unilateral: 140 minutes (2 hour 20 minutes) | Bilateral: 370 min (6 hour 10 minutes) |
| Oxygenation and Hypoxemia Events (SpO₂ Monitoring + Hypoxemia Criteria) | Continuous monitoring of peripheral oxygen saturation (SpO₂) during each therapy session. Any episode meeting one or more of the following hypoxemia criteria will be recorded:
All events will be documented throughout the intervention. Unit: Number of events. | Continuous monitoring; events recorded at any time during the intervention. |
| Unplanned Removal of Devices | Occurrence of unplanned removal of tubes or catheters during therapy (e.g., endotracheal tube, feeding tube, urinary catheter). Unit: Number of events. | During the intervention. |
| Serious Adverse Events | Occurrence of pneumothorax, cardiopulmonary arrest, or any event requiring emergency interruption or modification of therapy. Unit: Number of events. | During the intervention. |
| Baseline (pre-intervention). |
| Study Director |
| 37592166 | Background | Chen H, Liang M, He Y, Teboul JL, Sun Q, Xie J, Yang Y, Qiu H, Liu L. Inspiratory effort impacts the accuracy of pulse pressure variations for fluid responsiveness prediction in mechanically ventilated patients with spontaneous breathing activity: a prospective cohort study. Ann Intensive Care. 2023 Aug 17;13(1):72. doi: 10.1186/s13613-023-01167-0. |
| 37104255 | Background | Silva Junior EFFD, Campos SL, Leite WS, Melo PVS, Lins RAC, Araujo MDGR, Guerino MR. Surface electromyography signal processing and evaluation on respiratory muscles of critically ill patients: A systematic review. PLoS One. 2023 Apr 27;18(4):e0284911. doi: 10.1371/journal.pone.0284911. eCollection 2023. |
| 41166369 | Background | Costa LSP, Reinaux CMA, Junior EFFS, Leite WS, Brandao DC, de Andrade AD, Roldan R, Morais CCA, Campos SL. Physiology of body lateralization on regional lung ventilation and lung volumes in healthy subjects: Within-subjects design. PLoS One. 2025 Oct 30;20(10):e0335622. doi: 10.1371/journal.pone.0335622. eCollection 2025. |
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| Background | ROSA, Jéssica dos Santos Pereira et al. Impacts in the Respiratory Mechanics of the Ventilator Hyperinsuflation in the Flow Bias Concept: a Narrative Review. Journal of Health Sciences, v. 21, n. 3, p. 250-254, 2019. |
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| 38696429 | Background | Kubota S, Hashimoto H, Yoshikawa Y, Hiwatashi K, Ono T, Mochizuki M, Naraba H, Nakano H, Takahashi Y, Sonoo T, Nakamura K. Effects of mechanical insufflation-exsufflation on ventilator-free days in intensive care unit subjects with sputum retention; a randomized clinical trial. PLoS One. 2024 May 2;19(5):e0302239. doi: 10.1371/journal.pone.0302239. eCollection 2024. |
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| 38127779 | Background | Franchineau G, Jonkman AH, Piquilloud L, Yoshida T, Costa E, Roze H, Camporota L, Piraino T, Spinelli E, Combes A, Alcala GC, Amato M, Mauri T, Frerichs I, Brochard LJ, Schmidt M. Electrical Impedance Tomography to Monitor Hypoxemic Respiratory Failure. Am J Respir Crit Care Med. 2024 Mar 15;209(6):670-682. doi: 10.1164/rccm.202306-1118CI. |
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The Multicare: Bed for Protocol is used to standardize therapeutic positioning, ensuring precision and safety in evaluating the postural effects on lung aeration and respiratory drive |