Pulmonary expansion manoeuvres compared to usual care on ventilatory mechanics, oxygenation, length of mechanical ventilation and hospital stay, extubation, atelectasis, and mortality of patients in mechanical ventilation: A randomized clinical trial

PLOS ONE RESEARCH ARTICLE Pulmonary expansion manoeuvres compared to usual care on ventilatory mechanics, oxygenation, length of mechanical ventilation and hospital stay, extubation, atelectasis, and mortality of patients in mechanical ventilation: A randomized clinical trial a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 Karina da Silva1☯, Cristino Carneiro Oliveira ID1☯, Leandro Ferracini Cabral ID2☯, Carla Malaguti1☯, Anderson José ID1☯* 1 Postgraduate Program in Rehabilitation Sciences and Physical Functional Performance, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil, 2 Department of Cardiorespiratory and Musculoskeletal Physiotherapy, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil ☯ These authors contributed equally to this work. * OPEN ACCESS Citation: da Silva K, Oliveira CC, Cabral LF, Malaguti C, José A (2023) Pulmonary expansion manoeuvres compared to usual care on ventilatory mechanics, oxygenation, length of mechanical ventilation and hospital stay, extubation, atelectasis, and mortality of patients in mechanical ventilation: A randomized clinical trial. PLoS ONE 18(12): e0295775. https://doi.org/10.1371/journal. pone.0295775 Editor: Steven E. Wolf, University of Texas Medical Branch at Galveston, UNITED STATES Received: June 19, 2023 Accepted: November 10, 2023 Published: December 11, 2023 Copyright: © 2023 da Silva et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper and its Supporting Information files. Funding: The author(s) received no specific funding for this work. Competing interests: The authors have declared that no competing interests exist. Abstract Pulmonary expansion manoeuvres are therapeutic techniques used to prevent and reverse atelectasis; however, no randomized controlled trials have provided evidence supporting the use of this intervention among individuals on mechanical ventilation. Objective: To evaluate the effects of chest compression-decompression and chest block manoeuvres compared to usual care among patients on mechanical ventilation. Methods: The current study was a randomized clinical trial of adult subjects on mechanical ventilation for 12 to 48 hours. The control group received usual care (passive or active mobilization, manoeuvres for airway clearance and tracheal aspiration). The intervention group received usual care plus two lung expansion manoeuvres, i.e., chest decompression and chest block, while remaining on mechanical ventilation. Assessments were performed before and after usual care, immediately after the intervention and 30 minutes after the intervention. The primary outcome was static compliance. The secondary outcomes were the incidence of atelectasis, dynamic compliance, airway resistance, driving pressure, oxygenation, duration of mechanical ventilation, extubation success, length of hospital and ICU stay, and mortality. Results: Fifty-one participants (67±15 years old, 53% men, 26 in the control group and 25 in the intervention group) were evaluated. No differences in static compliance were observed between groups (intervention minus control) before and after expansion manoeuvres [3.64 ml/cmH2O (95% CI: -0.36–7.65, p = 0.074)]. Peripheral oxygen saturation differed between groups before and after expansion manoeuvres, with more favourable outcome observed in the control group [-1.04% (95% CI: -1.94 –-0.14), p = 0.027]. No differences were found in other outcomes. Conclusion: Chest compression-decompression and chest block manoeuvres did not improve ventilatory mechanics, the incidence of atelectasis, oxygenation, the duration of PLOS ONE | https://doi.org/10.1371/journal.pone.0295775 December 11, 2023 1 / 13 PLOS ONE Pulmonary expansion manoeuvres of patients in mechanical ventilation mechanical ventilation, the length of stay in the ICU and hospital, or mortality in individuals on mechanical ventilation. The findings of this study can be valuable for guiding evidencebased clinical practice and developing a therapeutic approach that provides real benefits for this population. Introduction Atelectasis is a common, noninfectious complication in individuals receiving mechanical ventilation. The occurrence of lung collapse leads to changes in ventilatory mechanics, worsens lung injuries, alters the ventilation/perfusion ratio and causes hypoxemia. Lung collapse is also associated with a greater risk of respiratory infections and readmission to or a longer stay in the intensive care unit [1–3]. In this context, lung expansion strategies are adopted to reverse or prevent atelectasis and avoid these complications; these strategies promote an increase in lung volumes by increasing the transpulmonary pressure gradient, which can be caused by an increase in alveolar pressure or a decrease in pleural pressure [4, 5]. The most common methods for promoting lung expansion utilize mechanical ventilation with positive pressure to increase alveolar pressure, such as alveolar recruitment [6], intermittent positive pressure breathing [7], PEEP therapy [7, 8], ventilator hyperinflation [9, 10], and increased inspiratory time [10]. Techniques that utilize an increase in positive pressure present few serious adverse events. Transient hypotension and desaturation are the most common adverse events, but they have been observed to be self-limited and do not lead to severe short-term sequelae. Serious adverse events such as barotrauma and arrhythmias were infrequent [11]. Other techniques for lung expansion induce a reduction in pleural pressure. Passive manual manoeuvres are among these strategies and include compression-decompression [12–17] and chest block techniques [18, 19]. Manual manoeuvres are commonly used in clinical practice in countries with few financial and instrumental resources [20]. However, despite being widely used in clinical practice [20], no randomized controlled trials support the use of passive manual manoeuvres in individuals on mechanical ventilation. Therefore, adequate investigation is necessary to assess whether there are beneficial effects of using manual manoeuvres for lung expansion among individuals under mechanical ventilation. The results of this investigation would guide professionals to adopt an evidence-based practice. Objective This study aimed to compare the effects of usual care plus chest compression-decompression and chest block manoeuvres with the effects of usual care on static compliance among patients undergoing mechanical ventilation. Additionally, the effects of these manoeuvres on ventilatory mechanics, the incidence of atelectasis, oxygenation, mechanical ventilation time, extubation success, the length of ICU stay, the length of hospital stay, and morta (...truncated)