title: Manual hyperinflation combined with expiratory rib cage compression for reduction of length of ICU stay in critically ill patients on mechanical ventilation.
abstract: OBJECTIVE
  Although manual hyperinflation (MH) is widely used for pulmonary secretion clearance, there is no evidence to support its routine use in clinical practice. Our objective was to evaluate the effect that MH combined with expiratory rib cage compression (ERCC) has on the length of ICU stay and duration of mechanical ventilation (MV).
  
  
  METHODS
  This was a prospective randomized controlled clinical trial involving ICU patients on MV at a tertiary care teaching hospital between January of 2004 and January of 2005. Among the 49 patients who met the study criteria, 24 and 25 were randomly assigned to the respiratory physiotherapy (RP) and control groups, respectively. Of those same patients, 6 and 8, respectively, were later withdrawn from the study. During the 5-day observation period, the RP patients received MH combined with ERCC, whereas the control patients received standard nursing care.
  
  
  RESULTS
  The two groups were similar in terms of the baseline characteristics. The intervention had a positive effect on the duration of MV, as well as on the ICU discharge rate and Murray score. There were significant differences between the control and RP groups regarding the weaning success rate on days 2 (0.0% vs. 37.5%), 3 (0.0% vs. 37.5%), 4 (5.3% vs. 37.5%), and 5 (15.9% vs. 37.5%), as well as regarding the ICU discharge rate on days 3 (0% vs. 25%), 4 (0% vs. 31%), and 5 (0% vs. 31%). In the RP group, there was a significant improvement in the Murray score on day 5.
  
  
  CONCLUSIONS
  Our results show that the use of MH combined with ERCC for 5 days accelerated the weaning process and ICU discharge.
authors.affiliation: Hospital das Clínicas de Botucatu, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil.
authors.forename: Juliana Savini Wey
authors.initials: JS
authors.lastname: Berti
authors.forename: Elisiane
authors.initials: E
authors.lastname: Tonon
authors.forename: Carlos Fernando
authors.initials: CF
authors.lastname: Ronchi
authors.forename: Heloisa Wey
authors.initials: HW
authors.lastname: Berti
authors.forename: Laércio Martins de
authors.initials: LM
authors.lastname: Stefano
authors.forename: Ana Lúcia
authors.initials: AL
authors.lastname: Gut
authors.forename: Carlos Roberto
authors.initials: CR
authors.lastname: Padovani
authors.forename: Ana Lucia Anjos
authors.initials: AL
authors.lastname: Ferreira
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D045853:Exhalation; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000592:standards*; D012138:Respiratory Therapy / Q000379:methods* / Q000592:standards; D017678:Sex Distribution; D016896:Treatment Outcome; D055815:Young Adult