Efeitos das manobras de expansão pulmonar comparada a assistência fisioterapêutica padrão na mecânica ventilatória, tempo de ventilação mecânica, hospitalização e mortalidade de indivíduos adultos sob ventilação mecânica: um ensaio clínico controlado e randomizado

Abstract

INTRODUCTION: Pulmonary expansion maneuvers are therapeutic approaches used for reversing and preventing atelectasis, however there is no scientific evidence on the effects of using these techniques. 5OBJECTIVE: To evaluate the effects of lung expansion maneuvers compared to standard care on ventilatory mechanics, duration of mechanical ventilation, oxygenation, hospitalization and mortality of adult individuals receiving mechanical ventilation. METHODS: A randomized clinical trial with adult subjects on mechanical ventilation for 12 to 48 hours. A control group received the standard physiotherapeutic protocol (passive or active movement, maneuvers to increase the expiratory flow and tracheal aspiration) and the intervention group received the same protocol, plus lung expansion maneuvers (bilateral chest compressiondecompression for five minutes and chest block for five minutes in each hemithorax) throughout the period in which they remained on mechanical ventilation. Assessments were performed before and after standard treatment, immediately after the intervention and 30 minutes after the intervention. The primary outcome was static compliance, while secondary outcomes included: dynamic compliance, airway resistance, driving pressure, oxygenation, duration of mechanical ventilation, length of hospital stay, incidence of complications and mortality. Comparison between groups was performed using the t-test for independent samples, Mann-Whitney, Chi-squared and generalized linear models when appropriate. P < 0.05 was considered significant. RESULTS: A total of 51 participants (mean of 67 years of age, 53% men, 26 in the control group and 25 in the intervention group) were evaluated. Dynamic compliance and peripheral oxygen saturation showed differences between groups (intervention minus control) before and after expansion maneuvers (-1.41 ± 0.65 ml/cmH2O, p=0.03; and -1.05 ± 0.48%, p=0.027, respectively).No differences were found between groups for the other outcomes. CONCLUSION: Maneuvers for lung expansion were not effective in promoting improvement in ventilatory mechanics, oxygenation, duration of mechanical ventilation, hospitalization time, and mortality in adult individuals under mechanical ventilation. Although dynamic compliance and saturation showed differences between groups, these differences were not clinically important.