Efeitos da compressão torácica manual versus a manobra de PEEP-ZEEP na complacência do sistema respiratório e na oxigenação de pacientes submetidos à ventilação mecânica invasiva

Santos, Flavio Renato Antunes dos; Júnior, Luiz Carlos Schneider; Forgiarini, Luiz Alberto; Veronezi, Jefferson

doi:10.1590/s0103-507x2009000200007

Cited by 22 publications

(28 citation statements)

References 15 publications

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“…The study by Santos et al (13) evaluated SpO 2 , which also remained similar to that of the control group at 30 min post-ERCC. However, in the intragroup analysis, SpO 2 was significantly increased in the ERCC group, rising from 96 % (94 - 98) to 98 % (95 - 100), p = 0.011.…”

Section: Resultsmentioning

confidence: 64%

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Expiratory rib cage compression in mechanically ventilated adults: systematic review with meta-analysis

Borges¹,

Saraiva²,

Saraiva³

et al. 2017

Revista Brasileira De Terapia Intensiva

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ObjectiveTo review the literature on the effects of expiratory rib cage compression on ventilatory mechanics, airway clearance, and oxygen and hemodynamic indices in mechanically ventilated adults.MethodsSystematic review with meta-analysis of randomized clinical trials in the databases MEDLINE (via PubMed), EMBASE, Cochrane CENTRAL, PEDro, and LILACS. Studies on adult patients hospitalized in intensive care units and under mechanical ventilation that analyzed the effects of expiratory rib cage compression with respect to a control group (without expiratory rib cage compression) and evaluated the outcomes static and dynamic compliance, sputum volume, systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, peripheral oxygen saturation, and ratio of arterial oxygen partial pressure to fraction of inspired oxygen were included. Experimental studies with animals and those with incomplete data were excluded.ResultsThe search strategy produced 5,816 studies, of which only three randomized crossover trials were included, totaling 93 patients. With respect to the outcome of heart rate, values were reduced in the expiratory rib cage compression group compared with the control group [-2.81 bpm (95% confidence interval [95%CI]: -4.73 to 0.89; I2: 0%)]. Regarding dynamic compliance, there was no significant difference between groups [-0.58mL/cmH2O (95%CI: -2.98 to 1.82; I2: 1%)]. Regarding the variables systolic blood pressure and diastolic blood pressure, significant differences were found after descriptive evaluation. However, there was no difference between groups regarding the variables secretion volume, static compliance, ratio of arterial oxygen partial pressure to fraction of inspired oxygen, and peripheral oxygen saturation.ConclusionThere is a lack of evidence to support the use of expiratory rib cage compression in routine care, given that the literature on this topic offers low methodological quality and is inconclusive.

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Section: Resultsmentioning

confidence: 64%

“…Additionally, both of these studies (6,13) described patient losses and exclusions in the course of follow-up (Table 3). …”

Section: Resultsmentioning

confidence: 99%

Expiratory rib cage compression in mechanically ventilated adults: systematic review with meta-analysis

Borges¹,

Saraiva²,

Saraiva³

et al. 2017

Revista Brasileira De Terapia Intensiva

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“…The effects of 0 PEEP on lung compliance, 4,28,30 gas exchange, 4,[28][29][30] tidal volume, 30 and hemodynamic repercussions 4,28,29 have also been analyzed. This technique consists of imposing a gradual PEEP increase to 15 cm H 2 O followed by an abrupt PEEP reduction to 0 PEEP in association with a manual bilateral thoracic compression to potentiate the increase of expiratory air flow, limiting the peak pressure to 40 cm H 2 O.…”

Section: Introductionmentioning

confidence: 99%

“…This technique consists of imposing a gradual PEEP increase to 15 cm H 2 O followed by an abrupt PEEP reduction to 0 PEEP in association with a manual bilateral thoracic compression to potentiate the increase of expiratory air flow, limiting the peak pressure to 40 cm H 2 O. 4,[28][29][30] The ventilator hyperinflation with increased volume or with 0 PEEP was similar to manual hyperinflation in terms of the bronchial secretion removal, oxygenation, and with insignificant hemodynamic repercussions. 4,28,29,31 The 0 PEEP technique appears to be safe, without alterations of hemodynamic variables, even in post-cardiac surgery patients.…”

Section: Introductionmentioning

confidence: 99%

Effects of 0 PEEP and < 1.0 F_IO₂ on S_pO₂ and P_ETCO₂ During Open Endotracheal Suctioning

Vianna

Lorenzo

Simões³

et al. 2020

Respir Care

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BACKGROUND: Hyperoxygenation and hyperinflation, preferably with a mechanical ventilator, is the most commonly used technique to prevent the adverse effects of open endotracheal suctioning on arterial oxygenation and pulmonary volume. However, limited data are available on the effects of oxygen concentrations < 100% and PEEP with zero end-expiratory pressure (0 PEEP) to improve oxygenation and to maintain adequate ventilation during open endotracheal suctioning. The aim of this study was to analyze the behavior of S pO 2 and end-tidal CO 2 pressure (P ETCO 2) in open endotracheal suctioning using the 0 PEEP technique with baseline F IO 2 (0 PEEP baseline F IO 2) and 0 PEEP + hyperoxygenation of 20% above the baseline value (0 PEEP F IO 2 + 0.20) in critically ill subjects receiving mechanical ventilation. METHODS: This was a prospective, randomized, single-blind crossover study, for which 48 subjects with various clinical and surgical conditions were selected; of these, 38 subjects completed the study. The subjects were randomized for 2 interventions: 0 PEEP baseline F IO 2 and 0 PEEP F IO 2 + 0.20 during the open endotracheal suctioning procedure. Oxygenation was assessed via oxygen saturation as measured with pulse oximetry (S pO 2), and changes in lung were monitored via P ETCO 2 using volumetric capnography. RESULTS: In the intragroup analysis with 0 PEEP baseline F IO 2 , there was no significant increase after open endotracheal suctioning in either S pO 2 (P 5 .63) or P ETCO 2 (P 5 .11). With 0 PEEP F IO 2 + 0.20, there was a significant increase in S pO 2 (P < .001), with no significant changes in P ETCO 2 (P 5 .55). In the intergroup comparisons, there was a significant increase compared to the basal values only with the 0 PEEP + 0.20 method at 1 min after hyperoxygenation (P < .001), post-immediately (P < .001), at 1 min after (P < .001), and at 2 min after open endotracheal suctioning (P < .001). CONCLUSIONS: The appropriate indication of the hyperinflation strategy via mechanical ventilation using 0 PEEP with or without hyperoxygenation proved to be efficient to maintain S pO 2 and P ETCO 2 levels. These results suggest that the technique can minimize the loss of lung volume due to open endotracheal suctioning. (ClinicalTrials.gov registration NCT02440919).

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“…Based on the idea of increasing expiratory airflow to remove secretion, a technique named PEEP-ZEEP has been previously proposed [6]. This technique consists in imposing a gradual positive end-expiratory pressure on the respiratory system (PEEP) until 15 cmH 2 O followed by an abrupt PEEP reduction to 0 cmH 2 O (ZEEP), in association with a manual bilateral thoracic compression to potentiate the increase of expiratory airflow.…”

Section: Introductionmentioning

confidence: 99%

PEEP-ZEEP technique: cardiorespiratory repercussions in mechanically ventilated patients submitted to a coronary artery bypass graft surgery

Herbst-Rodrigues

Carvalho

Auler

et al. 2011

J Cardiothorac Surg

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BackgroundThe PEEP-ZEEP technique is previously described as a lung inflation through a positive pressure enhancement at the end of expiration (PEEP), followed by rapid lung deflation with an abrupt reduction in the PEEP to 0 cmH2O (ZEEP), associated to a manual bilateral thoracic compression.AimTo analyze PEEP-ZEEP technique's repercussions on the cardio-respiratory system in immediate postoperative artery graft bypass patients.Methods15 patients submitted to a coronary artery bypass graft surgery (CABG) were enrolled prospectively, before, 10 minutes and 30 minutes after the technique. Patients were curarized, intubated, and mechanically ventilated. To perform PEEP-ZEEP technique, saline solution was instilled into their orotracheal tube than the patient was reconnected to the ventilator. Afterwards, the PEEP was increased to 15 cmH2O throughout 5 ventilatory cycles and than the PEEP was rapidly reduced to 0 cmH2O along with manual bilateral thoracic compression. At the end of the procedure, tracheal suction was accomplished.ResultsThe inspiratory peak and plateau pressures increased during the procedure (p < 0.001) compared with other pressures during the assessment periods; however, they were within lung safe limits. The expiratory flow before the procedure were 33 ± 7.87 L/min, increasing significantly during the procedure to 60 ± 6.54 L/min (p < 0.001), diminishing to 35 ± 8.17 L/min at 10 minutes and to 36 ± 8.48 L/min at 30 minutes. Hemodynamic and oxygenation variables were not altered.ConclusionThe PEEP-ZEEP technique seems to be safe, without alterations on hemodynamic variables, produces elevated expiratory flow and seems to be an alternative technique for the removal of bronchial secretions in patients submitted to a CABG.

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Efeitos da compressão torácica manual versus a manobra de PEEP-ZEEP na complacência do sistema respiratório e na oxigenação de pacientes submetidos à ventilação mecânica invasiva

Cited by 22 publications

References 15 publications

Expiratory rib cage compression in mechanically ventilated adults: systematic review with meta-analysis

Expiratory rib cage compression in mechanically ventilated adults: systematic review with meta-analysis

Effects of 0 PEEP and < 1.0 F_IO₂ on S_pO₂ and P_ETCO₂ During Open Endotracheal Suctioning

PEEP-ZEEP technique: cardiorespiratory repercussions in mechanically ventilated patients submitted to a coronary artery bypass graft surgery

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Efeitos da compressão torácica manual versus a manobra de PEEP-ZEEP na complacência do sistema respiratório e na oxigenação de pacientes submetidos à ventilação mecânica invasiva

Cited by 22 publications

References 15 publications

Expiratory rib cage compression in mechanically ventilated adults: systematic review with meta-analysis

Expiratory rib cage compression in mechanically ventilated adults: systematic review with meta-analysis

Effects of 0 PEEP and < 1.0 FIO2 on SpO2 and PETCO2 During Open Endotracheal Suctioning

PEEP-ZEEP technique: cardiorespiratory repercussions in mechanically ventilated patients submitted to a coronary artery bypass graft surgery

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Effects of 0 PEEP and < 1.0 F_IO₂ on S_pO₂ and P_ETCO₂ During Open Endotracheal Suctioning