title: Chest compression with a higher level of pressure support ventilation: effects on secretion removal, hemodynamics, and respiratory mechanics in patients on mechanical ventilation.
abstract: OBJECTIVE
  To determine the efficacy of chest compression accompanied by a 10-cmH2O increase in baseline inspiratory pressure on pressure support ventilation, in comparison with that of aspiration alone, in removing secretions, normalizing hemodynamics, and improving respiratory mechanics in patients on mechanical ventilation.
  
  
  METHODS
  This was a randomized crossover clinical trial involving patients on mechanical ventilation for more than 48 h in the ICU of the Porto Alegre Hospital de Clínicas, in the city of Porto Alegre, Brazil. Patients were randomized to receive aspiration alone (control group) or compression accompanied by a 10-cmH2O increase in baseline inspiratory pressure on pressure support ventilation (intervention group). We measured hemodynamic parameters, respiratory mechanics parameters, and the amount of secretions collected.
  
  
  RESULTS
  We included 34 patients. The mean age was 64.2 ± 14.6 years. In comparison with the control group, the intervention group showed a higher median amount of secretions collected (1.9 g vs. 2.3 g; p = 0.004), a greater increase in mean expiratory tidal volume (16 ± 69 mL vs. 56 ± 69 mL; p = 0.018), and a greater increase in mean dynamic compliance (0.1 ± 4.9 cmH2O vs. 2.8 ± 4.5 cmH2O; p = 0.005).
  
  
  CONCLUSIONS
  In this sample, chest compression accompanied by an increase in pressure support significantly increased the amount of secretions removed, the expiratory tidal volume, and dynamic compliance. (ClinicalTrials.gov Identifier:NCT01155648 [http://www.clinicaltrials.gov/]).
authors.affiliation: Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil, Physiotherapist. Adult ICU, Hospital de Clínicas de Porto Alegre - HCPA, Porto Alegre Hospital de Clínicas - Porto Alegre, Brazil.
authors.forename: Wagner da Silva
authors.initials: Wda S
authors.lastname: Naue
authors.affiliation: Methodist University Center, Porto Alegre Institute, Porto Alegre, Brazil, Professor of Physiotherapy. Methodist University Center, Porto Alegre Institute, Porto Alegre, Brazil.
authors.forename: Luiz Alberto
authors.initials: LA
authors.lastname: Forgiarini Junior
authors.affiliation: Federal University of Rio Grande do Sul, Porto Alegre, Brazil, Professor. Graduate Program in Human Movement Sciences and Respiratory Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Alexandre Simões
authors.initials: AS
authors.lastname: Dias
authors.affiliation: Federal University of Rio Grande do Sul, School of Medicine, Porto Alegre, Brazil, Professor. Federal University of Rio Grande do Sul School of Medicine; and Head. Department of Intensive Care, Hospital de Clínicas de Porto Alegre - HCPA, Porto Alegre Hospital de Clínicas - Porto Alegre, Brazil.
authors.forename: Silvia Regina Rios
authors.initials: SR
authors.lastname: Vieira
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D012121:Respiration, Artificial / Q000379:methods*; D015656:Respiratory Mechanics; D013909:Thorax; D013990:Tidal Volume