Respiratory therapy Archives - Critical Care Science (CCS)
Abstract
Rev Bras Ter Intensiva. 2014;26(4):367-372
DOI 10.5935/0103-507X.20140056
To test the effectiveness of using a cuff pressure relief valve technique to maintain cuff pressure levels within the normal in vitro range (Phase 1) in patients admitted to the intensive care unit (Phase 2) and to test the reproducibility of the technique using different syringes.
In Phase 1, a tracheal tube was inserted into a trachea model. Ten- and 20mL syringes were used to inflate the cuff through the tracheal tube. The cuff was slowly and steadily inflated until the syringe plunger would move in the opposite direction of the application. After the plunger stopped, the cuff pressures were recorded. In Phase 2, the same maneuvers for inflating the cuff were performed on 20 patients using 5, 10, and 20mL syringes and were compared with manometer measurements. The intraclass correlation coefficient and Bland-Altman analysis were employed to determine the reproducibility and agreement between syringes. Data were expressed as medians (interquartile range).
There was no reproducibility between syringes with an intraclass correlation coefficient ranging between -0.33 and 0.8 (p>0.05). The pressures generated with the syringes were higher than the pressures generated using a standard manometer: the 5mL syringe pressure was 105cmH2O (82.5-120cmH2O), the 10mL syringe pressure was 69cmH2O (47.5-111.3cmH2O), and the 20mL syringe pressure was 45cmH2O (35-59.5cmH2O). The Bland-Altman analysis confirmed the large bias and variability between the syringes used, compared with the manometer.
The use of syringes is not an effective technique for determining the cuff pressure in patients admitted to the intensive care unit.
Abstract
Rev Bras Ter Intensiva. 2014;26(4):367-372
DOI 10.5935/0103-507X.20140056
To test the effectiveness of using a cuff pressure relief valve technique to maintain cuff pressure levels within the normal in vitro range (Phase 1) in patients admitted to the intensive care unit (Phase 2) and to test the reproducibility of the technique using different syringes.
In Phase 1, a tracheal tube was inserted into a trachea model. Ten- and 20mL syringes were used to inflate the cuff through the tracheal tube. The cuff was slowly and steadily inflated until the syringe plunger would move in the opposite direction of the application. After the plunger stopped, the cuff pressures were recorded. In Phase 2, the same maneuvers for inflating the cuff were performed on 20 patients using 5, 10, and 20mL syringes and were compared with manometer measurements. The intraclass correlation coefficient and Bland-Altman analysis were employed to determine the reproducibility and agreement between syringes. Data were expressed as medians (interquartile range).
There was no reproducibility between syringes with an intraclass correlation coefficient ranging between -0.33 and 0.8 (p>0.05). The pressures generated with the syringes were higher than the pressures generated using a standard manometer: the 5mL syringe pressure was 105cmH2O (82.5-120cmH2O), the 10mL syringe pressure was 69cmH2O (47.5-111.3cmH2O), and the 20mL syringe pressure was 45cmH2O (35-59.5cmH2O). The Bland-Altman analysis confirmed the large bias and variability between the syringes used, compared with the manometer.
The use of syringes is not an effective technique for determining the cuff pressure in patients admitted to the intensive care unit.
Abstract
Rev Bras Ter Intensiva. 2012;24(2):119-129
DOI 10.1590/S0103-507X2012000200005
Developing guidelines for the role of the physiotherapist in neonatal and pediatric intensive care units is essential because these professionals are responsible for the rehabilitation of critically ill patients. Rehabilitation includes the evaluation and prevention of functional kinetic alterations, application of treatment interventions (respiratory and/or motor physiotherapy), control and application of medical gases, care of mechanical ventilation, weaning and extubation, tracheal gas insufflation, inflation/deflation of the endotracheal cuff protocol, and surfactant application, aiming to allow patients to have a full recovery and return to their functional activities. In this article, we present guidelines that are intended to guide the physiotherapist in some of the prevention/treatment interventions in respiratory therapy (airway clearance, lung expansion, position in bed, airway suction, drug inhalation, and cough assist), which help in the rehabilitation process of newborns and children in intensive care units during mechanical ventilation and up to 12 hours following extubation.
Abstract
Rev Bras Ter Intensiva. 2012;24(2):119-129
DOI 10.1590/S0103-507X2012000200005
Developing guidelines for the role of the physiotherapist in neonatal and pediatric intensive care units is essential because these professionals are responsible for the rehabilitation of critically ill patients. Rehabilitation includes the evaluation and prevention of functional kinetic alterations, application of treatment interventions (respiratory and/or motor physiotherapy), control and application of medical gases, care of mechanical ventilation, weaning and extubation, tracheal gas insufflation, inflation/deflation of the endotracheal cuff protocol, and surfactant application, aiming to allow patients to have a full recovery and return to their functional activities. In this article, we present guidelines that are intended to guide the physiotherapist in some of the prevention/treatment interventions in respiratory therapy (airway clearance, lung expansion, position in bed, airway suction, drug inhalation, and cough assist), which help in the rehabilitation process of newborns and children in intensive care units during mechanical ventilation and up to 12 hours following extubation.
Abstract
Rev Bras Ter Intensiva. 2012;24(1):58-63
DOI 10.1590/S0103-507X2012000100009
OBJECTIVE: Mechanical ventilation is associated with retained airway secretions. Manually assisted cough contributes to the displacement of bronchial mucus, whereas positive end-expiratory pressure increases collateral ventilation and maintains airway patency. This study aimed to assess the effects of manually assisted cough, either alone or added to increased positive end-expiratory pressure and inspiratory time (optimized manually assisted cough), on the expiratory peak flow and respiratory system mechanics in mechanically ventilated patients. METHODS: In this controlled and randomized clinical trial, respiratory mechanics and expiratory peak flow were assessed in male and female patients undergoing either tracheal suctioning alone, manually assisted cough followed by tracheal suctioning or optimized manually assisted cough followed by tracheal suctioning. RESULTS: Thirty-five patients completed the trial. Respiratory system resistance was significantly reduced after optimized manually assisted cough (16.0 ± 3.6 versus 12.4 ± 3.1 cmH2O/L/s; p = 0.04). The expiratory peak flow during optimized manually assisted cough was significantly higher in comparison with the values observed during manually assisted cough (112.3 ± 15.6 versus 95.8 ± 18.3 Lpm; p < 0.05). Both values were significantly higher than the values observed in the group undergoing tracheal suctioning alone (52.0 ± 7.6 Lpm; p < 0.001). CONCLUSION: Optimized manually assisted cough increases the expiratory peak flow in comparison with manually assisted cough; in addition, this procedure reduces respiratory system resistance.
Abstract
Rev Bras Ter Intensiva. 2012;24(1):58-63
DOI 10.1590/S0103-507X2012000100009
OBJECTIVE: Mechanical ventilation is associated with retained airway secretions. Manually assisted cough contributes to the displacement of bronchial mucus, whereas positive end-expiratory pressure increases collateral ventilation and maintains airway patency. This study aimed to assess the effects of manually assisted cough, either alone or added to increased positive end-expiratory pressure and inspiratory time (optimized manually assisted cough), on the expiratory peak flow and respiratory system mechanics in mechanically ventilated patients. METHODS: In this controlled and randomized clinical trial, respiratory mechanics and expiratory peak flow were assessed in male and female patients undergoing either tracheal suctioning alone, manually assisted cough followed by tracheal suctioning or optimized manually assisted cough followed by tracheal suctioning. RESULTS: Thirty-five patients completed the trial. Respiratory system resistance was significantly reduced after optimized manually assisted cough (16.0 ± 3.6 versus 12.4 ± 3.1 cmH2O/L/s; p = 0.04). The expiratory peak flow during optimized manually assisted cough was significantly higher in comparison with the values observed during manually assisted cough (112.3 ± 15.6 versus 95.8 ± 18.3 Lpm; p < 0.05). Both values were significantly higher than the values observed in the group undergoing tracheal suctioning alone (52.0 ± 7.6 Lpm; p < 0.001). CONCLUSION: Optimized manually assisted cough increases the expiratory peak flow in comparison with manually assisted cough; in addition, this procedure reduces respiratory system resistance.
Abstract
Rev Bras Ter Intensiva. 2010;22(2):186-191
DOI 10.1590/S0103-507X2010000200013
OBJECTIVES: To evaluate the applicability of the bag squeezing and zeep maneuvers in mechanically ventilated patients. METHODS: Twenty stable mechanically ventilated patients were studied. All patients were randomly allocated to either bag squeezing techinique followed by zeep maneuver, or the reversed sequence. Each group crossed to the other sequence four hours later. Heart rate, respiratory rate, peripheral oxygen saturation and blood pressure were measured before, during and after each technique use. The suctioned secretions were collected and measured. The data were analyzed by pairwise statistical analysis for inter-group comparisons, and ANOVA for each group results analysis. RESULTS: The heart rate was significantly increased, from 92.6 ± 18.3 bpm to 99.8 ± 18.5 bpm and the peripheral oxygen saturation significantly decreased from 96.9 ± 3.0% to 94.5 ± 4.3% during the bag squeezing maneuver, although the values remained within the normal range. No significant changes were seen for the zeep maneuver. Peripheral oxygen saturation during the maneuvers was found to change when the techniques were compared. No differences were found for the suctionedsecretions amounts. CONCLUSION: The results suggest that both techniques are feasible as they cause few hemodynamic changes, and both are effective for bronchial secretions removal.
Abstract
Rev Bras Ter Intensiva. 2010;22(2):186-191
DOI 10.1590/S0103-507X2010000200013
OBJECTIVES: To evaluate the applicability of the bag squeezing and zeep maneuvers in mechanically ventilated patients. METHODS: Twenty stable mechanically ventilated patients were studied. All patients were randomly allocated to either bag squeezing techinique followed by zeep maneuver, or the reversed sequence. Each group crossed to the other sequence four hours later. Heart rate, respiratory rate, peripheral oxygen saturation and blood pressure were measured before, during and after each technique use. The suctioned secretions were collected and measured. The data were analyzed by pairwise statistical analysis for inter-group comparisons, and ANOVA for each group results analysis. RESULTS: The heart rate was significantly increased, from 92.6 ± 18.3 bpm to 99.8 ± 18.5 bpm and the peripheral oxygen saturation significantly decreased from 96.9 ± 3.0% to 94.5 ± 4.3% during the bag squeezing maneuver, although the values remained within the normal range. No significant changes were seen for the zeep maneuver. Peripheral oxygen saturation during the maneuvers was found to change when the techniques were compared. No differences were found for the suctionedsecretions amounts. CONCLUSION: The results suggest that both techniques are feasible as they cause few hemodynamic changes, and both are effective for bronchial secretions removal.
Abstract
Rev Bras Ter Intensiva. 2010;22(1):40-46
DOI 10.1590/S0103-507X2010000100008
OBJECTIVE: To verify the effects of manual hyperinflation maneuver associated with positive end expiratory pressure in coronary artery bypass grafting patients. METHODS: This was a randomized trial, conducted from August 2007 to July 2008 in the intensive care unit of the Hospital Luterano (ULBRA). The patients were divided in the groups intervention - with manual hyperinflation plus positive end expiratory pressure - and controlThe ventilatory variables were measured before and after the manual hyperinflation. The t Student's test was used for independent and paired samples as well as Fisher's exact test and McNemar's Chi-square test with 0.05 significance level. RESULTS: Eighteen patients were included. The mean age was 64± 11 years and 55.6% were female. The inspired tidal volume was 594± 112ml in the intervention group and 487± 51ml in the control group (p=0.024) and the expired tidal volume was 598± 105ml in the intervention group and 490± 58ml in the control group (p=0.02). The mean pre-maneuver static pulmonary compliance in the intervention group was 41.6± 12.1 ml/cmH2O and post maneuver it was 47.4± 16.6 ml/cmH2O (p=0.03). There was no significant between groups difference in the following variables: oxygen peripheral saturation, oxygen arterial pressure, extubation time and radiological changes. CONCLUSION: The results show that the manual hyperinflation associated with positive end expiratory pressure maneuver trends to promote increased lung volumes and static compliance, however these findings require further confirmation.
Abstract
Rev Bras Ter Intensiva. 2010;22(1):40-46
DOI 10.1590/S0103-507X2010000100008
OBJECTIVE: To verify the effects of manual hyperinflation maneuver associated with positive end expiratory pressure in coronary artery bypass grafting patients. METHODS: This was a randomized trial, conducted from August 2007 to July 2008 in the intensive care unit of the Hospital Luterano (ULBRA). The patients were divided in the groups intervention - with manual hyperinflation plus positive end expiratory pressure - and controlThe ventilatory variables were measured before and after the manual hyperinflation. The t Student's test was used for independent and paired samples as well as Fisher's exact test and McNemar's Chi-square test with 0.05 significance level. RESULTS: Eighteen patients were included. The mean age was 64± 11 years and 55.6% were female. The inspired tidal volume was 594± 112ml in the intervention group and 487± 51ml in the control group (p=0.024) and the expired tidal volume was 598± 105ml in the intervention group and 490± 58ml in the control group (p=0.02). The mean pre-maneuver static pulmonary compliance in the intervention group was 41.6± 12.1 ml/cmH2O and post maneuver it was 47.4± 16.6 ml/cmH2O (p=0.03). There was no significant between groups difference in the following variables: oxygen peripheral saturation, oxygen arterial pressure, extubation time and radiological changes. CONCLUSION: The results show that the manual hyperinflation associated with positive end expiratory pressure maneuver trends to promote increased lung volumes and static compliance, however these findings require further confirmation.
Abstract
Rev Bras Ter Intensiva. 2009;21(2):155-161
DOI 10.1590/S0103-507X2009000200007
OBJECTIVES: Patients unable to perform breathing functions may be submitted to invasive mechanical ventilation. Chest physiotherapy acts directly on the treatment of these patients for the purpose of improving their lung function. The objective of this study was to evaluate the effects of manual rib-cage compression versus the positive end expiratory pressure-zero end expiratory pressure (PEEP-ZEEP) maneuver, on compliance of the respiratory system and oxygenation in patients under invasive mechanical ventilation. METHODS: A double centric, prospective, randomized and crossover study, with patients under invasive mechanical ventilation, in controlled mode for more than 48 hours was carried out. The protocols of chest physiothe-rapy were randomly applied at an interval of 24 hours. Data of respiratory system compliance and oxygenation were collected before application of the protocols and 30 minutes after. RESULTS: Twelve patients completed the study. Intragroup analysis, for both techniques showed a statistically significant difference in tidal volume (p=0.002), static compliance (p=0.002) and dynamic compliance (p=0.002). In relation to oxygenation, in the group of manual rib-cage compression, peripheral oxygen saturation increased with a significant difference (p=0.011). CONCLUSIONS: Manual rib-cage compression and PEEP-ZEEP maneuver have positive clinical effects. In relation to oxygenation we found a favorable behavior of peripheral oxygen saturation in the group of manual rib-cage compression.
Abstract
Rev Bras Ter Intensiva. 2009;21(2):155-161
DOI 10.1590/S0103-507X2009000200007
OBJECTIVES: Patients unable to perform breathing functions may be submitted to invasive mechanical ventilation. Chest physiotherapy acts directly on the treatment of these patients for the purpose of improving their lung function. The objective of this study was to evaluate the effects of manual rib-cage compression versus the positive end expiratory pressure-zero end expiratory pressure (PEEP-ZEEP) maneuver, on compliance of the respiratory system and oxygenation in patients under invasive mechanical ventilation. METHODS: A double centric, prospective, randomized and crossover study, with patients under invasive mechanical ventilation, in controlled mode for more than 48 hours was carried out. The protocols of chest physiothe-rapy were randomly applied at an interval of 24 hours. Data of respiratory system compliance and oxygenation were collected before application of the protocols and 30 minutes after. RESULTS: Twelve patients completed the study. Intragroup analysis, for both techniques showed a statistically significant difference in tidal volume (p=0.002), static compliance (p=0.002) and dynamic compliance (p=0.002). In relation to oxygenation, in the group of manual rib-cage compression, peripheral oxygen saturation increased with a significant difference (p=0.011). CONCLUSIONS: Manual rib-cage compression and PEEP-ZEEP maneuver have positive clinical effects. In relation to oxygenation we found a favorable behavior of peripheral oxygen saturation in the group of manual rib-cage compression.
Abstract
Rev Bras Ter Intensiva. 2008;20(4):339-343
DOI 10.1590/S0103-507X2008000400004
OBJECTIVE: After brain injury intracranial hypertension is the major cause of mortality, in addition to the possibility of functional, behavioral and cognitive sequels. Scarcity of studies on the effects of respiratory physiotherapy on these patients may lead to contradictory performances. This study aimed to assess the effects of customary respiratory physiotherapy maneuvers on intracranial and cerebral perfusion pressures in patients with severe brain injury. METHODS: Clinical, prospective trial with patients with severe traumatic brain injury, mechanically ventilated and with a continued measurement of intracranial pressure. The effects of manual vibrocompression maneuvers and intratracheal aspiration with or without saline infusion on the measurements of intracranial and cerebral perfusion pressures, between the first and third day after cerebral injury were evaluated. RESULTS: Data were collected from 11 patients, 41 years of age (median) and APACHE II of 19.5 ± 5. The manual vibrocompression maneuver did not cause an increase of intracranial pressure on any of the days assessed. Intracranial pressure significantly increased after intratracheal aspiration maneuvers in relation to the basal measurement (day1, 9.5 ± 0.9 mm Hg vs 18.0 ± 3.2 mm Hg; day 2, 10.6 ± 1.7 mm Hg vs 21.4 ± 3.8 mm Hg; day 3, 14.4 ± 1.0 vs 24.9 ± 2.7 mm Hg; p<0.05 for all). However, these elevations were transient (about 27 seconds) and accompanied by compensatory increases of the cerebral perfusion pressure. CONCLUSION: The manual vibrocompression maneuver did not increase intracranial pressure or cerebral perfusion pressure in patients with severe brain injury. Intratracheal aspiration induced a significant and transient increase of the intracranial and cerebral perfusion pressures.
Abstract
Rev Bras Ter Intensiva. 2008;20(4):339-343
DOI 10.1590/S0103-507X2008000400004
OBJECTIVE: After brain injury intracranial hypertension is the major cause of mortality, in addition to the possibility of functional, behavioral and cognitive sequels. Scarcity of studies on the effects of respiratory physiotherapy on these patients may lead to contradictory performances. This study aimed to assess the effects of customary respiratory physiotherapy maneuvers on intracranial and cerebral perfusion pressures in patients with severe brain injury. METHODS: Clinical, prospective trial with patients with severe traumatic brain injury, mechanically ventilated and with a continued measurement of intracranial pressure. The effects of manual vibrocompression maneuvers and intratracheal aspiration with or without saline infusion on the measurements of intracranial and cerebral perfusion pressures, between the first and third day after cerebral injury were evaluated. RESULTS: Data were collected from 11 patients, 41 years of age (median) and APACHE II of 19.5 ± 5. The manual vibrocompression maneuver did not cause an increase of intracranial pressure on any of the days assessed. Intracranial pressure significantly increased after intratracheal aspiration maneuvers in relation to the basal measurement (day1, 9.5 ± 0.9 mm Hg vs 18.0 ± 3.2 mm Hg; day 2, 10.6 ± 1.7 mm Hg vs 21.4 ± 3.8 mm Hg; day 3, 14.4 ± 1.0 vs 24.9 ± 2.7 mm Hg; p<0.05 for all). However, these elevations were transient (about 27 seconds) and accompanied by compensatory increases of the cerebral perfusion pressure. CONCLUSION: The manual vibrocompression maneuver did not increase intracranial pressure or cerebral perfusion pressure in patients with severe brain injury. Intratracheal aspiration induced a significant and transient increase of the intracranial and cerebral perfusion pressures.
