Immediate and long-term effects of manual chest compression and decompression maneuver on patients receiving invasive mechanical ventilation.

Abstract

It has been reported that the manual chest compression and decompression (MCCD) maneuver can increase lung volume in patients receiving invasive mechanical ventilation (IMV), but some important questions related to this maneuver require answers: how long the effects of MCCD on lung volume remain, and whether there are effects on other respiratory and hemodynamic variables. Patients receiving IMV support in an intensive care unit (ICU) with signs of hypoventilation, hypoexpansion, or atelectasis were eligible to receive the MCCD maneuver. Immediately before the maneuver, respiratory and hemodynamic parameters were collected. Then, 20MCCD maneuvers were performed while measured the same parameters. After 10min, all parameters were measured again. The primary outcome was the tidal volume (Vt ) during the MCCD maneuver and after 10min compared to the previous Vt . Of the 255 patients who were mechanically ventilated in the study period, 105 patients composed the final cohort. The MCCD increased inspiratory tidal volume (iVt ), expiratory tidal volume (eVt ), and chest dynamic compliance (Cdyn ) during the application of the maneuver, but after 10min, these parameters returned to their basal levels. The MCCD maneuver did not change the peak pressure, respiratory rate, peripheral oxygen saturation (SpO2 ), heart rate, or blood pressure. There was no difference in increased iVt in patients with sedation, respiratory comorbidity, or obesity. Further, there was no association between the iVt response to the MCCD and the admission diagnosis, and no correlation with the ICU length of stay, IMV duration, or APACHE II score. We concluded that MCCD increased iVt , eVt , and Cdyn during the application of the maneuver, but this effect was not observed after 10min. Randomized controlled trials should be performed in the future to investigate the mechanism involved in increasing Vt and the possible impact of the MCCD maneuver on ICU outcomes.