title: The effect of expiratory rib cage compression before endotracheal suctioning on the vital signs in patients under mechanical ventilation.
abstract: BACKGROUND
  In patients undergoing mechanical ventilation, mucus production and secretion is high as a result of the endotracheal tube. Because endotracheal suction in these patients is essential, chest physiotherapy techniques such as expiratory rib cage compression before endotracheal suctioning can be used as a means to facilitate mobilizing and removing airway secretion and improving alveolar ventilation. As one of the complications of mechanical ventilation and endotracheal suctioning is decrease of cardiac output, this study was carried out to determine the effect of expiratory rib cage compression before endotracheal suctioning on the vital signs in patients under mechanical ventilation.
  
  
  METHODS
  This study was a randomized clinical trial with a crossover design. The study subjects included 50 mechanically ventilated patients, hospitalized in intensive care wards of Valiasr and Mousavi hospitals in Zanjan, Iran. Subjects were selected by consecutive sampling and randomly allocated to groups 1 and 2. The patients received endotracheal suctioning with or without rib cage compression, with a minimum of 3 h interval between the two interventions. Expiratory rib cage compression was performed for 5 min before endotracheal suctioning. Vital signs were measured 5 min before and 15 and 25 min after endotracheal suctioning. Data were recorded on a data recording sheet. Data were analyzed using paired t-tests.
  
  
  RESULTS
  There were statistically significant differences in the means of vital signs measured 5 min before with 15 and 25 min after endotracheal suctioning with rib cage compression (P < 0. 01). There was no significant difference in the means of diastolic pressure measured 25 min after with baseline in this stage). But on the reverse mode, there was a significant difference between the means of pulse and respiratory rate 15 min after endotracheal suctioning and the baseline values (P < 0.002). This effect continued up to 25 min after endotracheal suctioning just for respiratory rate (P = 0.016). Moreover, there were statistically significant differences in the means of vital signs measured 5 min before and 15 min after endotracheal suctioning between the two methods (P ≤ 0001).
  
  
  CONCLUSIONS
  Findings showed that expiratory rib cage compression before endotracheal suctioning improves the vital signs to normal range in patients under mechanical ventilation. More studies are suggested on performing expiratory rib cage compression before endotracheal suctioning in patients undergoing mechanical ventilation.
authors.affiliation: Department of Nursing and Midwifery, Faculty of Zanjan University of Medical Sciences and Health Services, Zanjan, Iran.
authors.forename: Mitra Payami
authors.initials: MP
authors.lastname: Bousarri
authors.affiliation: Mousavi Hospital, Zanjan University of Medical Sciences and Health Services, Zanjan, Iran.
authors.forename: Yadolah
authors.initials: Y
authors.lastname: Shirvani
authors.affiliation: Mousavi Hospital, Zanjan University of Medical Sciences and Health Services, Zanjan, Iran.
authors.forename: Saeed
authors.initials: S
authors.lastname: Agha-Hassan-Kashani
authors.affiliation: Department of Statistics, School of Medicine, Zanjan University of Medical Sciences and Health Services, Zanjan, Iran.
authors.forename: Nouredin Mousavi
authors.initials: NM
authors.lastname: Nasab
keywords: Endotracheal suctioning; expiratory rib cage compression; mechanical ventilation; vital signs