RecruitingNot ApplicableNCT06805357

Lung Recruitment During Chest Physiotherapy in Mechanically Ventilated Patients

Evaluation of Lung Recruitment During Chest Physiotherapy in Mechanically Ventilated Patients

Sponsor

Assistance Publique - Hôpitaux de Paris

Enrollment

40 participants

Start Date

Jul 23, 2024

Study Type

INTERVENTIONAL

Conditions

Intensive Care

Summary

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

Min Age: 18 YearsMax Age: 100 Years

Inclusion Criteria4

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

Exclusion Criteria12

Age under 18 years
Legal guardian required
Recent cardiac and/or thoracic and/or abdominal surgery (\< 3 months)
Rib fracture(s)
Pneumothorax and/or presence of a chest drain
Recent neurosurgery (\< 3 months) and/or proven or suspected increased intracranial pressure (ICP)
Hemodynamic instability defined as: noradrenaline ≥ 1mg/h, adrenaline ≥ 0.5 mg/h, dobutamine ≥ 5γ/kg/min.
Respiratory instability defined as: PEEP \> 10 cmH2O and/or PaO2/FiO2 \< 150 mm Hg
Pregnancy
Hemoptysis
Sever skin lesions (e.g., burns, Lyell's syndrome)
Patient under foreign health insurance

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Interventions

OTHERChest Physiotherapy by Rib Cage Compressions (RCC)

Bimanual 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).