Effects of Manual Rib Cage Compressions on Mucus Clearance in Mechanically Ventilated Pigs
Effects of Manual Rib Cage Compressions on Mucus Clearance in Mechanically Ventilated Pigs
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DOI：
10.4187/respcare.07249
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发表时间：
2020-08-01
期刊：
影响因子：
2.5
通讯作者：
Inoue, Yoshiaki
中科院分区：
文献类型：
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作者：
Ouchi, Akira;Sakuramoto, Hideaki;Inoue, Yoshiaki
背景：手法肋骨加压是临床上常规使用的胸部理疗技术。然而，关于人工肋骨加压对机械通气患者的呼吸道清除和氧合的影响的科学证据仍然很少。方法：麻醉猪经气管插管，机械通气。为了造成肺不张，人工粘液被注入呼吸道。将每头猪随机分为两组：单纯密闭吸引组(对照组，7头)或手法加压加密闭吸引组(手法加压组，8头)。测试与呼气早期同步的硬而短暂的肋骨压缩。干预后评估粘液清除和氧合情况。观察干预后血流动力学的动态变化。结果：在硬手法肋间加压时，平均+/-SD呼气峰流量由治疗前的31+/-7 L/min增加到44+/-7 L/min(P<；.001)。与闭式吸痰相比，手动肋骨加压联合气管内吸引术增加了粘液清除(粘液量，5.5[3.4-9.4]g比0.7[0.5-2.0]g；P=0.004)；然而，它并没有改善气体交换和放射学表现。两组患者的血流动力学指标无显著差异。结论：我们的研究结果表明，硬而短暂的手动肋骨加压结合闭式吸引术是安全的，并能改善粘液清除，但在氧合和换气方面并未证实有效。
BACKGROUND: Manual rib cage compression is a chest physiotherapy technique routinely used in clinical practice. However, scientific evidence remains scarce on the effects of manual rib cage compression on airway clearance and oxygenation in mechanically ventilated patients. METHODS: Anesthetized pigs were intubated via the trachea and mechanically ventilated. To create atelectasis, artificial mucus was infused into the airway. Each pig was randomly assigned to 1 of 2 groups: closed suctioning alone (control group, 7 pigs), or manual rib cage compression combined with closed suctioning (manual rib cage compression group, 8 pigs). Hard and brief rib cage compression synchronized with early expiratory phase was tested. Mucus clearance and oxygenation were assessed after the intervention. Sequential changes of hemodynamics were assessed after the intervention. RESULTS: During hard manual rib cage compression, the mean +/- SD peak expiratory flow increased to 44 +/- 7 L/min compared with 31 +/- 7 L/min without treatment (P < .001). Manual rib cage compression combined with endotracheal suctioning increased mucus clearance compared with closed suctioning alone (mucus amounts, 5.5 [3.4-9.4] g vs 0.7 [0.5-2.0] g; P = .004); however, it did not improve gas exchange and radiologic findings. There were no significant differences in hemodynamic variables between the 2 groups. CONCLUSIONS: Our findings indicated that hard and brief manual rib cage compression combined with closed suctioning was safe and led to improvement of mucus clearance; however, no effectiveness was confirmed with regard to oxygenation and ventilation.