Effects of Lung Expansion Therapy on Lung Function in Patients with Prolonged Mechanical Ventilation

Abstract

Common complications in PMV include changes in the airway clearance mechanism, pulmonary function, and respiratory muscle strength, as well as chest radiological changes such as atelectasis. Lung expansion therapy which includes IPPB and PEEP prevents and treats pulmonary atelectasis and improves lung compliance. Our study presented that patients with PMV have improvements in lung volume and oxygenation after receiving IPPB therapy. The combination of IPPB and PEEP therapy also results in increase in respiratory muscle strength. The application of IPPB facilitates the homogeneous gas distribution in the lung and results in recruitment of collapsed alveoli. PEEP therapy may reduce risk of respiratory muscle fatigue by preventing premature airway collapse during expiration. The physiologic effects of IPPB and PEEP may result in enhancement of pulmonary function and thus increase the possibility of successful weaning from mechanical ventilator during weaning process. For patients with PMV who were under the risk of atelectasis, the application of IPPB may be considered as a supplement therapy for the enhancement of weaning outcome during their stay in the hospital.

Efficacy of Physiotherapy Interventions on Weaning in Mechanically Ventilated Critically Ill Patients: A Systematic Review and Meta-Analysis

“…Therefore, the following RCTs were included in the present systematic review: Berti ( 33 ), Cader ( 34 ), Cader ( 42 ), Chen ( 35 ), Dong ( 36 ), Liu and Zhang ( 43 ), Martin ( 37 ), McCaughey ( 38 ), Pattanshetty and Gaude ( 39 ), Pinkaew et al ( 44 ), Sandoval Moreno ( 40 ), and Taniguchi ( 41 ).…”

“…The studies included were published between 2010 ( 39 ) and 2021 ( 36 ) and were conducted in America [United States n: 1 ( 37 ); Brazil n = 4 ( 33 , 34 , 41 , 42 ); Colombia n = 1 ( 40 )], Australia [ n = 1 ( 38 )], and Asia [China n = 2 ( 36 , 43 ), India n = 1 ( 39 ); Taiwan n = 1 ( 35 ); Thailand n = 1 ( 44 )].…”

Prolonged Weaning: S2k Guideline Published by the German Respiratory Society

“…Besides respiratory therapy, special techniques for secretion lysis [542] are also deployed in the secretion management process, such as those using endobronchial or transthoracic oscillatory systems [543-545], or inhalative therapy such as hypertonic saline solution [546]. Secretion elimination can subsequently take place via positioning therapy, huffing, a PEP system [547, 548], manually-assisted cough [549] or use of mechanical coughing aids such as the mechanical insufflator-exsufflator [550-552], which is only indicated for patients with neuromuscular diseases and healthy lungs. However, according to a Cochrane analysis, a limitation of the latter technique is that there is no compelling evidence for the use of mechanical coughing aids in some patient groups including those undergoing weaning from the ventilator [553].…”

Patient-ventilator asynchrony in conventional ventilation modes during short-term mechanical ventilation after cardiac surgery: randomized clinical trial

“…However, the continuity of the inspiratory effort after the opening of the exhalation valve can again activate the triggering, and thus a second cycle is triggered with a short expiratory period between both. As described in the literature [56,57], inadequate tidal volume and inspiratory time are common causes of asynchrony, especially when there is greater autonomy of spontaneous effort. Inspiratory times were similar in patients either ventilated in VCV or PCV modes and it increased when ventilated in PSV mode.…”