Pulmonary expansion and disobstruction maneuver with a closed system in patients with acute lung injury and acute distress syndrome, and its effect on gas exchange

Introduction

Respiratory physiotherapy is ever more utilized for the treatment of critical patients. However, it is known that there are few studies on the effect on gas exchange in patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) and physiotherapy techniques. The purpose of this study was to assess the effect of a pulmonary expansion and disobstruction maneuver with a closed system on the gas exchange of patients with ALI and ARDS.

Methods

The patients with the diagnosis of ALI and ARDS who met the inclusion criteria were randomized to one of the two groups: those of the intervention group were subjected to a pulmonary expansion and bronchial disobstruction maneuvers, for approximately 10 minutes by the association of the following physiotherapy techniques: sighs, side-lying position, expiratory rib-cage compression and endotracheal suctioning with a closed system and after observed for 10 minutes; the patients of the control group did not receive any treatment, they were only observed for 20 minutes. Ventilatory parameters and arterial blood gases were measured before (Time 1) and 10 minutes after the procedures (Time 2). The analysis of variance test for repeated measurements was used for comparing variables at different times. Results are shown as the mean and standard deviation. The significant level was P < 0.05.

Results

At Time 1, the control group (n = 21) had ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO₂/FiO₂) and partial arterial carbon dioxide pressure (PaCO₂) of 167.7 ± 56.2 and 40.3 ± 10.1, respectively, and the intervention group (n = 19) had PaO₂/FiO₂ of 180.5 ± 67.0 and PaCO₂ of 38.6 ± 10.5. At Time 2, the control group had, respectively, PaO₂/FiO₂ and PaCO₂ of 165.9 ± 63.8 and 38.9 ± 10.3, and the intervention group of 177.2 ± 4.5 and 39.0 ± 10.8. No variable was significantly different between the groups at Time 1 and Time 2 (P > 0.05).

Conclusion

The proposed maneuver was not beneficial for gas exchange in the sample studied.