Respiratory therapy for removing bronchial secretions in mechanically ventilated adult patients

The effects of regional anesthesia combined with awake delayed extubation in patients undergoing esophageal cancer surgery: a single-blind randomized controlled trial

“…In recent years, the MIE has been the most popular surgical procedure for the treatment of esophageal cancer, which can signi cantly reduce the surgical trauma pulmonary complications [13,14]. Despite improved perioperative management, the morbidity and mortality rates are still the highest after esophagectomy among all solid tumor surgeries.…”

“…Though secretions in the proximal large airways are accessible to suctioning, airways beyond the 3rd generation are beyond the suction catheter's reach [32]. Quintana et al reported that respiratory physiotherapy, consisting of a set of techniques for mobilizing and eliminating pulmonary secretions, could minimize pulmonary complications in mechanically ventilated patients [13]. In our study, we adopted the respiratory physiotherapy technique during the awake period, in order to eliminate the secretions produced during the surgery.…”

“…At the end of the operation, 5 mL of 2% lidocaine was instilled through the endotracheal tube, and drain the air in the balloon at the same time, letting the local anesthetic distribute around the balloon, then the balloon was re-in ated. After the patient was fully awake, respiratory physiotherapy techniques that consist of lateral rotation, manual lung hyperin ation, tapotement and aspiration, were applied [13]. Let the patient in right tilt position associated with manually tapotement to facilitate the mobilization and drainage of the secretions away from the bottom of pulmonary, using the force of gravity.…”

“…Strategies aiming to maintain lung recruitment in the postanesthesia care unit, ICU or surgical ward may independently improve postoperative outcomes and be at least as valuable as intraoperative lung expansion interventions. Respiratory physiotherapy, consisting of a set of techniques for mobilizing and eliminating pulmonary secretions, could minimize pulmonary complications in mechanically ventilated patients [11][12][13]. However, few studies have analyzed the effectiveness of respiratory physiotherapy during extubation in prevention of hypoxemia for MIE patients.…”