Increasing pressure support does not enhance secretion clearance if applied during manual chest wall vibration in intubated patients: a randomised trial.

QUESTIONS: What is the effect of increasing pressure support during the application of manual chest wall compression with vibrations for secretion clearance in intubated patients in intensive care? DESIGN: A randomised trial with concealed allocation, assessor blinding and intention-to-treat analysis. PARTICIPANTS: 66 patients receiving mechanical ventilation for greater than 48 hours. INTERVENTION: All participants were positioned supine in bed with the backrest elevated 30 degrees. The experimental group received manual chest wall compression with vibrations during which their pressure support ventilation was increased by 10 cm H(2)O over its existing level. The control group received manual chest wall compression with vibrations but no adjustment of the ventilator settings. Both groups then received airway suction. OUTCOME MEASURES: The primary outcome was the weight of the aspirate. Secondary outcomes were pulmonary and haemodynamic measures and oxygenation. RESULTS: Although both treatments increased the weight of the aspirate compared to baseline, the addition of increased pressure support during manual chest wall compression with vibrations did not significantly increase the clearance of secretions, mean between-group difference in weight of the aspirate 0.4 g, 95% CI -0.5 to 1.4. Although several other measures also improved in one or both groups with treatment, there were no significant differences between the groups for any of the secondary outcomes. CONCLUSION: Although increasing pressure support has previously been shown to increase secretion clearance in intubated patients, the current study did not show any benefits when it was added to chest wall compression with vibrations. TRIAL REGISTRATION: NCT01155648.

Mobilização do paciente crítico em ventilação mecânica: relato de caso / Mobilization of the critically ill patient in mechanical ventilation

A polineuropatia do paciente crítico (PNPC) é uma patologia relativamente comum no ambiente de terapia intensiva e ocasiona aumento do tempo de internação e de ventilação mecânica. Uma das causas relacionadas a essa patologia é a imobilização do paciente. O caso relatado é de um paciente de 18 anos, desnutrido, usuário de crack e com vírus da imunodeficiência humana e tuberculose pulmonar e intestinal. O paciente apresentou insuficiência respiratória necessitando de ventilação mecânica (VM) prolongada e PNPC associada. A fisioterapia com mobilização do paciente mesmo em uso de VM parece ter sido fundamental para a melhora da recuperação funcional associada à adequada nutrição e o tratamento das patologias apresentadas pelo paciente.

Polyneuropathy of critically ill patients, a relatively common condition in intensive care settings, increases length of hospitalization and mechanical ventilation. This disease is associated with patient immobilization. This report describes the case of an 18-year-old malnourished crack user and HIV-positive patient that had intestinal and pulmonary tuberculosis. The patient developed respiratory failure, which required prolonged mechanical ventilation, and polyneuropathy. Physical therapy with mobilization of the patient even while receiving mechanical ventilation, together with appropriate nutrition and treatment of the diseases, was instrumental in improving functional recovery.