Effect of breath stacking in mechanically ventilated patients admitted to the Intensive Care Unit
DOI:
https://doi.org/10.33233/fb.v24i6.5511Keywords:
physical therapy, intensive care unit, artificial respirationAbstract
Objective: To compare two methods of the Breath Stacking maneuver, using a mechanical ventilator and a manual resuscitator, in patients on mechanical ventilation admitted to the intensive care unit. Method: This is a non-randomized clinical study consisting of 32 patients. The subjects were initially submitted to the breath stacking technique with a mechanical ventilator, occluding the expiratory branch of the circuit for 20 seconds. The technique was performed six consecutive times with a two-minute interval between maneuvers. After 24 hours, the second breath stacking technique was performed with a manual resuscitator, with 20 seconds of insufflations with the valve closed, being performed 10 consecutive times with 1-minute pauses between applications. Results: It was observed that the breath stacking maneuver, when analyzing hemodynamic variables, did not show significant changes after applying the techniques, therefore, it was safe without changing vital signs. In the analysis of pulmonary variables: respiratory rate, peripheral oxygen saturation, tidal volume and static compliance, there were no significant variations after application of the techniques. In the variables: peak pressure (p-0.02) and driving pressure (p-0.03), it can be seen that peak pressure and driving pressure were better in both others, however, in the breath group stacking with a mechanical ventilator, there was a superiority of the technique compared to breath stacking with a manual resuscitator. Conclusion: The breath stacking technique with a mechanical ventilator compared to breath stacking with a manual resuscitator was more effective in lung expansion, being a safe and effective maneuver in the respiratory mechanics of patients on invasive mechanical ventilation.
References
Moreira FC, Teixeira C, Savi A, Xavier R. Alterações da mecânica ventilatória durante a fisioterapia respiratória em pacientes ventilados mecanicamente. Rev Bras Ter Intensiva. 2015;27(2):155-160. doi: 10.5935/0103-507X.20150027
Kyo M, Shimatani T, Hosokawa K. Patient–ventilator asynchrony, impact on clinical outcomes and effectiveness of interventions: a systematic review and meta-analysis. J Intensive Care 2021;9:50. doi: 10.1186/s40560-021-00565-5
Chicayban L, Hemetrio AC, Azevedo LTR. Comparação dos efeitos das técnicas de breath stacking voluntário e involuntário na mecânica respiratória e nos padrões de função pulmonar em pacientes traqueostomizados: um ensaio clínico cruzado randomizado. J Bras Pneumol 2020;46(4)e20190295. doi: 10.36416/1806-3756/e20190295
Oliveira ABF, Dias OM, Mello MM, Araújo S, Dragosavac D, Nucci A, et al. Fatores associados à maior mortalidade e tempo de internação prolongado em uma unidade de terapia intensiva de adultos. Rev Bras Ter Intensiva. 2010;22(3):250-6. doi: 10.1590/s0103-507x2010000300006
Yoo H, Pyun SB. Efficacy of bedside respiratory muscle training in patients with stroke. Am J Phys Med Rehabil 2018;97(10). doi: 10.1097/PHM.0000000000000933
Dorça A, Alcântara LA, Diniz DS, Sarmet MM, Menezes SR, Oliveira LVF, et al. Comparison between breath stacking technique associated with expiratory muscle training and breath stacking technique in amyotrophic lateral sclerosis patients: protocol for randomized single blind trial. Contemporary Clinical Trials Communications 2020;19. doi: 10.1016/j.conctc.2020.100647
Marques LBC, Castro IFB. Terapia incentivadora da inspiração: uma revisão das técnicas de espirometria a fluxo e a volume e o Breath Stacking. Revista Brasileira em Promoção da Saúde [citado 2023 Jun 12]. 2009;22(1):55-60. Disponível em: https://www.redalyc.org/articulo.oa?id=40811729010
Marini JJ, Rodriguez RM, Lamb VJ. Involuntary Breath-Stacking. An alternative method for vital capacity estimation in poorly cooperative subjects. Am Rev Respir Dis 1986;134: 694-698. doi: 10.1164/arrd.1986.134.4.694
Dias CM, Vieira RO, Oliveira JF, Lopes AJ, Menezes SL, Guimarães FS. Três protocolos fisioterapêuticos: efeitos sobre os volumes pulmonares após cirurgia cardíaca. J Bras Pneumol 2011;37(1):54-60. doi: 10.1590/s1806-37132011000100009
Dias CM, Plácido TR, Ferreira MF, Guimarães FS, Menezes SLS. Inspirometria de incentivo e breath stacking: repercussões sobre a capacidade inspiratória em indivíduos submetidos à cirurgia abdominal. Revista Brasileira de Fisioterapia 2008;12(2):94-99. doi: 10.1590/s1413-35552008000200004
De Rooji S, Abu-Hanna A, Levi M, Jonge E. Factors that predict outcome of intensive care treatment in very elderly patients: a review. Crit Care 2005;9(4):307-14. doi: 10.1186/cc3536
Ribeiro R, Brandão D, Noronha J, Lima C, Fregonezi G, Resqueti V, et al. Breath-stacking and incentive spirometry in Parkinson’s disease: Randomized crossover clinical trial. Respir Physiol Neurobiol. 2018;255:11-16. doi: 10.1016/j.resp.2018.04.011
Guia CM. Epidemiological profile and predictors of mortality in an intensive care unit in a general hospital in Distrito Federal. Com. Ciências Saúde: Com. Ciências Saúde 2015;1(26):9-19. Disponível em: https://bvsms.saude.gov.br/bvs/periodicos/ccs_artigos/2015_perfil_epidemiologico.pdf
Nardeli LM, Garcia CS, Pássaro CP, Rocco PRM. Entendendo os mecanismos determinantes da lesão pulmonar induzida pela ventilação mecânica. Rev Bras Ter Int 2007;19(4)469. doi: 10.1590/S0103-507X2007000400011
Stein FC, Barros RK, Feitosa FS, Toledo DO, Silva JJM, Ísola, AM, et al. Fatores prognósticos em pacientes idosos admitidos em unidade de terapia intensiva. Rev Bras Ter Int 2009;21(3):255-261. doi: 10.1590/S0103-507X2009000300004
Jenkins HM, Stocki A, Kriellaars D, Pasterkamp H. Breath stacking in children with neuromuscular disorders. Pediatr Pulmonol 2013;49(6):544–53. doi: 10.1002/ppul.22865
Barcelar JDM, Aliverti A, Rattes C, Ximenes ME, Campos SL, Brandão DC, et al. The expansion of the pulmonary rib cage during breath stacking is influenced by age in obese women. PLoSONE 20149(11):e110959. doi: 10.1371/journal.pone.0110959
Castrillo LDA, Lacombe M, Boré A, Vaugier I, Falaize L, Orlikowski D, et al. Comparison of two cough-augmentation techniques delivered by a home ventilator in subjects with neuromuscular disease. Respiratory Care 2019;64(3):255-261. doi: 10.4187/respcare.06259
Pincelli, MP, Grumann, ACB, Fernandes C, Cavalheiro, AGC, Haussen DAP, Maia IS. Características de pacientes com DPOC internados em UTI de um hospital de referência para doenças respiratórias no Brasil. J Bras Pneumol 2011;37(2):217-22. doi: 10.1590/S1806-37132011000200012
Pelosi P, Lorenzo B. Should we titrate ventilation based on driving pressure? Maybe not in the way we would expect. Annals of translational medicine 2018;6(19):389. doi: 10.21037/atm.2018.09.48
Granholm A, Møller MH, Krag M, Perner A, Hjortrup PB. Predictive Performance of the Simplified Acute Physiology Score (SAPS) II and the Initial Sequential Organ Failure Assessment (SOFA) Score in Acutely Ill Intensive Care Patients: Post-Hoc Analyses of the SUP-ICU Inception Cohort Study. PLoS One. 2016;(12):e0168948. doi: 10.1371/journal.pone.0168948
Somme D, Maillet JM, Gisselbrecht M, et al: Critically ill old and the oldest-old patients in intensive care: Short- and long-term outcomes. Intensive Care Med 2003; (29):2137–2143 7. doi: 10.1007/s00134-003-1929-2
Marik PE. Management of the critically ill geriatric patient. Crit Care Med 2006; 34:S176–S182. doi: 10.1097/01.CCM.0000232624.14883.9A
Fernandes DDL, Righi NC, Rubin Neto LJ, Bellé JM, Pippi CM, Ribas CZDM, et al. Effects of the breath stacking technique after upper abdominal surgery: a randomized clinical trial. J Bras Pneumol. 2022;48(1):e20210280. doi: 10.36416/1806-3756/e20210280
Sá Feitosa LA, Barbosa PA, Pessoa MF, Rodrigues-Machado MG, Andrade AD. Clinimetric properties of breath-stacking technique for assessment of inspiratory capacity. Physiother Res Int. 2012;17(1):48-54. doi: 10.1002/pri.512 36
Published
Issue
Section
License
Copyright (c) 2023 Thays Roberta Pessoa de Freitas, Fabiana Della Via, Silvia Lanziotti Azevedo da Silva, Vanessa Sampaio dos Santos Milani, Carolina Kosour
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors are authorized for non-exclusive distribution of the version of the work published in this journal (eg, publishing in an institutional repository or as a book chapter), with acknowledgment of authorship and initial publication in this journal.
