Chest physiotherapy improves lung aeration in hypersecretive critically ill patients: a pilot randomized...

Area of Science:

• Critical Care Medicine
• Respiratory Physiology
• Pulmonary Engineering

Background:

• Patients on invasive mechanical ventilation (iMV) benefit from chest physiotherapy for mucus removal.
• Limited data exists on oscillating devices for mucus clearance in acute respiratory failure with iMV.
• This study investigates high-frequency chest wall oscillation (HFCWO) and its combination with recruitment maneuvers (RM).

Purpose of the Study:

• Assess HFCWO effects on lung aeration and ventilation distribution using electrical impedance tomography (EIT).
• Evaluate the combined effect of HFCWO and recruitment maneuvers (RM) in patients with acute respiratory failure on iMV.

Main Methods:

• Sixty patients on iMV were divided into normosecretive and hypersecretive groups.
• HFCWO was applied for 10 minutes, with EIT measurements taken at baseline and up to 3 hours post-treatment.
• Patients were randomized to receive RM or not; arterial blood gases (ABGs) were analyzed.

Main Results:

• HFCWO significantly increased end-expiratory lung impedance in hypersecretive patients at 2 and 3 hours post-treatment.
• No significant changes in lung aeration were observed in normosecretive patients.
• Arterial blood gases showed no significant differences between groups.

Conclusions:

• HFCWO improves dorsal lung aeration in hypersecretive patients on iMV without altering ABGs.
• The addition of recruitment maneuvers (RM) did not provide additional benefits.
• HFCWO is a potentially effective adjunct for mucus clearance in select ventilated patients.