Lung Recruitment During Chest Physiotherapy in Mechanically Ventilated Patients
Trial statusRecruiting
Trial phaseNot applicable
Trial typeInterventional
Biological sexAll
Age18-100
SponsorAssistance Publique - Hôpitaux de Paris
About this trial
In intensive care, respiratory physiotherapy is an integral part of the daily care of patients under invasive mechanical ventilation. Its goals are to improve the clearance of bronchial secretions to allow for the resolution of atelectasis and alveolar recruitment, thereby enhancing respiratory mechanics and gas exchange. The most widespread technique in France is external expiratory compression of the chest.
The effectiveness of this technique depends on the selection of patients (it seems to be more effective in patients with higher secretion levels) and on the practical implementation of the technique (favoring brief and vigorous compressions at the beginning of expiration). However, the effect of the artificial ventilator settings, particularly the ventilatory mode used during the respiratory physiotherapy session, has never been evaluated. The two most commonly used ventilatory modes worldwide are Volume Assist Control Ventilation (V-ACV) and pressure support ventilation (PSV). In this unit, respiratory physiotherapy under artificial ventilation is performed daily on patients with artificial ventilation with abundant secretions, regardless of the ventilatory mode.
Eligibility criteria
This trial does not accept healthy volunteersQualifiers
Patient under assisted ventilation (in V-ACV or PSV) triggering all ventilator cycles
Patient deemed " secretive ": requiring ≥ 2 tracheal aspirations every 3 hours
Patient (or relative) who has given consent to participate in the research
Patient covered by social security
Disqualifiers
Age under 18 years
Legal guardian required
Recent cardiac and/or thoracic and/or abdominal surgery (< 3 months)
Rib fracture(s)
Trial design
Design model
Crossover
Treatments tested in this trial
Chest Physiotherapy by Rib Cage Compressions (RCC)
Other interventionBimanual Rib Cage Compressions (RCC) applied to the thorax only, with patients in a standardized position (supine with the head of the bed elevated to 35 degrees). The intervention is standardized in terms of the direction of force (posterior and downward) and the characteristics of the compression (brief and vigorous compressions at the beginning of expiration).
Treatment groups
40 Participants
are divided into 2 treatment groupsGroup A: RCC applied in V-ACVOther 1 intervention
Group B: RCC applied in PSOther 1 intervention
Trial outcomes
Primary outcomes
1
Comparison of ΔEELV (after-before) Induced by an RCC Session Performed in V-ACV and PSV
the variation in end-expiratory lung volume (ΔEELV), which refers to the change in the volume of air in the lungs at the end of expiration. This is measured by comparing the end-expiratory lung volume 5 minutes before and 5 minutes after the respiratory physiotherapy session. The ΔEELV is measured in milliliters using the E-sCOVX module of the CARESCAPE R860 ventilator, which employs the nitrogen wash-in/wash-out technique.
Time frame
EELV is mesured 5 minutes before, 5 minutes after and 1 hour after each physiotherapy session (morning & afternoon).2
Variation in FiO2 During the Session
the variation in FiO2 (fraction of inspired oxygen) during the physiotherapy session. FiO2 refers to the percentage of oxygen delivered to the patient through the ventilator. This variation is tracked to assess any changes in the oxygen concentration during the session. The FiO2 variation is expressed as a percentage, with a typical variation of +10% during the procedure, measured using the CARESCAPE R860 ventilator.
Time frame
FiO2 variation is during the physiotherapy session and up to 5 minutes after the session.Secondary outcomes
1
Measurement of Airflow in the Ventilator Circuit During Respiratory Physiotherapy Sessions
A pneumotachograph, which measures the flow of air entering and exiting the ventilator circuit, is used for this assessment. The airflow is recorded in liters per minute and provides insight into the volume of air being ventilated during the session. This data is collected using the MP150 Pneumotachograph
Time frame
during and up to 5 minutes after each physiotherapy session2
mucus volume measurement
A mucus collection trap (Cair, LGL) is positioned on the suction line, and the volume of the extracted mucus is precisely measured using a syringe. The volume is recorded in milliliters to assess the amount of mucus cleared during the respiratory physiotherapy session.
Time frame
measured after each physiotherapy session.3
Assessment of gas exchange.
Arterial blood gases are performed only if the patient has an arterial catheter
Time frame
5 minutes before and 5 minutes after each physiotherapy session4
Assessment of regional lung ventilation distribution.
Electrical Impedance Tomography (EIT) Pulmovista 500® (Dräger) with the dedicated belt.
Time frame
5 minutes before, during and 5 minutes after each physiotherapy session.Sponsors and contacts
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Source ClinicalTrials.gov