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Updated: Aug 15, 2026

Preoxygenation Techniques for Tracheal Intubation in Critically Ill Adults Utilizing Oxygen Mask and Noninvasive Ventilation
Published on: December 5, 2025
Effects of expiratory rib-cage compression on oxygenation, ventilation, and airway-secretion removal in patients
Takeshi Unoki1, Yuri Kawasaki, Taro Mizutani
1Emergency and Critical Care Center, St Luke's International Hospital, Tokyo, Japan. utake@yj8.so-net.ne.jp
Background:
Expiratory rib-cage compression, a chest physiotherapy technique, is well known as the "squeezing" technique in Japan.
Objective:
To determine the effects of rib-cage compression on airway-secretion removal, oxygenation, and ventilation in patients receiving mechanical ventilation.
Setting:
An intensive care unit of an emergency and critical care center at a tertiary-care teaching hospital in Tokyo, Japan.
Methods:
Thirty-one intubated, mechanically ventilated patients in an intensive care unit were studied in a randomized, crossover trial. The patients received endotracheal suctioning with or without rib-cage compression, with a minimum 3-hour interval between the 2 interventions. Rib-cage compression was performed for 5 min before endotracheal suctioning. Arterial blood gas and respiratory mechanics were measured 5 min before endotracheal suctioning (baseline) and 25 min after suctioning. The 2 measurement periods were carried out on the same day.
Results:
There were no significant differences in the ratio of arterial partial pressure of oxygen to fraction of inspired oxygen, P(aCO2), or dynamic compliance of the respiratory system between the 2 periods (before and after endotracheal suctioning). Moreover, there were no significant differences in airway-secretion removal between the 2 periods.
Conclusions:
This study suggests that rib-cage compression prior to endotracheal suctioning does not improve airway-secretion removal, oxygenation, or ventilation after endotracheal suctioning in this unselected population of mechanically ventilated patients.
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