Anesthesia and Intensive Care Unit, Department of Medical and Surgical Sciences, University Hospital Mater Domini, Magna Graecia University, Catanzaro, Italy.
Anesthesia and Intensive Care, Sant'Andrea Hospital, ASL VC, Vercelli, Italy.
Crit Care. 2020 Aug 3;24(1):479. doi: 10.1186/s13054-020-03198-6.
Besides airway suctioning, patients undergoing invasive mechanical ventilation (iMV) benefit of different combinations of chest physiotherapy techniques, to improve mucus removal. To date, little is known about the clearance effects of oscillating devices on patients with acute respiratory failure undergoing iMV. This study aimed to assess (1) the effects of high-frequency chest wall oscillation (HFCWO) on lung aeration and ventilation distribution, as assessed by electrical impedance tomography (EIT), and (2) the effect of the association of HFCWO with recruitment manoeuvres (RM).
Sixty critically ill patients, 30 classified as normosecretive and 30 as hypersecretive, who received ≥ 48 h of iMV, underwent HFCWO; patients from both subgroups were randomized to receive RM or not, according to two separated randomization sequences. We therefore obtained four arms of 15 patients each. After baseline record (T0), HFCWO was applied for 10 min. At the end of the treatment (T1) or after 1 (T2) and 3 h (T3), EIT data were recorded. At the beginning of each step, closed tracheobronchial suctioning was performed. In the RM subgroup, tracheobronchial suctioning was followed by application of 30 cmHO to the patient's airway for 30 s. At each step, we assessed the change in end-expiratory lung impedance (ΔEELI) and in tidal impedance variation (ΔTIV), and the center of gravity (COG) through EIT. We also analysed arterial blood gases (ABGs).
ΔTIV and COG did not differ between normosecretive and hypersecretive patients. Compared to T0, ΔEELI significantly increased in hypersecretive patients at T2 and T3, irrespective of the RM; on the contrary, no differences were observed in normosecretive patients. No differences of ABGs were recorded.
In hypersecretive patients, HFCWO significantly improved aeration of the dorsal lung region, without affecting ABGs. The application of RM did not provide any further improvements.
Prospectively registered at the Australian New Zealand Clinical Trial Registry ( www.anzctr.org.au ; number of registration: ACTRN12615001257550; date of registration: 17th November 2015).
除了气道吸引，接受有创机械通气（iMV）的患者还受益于不同组合的胸部物理治疗技术，以改善黏液清除。迄今为止，关于振荡装置对接受 iMV 的急性呼吸衰竭患者的清除效果知之甚少。本研究旨在评估（1）高频胸壁振荡（HFCWO）对肺通气的影响，通过电阻抗断层成像（EIT）评估，以及（2）HFCWO 与募集手法（RM）联合应用的效果。
60 名危重症患者，30 名被分类为正常分泌组，30 名被分类为高分泌组，他们接受了≥48 小时的 iMV，接受了 HFCWO；根据两个独立的随机序列，这两个亚组的患者被随机分为接受或不接受 RM。因此，我们得到了四个组，每组 15 名患者。在基线记录（T0）后，进行了 10 分钟的 HFCWO。在治疗结束时（T1）或 1 小时（T2）和 3 小时（T3）后，记录 EIT 数据。在每个步骤的开始时，进行了支气管内吸引。在 RM 亚组中，支气管内吸引后，向患者气道施加 30 cmHO 持续 30 秒。在每个步骤中，我们通过 EIT 评估呼气末肺阻抗变化（ΔEELI）和潮气量阻抗变化（ΔTIV）以及重心（COG）。我们还分析了动脉血气（ABG）。
正常分泌组和高分泌组患者之间的 ΔTIV 和 COG 没有差异。与 T0 相比，高分泌组患者在 T2 和 T3 时 ΔEELI 显著增加，无论 RM 如何；相反，正常分泌组患者没有观察到差异。ABG 没有差异。
在高分泌患者中，HFCWO 显著改善了背部肺区域的通气，而不影响 ABG。应用 RM 没有提供任何进一步的改善。
前瞻性注册于澳大利亚和新西兰临床试验注册中心（www.anzctr.org.au；注册号：ACTRN12615001257550；注册日期：2015 年 11 月 17 日）。
Zotero 插件