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Arriagada R, Bachmann MC, San Martin C, Rauseo M, Battaglini D. Electrical impedance tomography: Usefulness for respiratory physiotherapy in critical illnesses. Med Intensiva 2024; 48:403-410. [PMID: 38538496 DOI: 10.1016/j.medine.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 02/26/2024] [Indexed: 07/05/2024]
Abstract
Respiratory physiotherapy, including the management of invasive mechanical ventilation (MV) and noninvasive mechanical ventilation (NIV), is a key supportive intervention for critically ill patients. MV has potential for inducing ventilator-induced lung injury (VILI) as well as long-term complications related to prolonged bed rest, such as post-intensive care syndrome and intensive care unit acquired weakness. Physical and respiratory therapy, developed by the critical care team, in a timely manner, has been shown to prevent these complications. In this pathway, real-time bedside monitoring of changes in pulmonary aeration and alveolar gas distribution associated with postural positioning, respiratory physiotherapy techniques and changes in MV strategies can be crucial in guiding these procedures, providing safe therapy and prevention of potential harm to the patient. Along this path, electrical impedance tomography (EIT) has emerged as a new key non-invasive bedside strategy free of radiation, to allow visualization of lung recruitment. This review article presents the main and potential applications of EIT in relation to physiotherapy techniques in the ICU setting.
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Affiliation(s)
- Ricardo Arriagada
- Unidad de Paciente Crítico Adulto, Hospital Las Higueras de Talcahuano, Chile; Escuela de Kinesiología Universidad San Sebastián, Sede Tres Pascualas, Concepción, Chile; Unidad de Paciente Crìtico, Clìnica Biobìo, Hualpén, Chile
| | - María Consuelo Bachmann
- Unidad de Paciente Crítico Adulto, Hospital Clínico Pontificia Universidad Católica de Chile, Escuela de Kinesiología, Universidad de Los Andes, Santiago, Chile
| | - Constanza San Martin
- Unidad de Paciente Crítico Adulto, Hospital Las Higueras de Talcahuano, Chile; Escuela de Kinesiología Universidad San Sebastián, Sede Tres Pascualas, Concepción, Chile
| | - Michela Rauseo
- Anesthesia and Intensive Care Medicine, University of Foggia, Policlinico Riuniti di Foggia, Foggia, Italy
| | - Denise Battaglini
- Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genova, Italy.
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Zhang J, Wang X, Xie J, Shen L, Mo G, Xie L. Effects of THE PEEP-ZEEP Maneuver in Adults Receiving Mechanical Ventilation: A Systematic Review with Meta-Analysis. Heart Lung 2024; 63:159-166. [PMID: 37922664 DOI: 10.1016/j.hrtlng.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/31/2023] [Accepted: 10/15/2023] [Indexed: 11/07/2023]
Abstract
INTRODUCTION It is important to clarify the secretion clearance and lung-related effects of the PEEP-ZEEP maneuver in adults undergoing mechanical ventilation (MV). There is no published comprehensive meta-analysis of the effects of PEEP-ZEEP in adults receiving MV. OBJECTIVES The aim of this study was to analyze published randomized controlled trials, investigating the effects of the PEEP-ZEEP maneuver in adults undergoing mechanical ventilation. METHODS We searched Embase, PubMed, Cochrane Central Register of Controlled Trials, Scopus, and Web of Science from the date of inception of the databases until 6 May 2023. Quality assessment was using the Cochrane Systematic Assessment Handbook. The GRADE system was used to grade the quality of the evidence. RESULTS A total of 12 trials were included, and the results of the meta-analysis showed that PEEP-ZEEP was not superior to bag squeezing for the removal of bronchial secretions. One study showed a significant increase in the amount of secretion retrieved with the PEEP-ZEEP when compared with tracheal suctioning. Additionally, PEEP-ZEEP was more effective than bag squeezing at improving oxygen saturation. However, one trial showed that bag squeezing was better at improving dynamic compliance. No other differences were found between PEEP-ZEEP and other techniques, except for one study showing more frequent changes in diastolic blood pressure with PEEP-ZEEP compared with ventilator hyperinflation. CONCLUSION PEEP-ZEEP was not superior to bag squeezing in removing bronchial secretions. However, it improves oxygen saturation when compared to bag squeezing, and no adverse effects on patients' respiratory systems have yet been observed.
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Affiliation(s)
- Junhong Zhang
- Department of Respiratory and Critical Care Medicine, The Eighth Medical Center of PLA General Hospital, Beijing, China
| | - Xuling Wang
- Department of Neurology, The Eighth Medical Center of PLA General Hospital, Beijing, China
| | - Jinfeng Xie
- Department of Geriatrics, The Eighth Medical Center of PLA General Hospital, Beijing, China
| | - Li Shen
- Ruifang Medical Technology (Suzhou) Co, China
| | - Guoxin Mo
- Department of Respiratory and Critical Care Medicine, The Eighth Medical Center of PLA General Hospital, Beijing, China
| | - Lixin Xie
- Department of Respiratory and Critical Care Medicine, The Eighth Medical Center of PLA General Hospital, Beijing, China.
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Volpe MS, Dias LMS, Leite CF, Annoni R, Paro FM, Oliveira ACO, Accioly M, Guimaraes FS. Chest physiotherapy techniques administered by certified specialists to hospitalized patients with COVID-19 in Brazil: A look towards future practice. Heart Lung 2023; 62:87-94. [PMID: 37354583 PMCID: PMC10258579 DOI: 10.1016/j.hrtlng.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/15/2023] [Accepted: 06/06/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Chest physiotherapy for hospitalized patients with COVID-19 has been poorly reported. Although recommendations were published to guide physiotherapists, practice might have differed depending on education and training. OBJECTIVE To analyze the differences in chest physiotherapy applied for hospitalized patients with COVID-19 between certified specialists and non-certified specialists. METHODS An online questionnaire survey was developed for physiotherapists involved in the management of hospitalized patients with COVID-19. The questionnaire inquired about professional information and characteristics of physiotherapy practice. RESULTS There were 485 respondents, yielding a completion rate of 76%. Of these, 61 were certified specialists and 424 non-certified specialists. The certified specialists were older, had more years of professional experience, were more qualified, and had better job conditions. For mechanically ventilated patients, the certified specialists used the ventilator hyperinflation maneuver more frequently (50.4% vs 35.1%, p = 0.005), and the hard/brief expiratory rib cage compression (ERCC) (26.9% vs 48.3%, p = 0.016), soft/long ERCC (25.2% vs 39.1%, p = 0.047), and manual chest compression-decompression (MCCD) maneuver (22.4% vs 35.6%, p = 0.001) less often. For spontaneously breathing patients, the certified specialists used the active cycle of breathing technique (30.8% vs 67.1%, p<0.001), autogenic drainage (7.7% vs 20.7%, p = 0.017), and MCCD maneuver (23.1% vs 41.4%, p = 0.018) less frequently. CONCLUSIONS Certified specialists with higher levels of expertise seem to prefer the use of chest physiotherapy techniques that are applied with the mechanical ventilator over manual techniques. Furthermore, they use techniques that could potentially increase the work of breathing less frequently, mitigating the risk of exacerbating respiratory conditions in patients with COVID-19.
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Affiliation(s)
- Marcia Souza Volpe
- Interdisciplinary Postgraduate Program in Health Sciences, Universidade Federal de São Paulo - UNIFESP - Campus Baixada Santista. Rua Silva Jardim, 136, CEP 11015-020, Santos, SP, Brazil; Department of Sciences of Human Movement, Universidade Federal de São Paulo -UNIFESP - Campus Baixada Santista, Rua Silva Jardim, 136, CEP 11015-020, Santos, São Paulo, Brazil.
| | - Letícia Marcelino Sotelo Dias
- Interdisciplinary Postgraduate Program in Health Sciences, Universidade Federal de São Paulo - UNIFESP - Campus Baixada Santista. Rua Silva Jardim, 136, CEP 11015-020, Santos, SP, Brazil
| | - Camila Ferreira Leite
- Master Program in Physiotherapy and Functioning, Universidade Federal do Ceara - UFC, Graduate Program in Cardiovascular Sciences, UFC. Rua Coronel Nunes de Melo, 1127, 1 andar, Rodolfo Teófilo, Campus Porangabussu, CEP: 60. 430-275, Fortaleza, CE, Brazil
| | - Raquel Annoni
- Laboratory for Functional Investigation of Cardiopulmonary and Metabolic Systems, Department of Applied Physiotherapy. Universidade Federal do Triângulo Mineiro - UFTM. Rua Frei Paulino, 30, CEP, 38025-180, Uberaba, MG, Brazil
| | - Flavia Marini Paro
- Department of Integrated Health Education, Universidade Federal do Espírito Santos-UFES - Centro de Ciências da Saúde. Av. Mal. Campos, 1468, CEP, 29043-900, Vitoria, Espírito Santo, Brazil
| | - Ana Carolina Otoni Oliveira
- Master's Program in Cardiorespiratory Physiotherapy. Universidade Federal do Triângulo Mineiro, UFTM. Rua Frei Paulino, 30, CEP, 38025-180, Uberaba-MG, Brazil
| | - Marilita Accioly
- Laboratory for Functional Investigation of Cardiopulmonary and Metabolic Systems, Department of Applied Physiotherapy. Universidade Federal do Triângulo Mineiro - UFTM. Rua Frei Paulino, 30, CEP, 38025-180, Uberaba, MG, Brazil; Master's Program in Cardiorespiratory Physiotherapy. Universidade Federal do Triângulo Mineiro, UFTM. Rua Frei Paulino, 30, CEP, 38025-180, Uberaba-MG, Brazil
| | - Fernando Silva Guimaraes
- Department of Cardiorespiratory and Musculoskeletal Physiotherapy, Faculty of Physiotherapy, Universidade Federal do Rio de Janeiro - UFRJ. Rua Prof. Rodolpho Paulo Rocco, 255, oitavo andar, sala 3 - Cidade Universitária da UFRJ, CEP 21941-617, Rio de Janeiro, RJ, Brazil
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Rodrigues-Gomes RM, Lage Cendón L, Martínez Rolán R, Gelabert-González M. Respiratory physiotherapy as a tool to allow and optimize lung donation. Respir Med Case Rep 2023; 46:101917. [PMID: 37860584 PMCID: PMC10582771 DOI: 10.1016/j.rmcr.2023.101917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 08/18/2023] [Accepted: 09/25/2023] [Indexed: 10/21/2023] Open
Abstract
Lung donation is complex and sometimes the secretion retention makes it impossible. We report a case of a patient that was screened as potential lung donor with PaO2/FiO2 ratio below range. As in viable patients, the respiratory physiotherapist applied a ventilator-based group of techniques with removal of huge amount of secretions and consequent increase in the PaO2/FiO2 ratio that allowed the inclusion of the patient as potentially lung donor. The protocol was applied until the extraction day, with successful extraction and transplantation. We believe that respiratory physiotherapy could have a potential role in increasing lung viability.
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Affiliation(s)
- Ricardo Miguel Rodrigues-Gomes
- Facultade Medicina, Universidade de Santiago de Compostela, Santiago Compostela, Spain
- Hospital Álvaro Cunqueiro, Vigo, Spain
| | | | - Rosa Martínez Rolán
- Facultade Medicina, Universidade de Santiago de Compostela, Santiago Compostela, Spain
- Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Miguel Gelabert-González
- Facultade Medicina, Universidade de Santiago de Compostela, Santiago Compostela, Spain
- Centro Hospitalario Santiago de Compostela, Santiago de Compostela, Spain
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de Oliveira TF, Peringer VS, Forgiarini Junior LA, Eibel B. PEEP-ZEEP Compared with Bag Squeezing and Chest Compression in Mechanically Ventilated Cardiac Patients: Randomized Crossover Clinical Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2824. [PMID: 36833521 PMCID: PMC9957294 DOI: 10.3390/ijerph20042824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/28/2023] [Accepted: 02/03/2023] [Indexed: 06/18/2023]
Abstract
Background and Objectives: Perform the bag squeezing and PEEP-ZEEP techniques associated with manual chest compression in mechanically ventilated cardiac patients in order to observe their effectiveness in the removal of pulmonary secretions and safety from a hemodynamic and ventilatory point of view. Methods: This is a randomized crossover clinical trial developed in a hospital in southern Brazil. We included hemodynamically stable male and female patients aged over 18 years who used invasive mechanical ventilation for at least 48 h. The control group was established for the bag-squeezing technique and the intervention group for the PEEP-ZEEP maneuver, both associated with manual chest compression. Tracheal aspiration was performed 2 h before in order to match the groups in relation to the volume of secretion, and also immediately at the end of the techniques in order to measure the amount of secretion collected. Results: The sample had 36 individuals with a mean age of 70.3 years, 21% of the patients were male, and the majority (10.4%) were hospitalized for ischemic heart disease. DBP (p = 0.024), MAP (p = 0.004) and RR (p = 0.041) showed a significant difference in the post-moment in both groups. There was a significant difference in the reduction of peak pressure values (p = 0.011), in the moment after performing the techniques, and also in the Cdyn (p = 0.004) in the control group versus moment. Conclusions: Both maneuvers are safe in terms of hemodynamics and ventilatory mechanics, in addition to being capable of favoring airway clearance through secretion removal, and they can be used in routine physiotherapeutic care.
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Affiliation(s)
- Taís Flores de Oliveira
- Instituto de Cardiologia, Fundação Universitária de Cardiologia (IC/FUC), 395 Princesa Isabel Avenue, Porto Alegre 90620-001, Brazil
| | - Vinicius Serra Peringer
- Instituto de Cardiologia, Fundação Universitária de Cardiologia (IC/FUC), 395 Princesa Isabel Avenue, Porto Alegre 90620-001, Brazil
| | | | - Bruna Eibel
- Instituto de Cardiologia, Fundação Universitária de Cardiologia (IC/FUC), 395 Princesa Isabel Avenue, Porto Alegre 90620-001, Brazil
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Fernandes Junior F, Pinheiro LB, Nascimento MS, Prado CD. Management of an infant with epidermolysis bullosa on invasive mechanical ventilation. REVISTA PAULISTA DE PEDIATRIA 2022. [PMCID: PMC8280762 DOI: 10.1590/1984-0462/2022/40/2020290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective: To describe, for the first time in the pediatric population, the use of an effective technique to mobilize secretion in a patient whose disease imposes many care limitations. Case description: 2-year-old infant with Epidermolysis Bullosa, dependent on mechanical ventilation after cardiorespiratory arrest. Infant evolved with atelectasis in the right upper lobe with restriction to all manual secretion mobilization techniques due to the risk of worsening skin lesions. We opted for tracheal aspiration in a closed system combined with expiratory pause, a technique only described in adult patients so far. Comments: This case report is the first to use this technique in a pediatric patient. The use of expiratory pause combined with tracheal aspiration not only optimized the mobilization of secretion, but it was also a safe tool for reversing atelectasis. Our case report brings an important result because it increases the possibilities of managing pediatric patients admitted to intensive care units, especially in situations of absolute contraindication for chest maneuvers.
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Value of Peak Expiratory Flow Rate in Evaluating Cough Ability in Patients Undergoing Lung Surgery. Can Respir J 2021; 2021:5888783. [PMID: 34956429 PMCID: PMC8695022 DOI: 10.1155/2021/5888783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/12/2021] [Accepted: 12/01/2021] [Indexed: 02/05/2023] Open
Abstract
Introduction Postoperative ineffective cough is easy to occur after thoracic surgery, and it is also a risk factor for postoperative pulmonary complications (PPCs). Objectives To explore the value of peak expiratory flow rate (PEF) in evaluating cough ability in patients undergoing lung surgery and evaluate the effectiveness of chest wall compression during the expiratory phase by PEF. Methods From September 2020 to May 2021, the researchers collected the data of patients who underwent lung surgery. Eventually, 153 patients who met the criteria were included, 102 cases were included in the effective cough group and 51 cases were included in the ineffective cough group. The receiver working curve (ROC curve) was used to analyze whether PEF could evaluate cough ability. At the same time, the researchers collected the pulmonary function data of the first 30 patients of the ineffective cough group while compressing the chest wall during the expiratory phase to evaluate the effectiveness of chest wall compression. Results The area under the curve (AUC) of postoperative PEF to evaluate the postoperative cough ability was 0.955 (95% CI: 0.927–0.983, P < 0.001). The values of PEF (127.17 ± 34.72 L/min vs. 100.70 ± 29.98 L/min, P < 0.001, 95% CI: 18.34–34.59) and FEV1 (0.72 (0.68–0.97) L vs. 0.64 (0.56–0.82) L, P < 0.001) measured while compressing the chest wall were higher than those without compression. Conclusions PEF can be used as a quantitative indicator of cough ability. Chest wall compression could improve cough ability for patients who have ineffective cough.
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