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

Abstract

Background: 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.

Methods: 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, 20 MCCD maneuvers were performed while measured the same parameters. After 10 min, all parameters were measured again. The primary outcome was the tidal volume (V_t ) during the MCCD maneuver and after 10 min compared to the previous V_t .

Results: Of the 255 patients who were mechanically ventilated in the study period, 105 patients composed the final cohort. The MCCD increased inspiratory tidal volume (iV_t ), expiratory tidal volume (eV_t ), and chest dynamic compliance (C_dyn ) during the application of the maneuver, but after 10 min, 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 iV_t in patients with sedation, respiratory comorbidity, or obesity. Further, there was no association between the iV_t response to the MCCD and the admission diagnosis, and no correlation with the ICU length of stay, IMV duration, or APACHE II score.

Implications of physiotherapy practice: We concluded that MCCD increased iV_t , eV_t , and C_dyn during the application of the maneuver, but this effect was not observed after 10 min. Randomized controlled trials should be performed in the future to investigate the mechanism involved in increasing V_t and the possible impact of the MCCD maneuver on ICU outcomes.

Keywords: invasive mechanical ventilation; manual chest compression decompression maneuver; physiotherapy; respiratory mechanics.