title: Can the Flutter Valve improve respiratory mechanics and sputum production in mechanically ventilated patients? A randomized crossover trial.
abstract: OBJECTIVE
  The Flutter Valve (Varioraw SARL, Scandipharm Inc, Birmingham, AL) has proven efficacy in hypersecretive spontaneously ventilated patients. This study was designed to evaluate whether an airway clearance protocol using the Flutter Valve can affect the therapeutic and physiologic outcomes in mechanically ventilated patients with pulmonary infection.
  
  
  METHODS
  In a randomized crossover study, sputum production, respiratory mechanics, hemodynamics, and gas exchange were evaluated from 20 mechanically ventilated patients submitted to 2 interventions. FLUTTER intervention consisted of connecting the Flutter Valve to the exhalation port of the mechanical ventilator. Control intervention (CTRL) was normal ventilation in pressure controlled mode.
  
  
  RESULTS
  Compared with CTRL, FLUTTER improved sputum production (P < .001), respiratory system static compliance (P = .02), peak expiratory flow (P = .048), expiratory flow at 75% of tidal volume (P = .005), and arterial PO(2)-to-inspired oxygen concentration ratio (P < .001). Respiratory resistance, heart rate, and mean arterial pressure remained unaltered during the interventions (P > .05).
  
  
  CONCLUSIONS
  The Flutter Valve improves lung secretion removal, mucus production, respiratory mechanics, and arterial oxygenation in mechanically ventilated patients with respiratory infection, without causing clinically relevant hemodynamic repercussions.
authors.affiliation: Aluno do Programa de Pós Graduação em Clínica Médica, Faculdade de Medicina da UFRJ, Brazil.
authors.forename: Luciano M
authors.initials: LM
authors.lastname: Chicayban
authors.forename: Walter A
authors.initials: WA
authors.lastname: Zin
authors.forename: Fernando S
authors.initials: FS
authors.lastname: Guimarães
mesh_terms: D019296:Capnography; D018592:Cross-Over Studies; D005260:Female; D006339:Heart Rate; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D012121:Respiration, Artificial / Q000295:instrumentation*; D015656:Respiratory Mechanics / Q000502:physiology*; D013183:Sputum / Q000378:metabolism / Q000502:physiology*; D013223:Statistics as Topic; D013990:Tidal Volume