Document Detail


Effects of manual rib cage compressions on expiratory flow and mucus clearance during mechanical ventilation.
MedLine Citation:
PMID:  23314585     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: We investigated the effects of two different types of manual rib cage compression on expiratory flow and mucus clearance during prolonged mechanical ventilation in pigs.
DESIGN: Prospective randomized animal study.
SETTING: Animal research facility, University of Barcelona, Spain.
SUBJECTS: Nine healthy pigs.
MEASUREMENT AND MAIN RESULTS: Pigs were tracheally intubated, sedated, paralyzed, and mechanically ventilated. The animals were prone on a surgical bed in the anti-Trendelenburg position. The experiments were carried out at approximately 60 and 80 hrs from the beginning of mechanical ventilation. Two types of manual rib cage compressions were tested: Hard and brief rib cage compressions synchronized with early expiratory phase (hard manual rib cage compression) and soft and gradual rib cage compressions applied during the late expiratory phase (soft manual rib cage compression). The interventions were randomly applied for 15min with a 15-min interval between treatments. Respiratory flow and mucus movement were assessed during the interventions. Respiratory mechanics and hemodynamics were assessed prior to and after the interventions. Peak expiratory flow increased to 60.1±7.1L/min in comparison to 51.2±4.6L/min without treatment (p < 0.0015) and 48.7±4.3L/min with soft manual rib cage compression (p = 0.0002). Similarly, mean expiratory flow increased to 28.4±5.2L/min during hard manual rib cage compression vs. 15.9±2.2 and 16.6±2.8L/min without treatment and soft manual rib cage compression, respectively (p = 0.0006). During hard manual rib cage compression, mucus moved toward the glottis (1.01 ± 2.37mm/min); conversely, mucus moved toward the lungs during no treatment and soft manual rib cage compression, -0.28 ± 0.61 and -0.15±0.95mm/min, respectively (p = 0.0283). Soft manual rib cage compression slightly worsened static lung elastance and cardiac output (p = 0.0391).
CONCLUSIONS: Hard manual rib cage compression improved mucus clearance in animals positioned in the anti-Trendelenburg position. The technique appeared to be safe. Conversely, soft manual rib cage compression was not effective and potentially unsafe. These findings corroborate the predominant role of peak expiratory flow on mucus clearance.
Authors:
Joan Daniel Martí; Gianluigi Li Bassi; Montserrat Rigol; Lina Saucedo; Otavio Tavares Ranzani; Mariano Esperatti; Nestor Luque; Miquel Ferrer; Jordi Vilaro; Theodor Kolobow; Antoni Torres
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Critical care medicine     Volume:  41     ISSN:  1530-0293     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-02-21     Completed Date:  2013-04-16     Revised Date:  2013-08-09    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  850-6     Citation Subset:  AIM; IM    
Affiliation:
Pulmonary and Critical Care Unit, Animal Experimentation Division, Thorax Institute, Hospital Clínic, Barcelona, Spain.
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MeSH Terms
Descriptor/Qualifier:
Animals
Chest Wall Oscillation / methods*,  standards
Female
Mucociliary Clearance / physiology*
Outcome Assessment (Health Care)
Peak Expiratory Flow Rate / physiology
Prospective Studies
Pulmonary Ventilation*
Random Allocation
Respiration, Artificial*
Spain
Swine
Comments/Corrections
Comment In:
Crit Care Med. 2013 Mar;41(3):929-30   [PMID:  23425835 ]
Crit Care Med. 2013 Jul;41(7):e135-6   [PMID:  23774359 ]
Crit Care Med. 2013 Jul;41(7):e134-5   [PMID:  23774358 ]

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