Effect of Lung Volume Recruitment Technique After Extubation
Condition: Mechanical Ventilation Complication; Diaphragm Issues; Cough; Ineffective Airway Clearance; Intensive Care Unit Acquired Weakness
MeSH terms: Cough
Study type: Interventional

Summary: 
      This study was conducted to investigate the effect of the LVR technique on cough
      ineffectiveness, to determine its benefit as a simple, safe, and inexpensive cough
      augmentation technique, and to determine how much the LVR method, for augmenting CPF, is
      useful in enhancing the success of extubation and reducing the rate of reintubation.
    

Detailed description: 
      An effective cough is so vital in protecting against respiratory tract infections, so the
      importance of an intact cough mechanism is reflected in the occurrence of pulmonary problems
      which are the most common cause of hospital admission in people with respiratory muscle
      weakness who are unable to cough effectively. Ineffective cough results in a tendency to
      retain bronchial secretions and an increased risk of pulmonary complications, such as
      frequent or recurrent pneumonia, atelectasis, and infectious respiratory problems.

      Cough flow testing (expiratory flows testing) is useful as a monitoring or diagnostic tool in
      clinical practice and research. Both peak expiratory flows (PEF) and cough peak flows (CPF)
      have been described as useful clinical measures of respiratory muscle function and cough
      effectiveness. Cough peak flow (CPF) gives an important measure of the cough strength which
      determines the effectiveness of cough. It is the maximum expiratory flow recorded immediately
      following the opening of the glottis during normal cough. Cough effectiveness is suboptimal
      when cough peak flow (CPF) is less than 270 L/min.

      Mechanical Ventilation "MV" has deleterious effects caused by the endotracheal intubation,
      including changes in mucociliary clearance and inhibition of the coughing mechanism which, in
      turn, favor areas of hypoventilation and atelectasis, thus increasing the risk of
      ventilator-associated pneumonia. Respiratory compromise due to recurrent atelectasis,
      inability to clear secretions, and respiratory infections also increase morbidity and
      mortality. Prolonged MV results in respiratory muscle dysfunction shown in diaphragmatic
      atrophy and contractile dysfunction (ic., Ventilator-induced diaphragmatic dysfunction
      "VIDD") affecting the ability of the person to cough effectively. Indeed, the onset of VIDD
      in both animals and humans is rapid as significant diaphragmatic atrophy and contractile
      dysfunction occur within the first 24 - 48 h of MV. Although suctioning of secretions from
      the trachea to remove tracheobronchial and upper airway secretions is the standard of care,
      this method is ineffective for clearing peripheral airways and basal retained secretions.

      The clinical practice guides referred to patients with respiratory muscles weakness like
      after prolonged MV and in neuromuscular diseases recommend the usage of cough augmentation
      and mucociliary clearance techniques in patients with CPF < 4.5 L/s (270 L'min) and using
      such techniques continuously in patients with CPF < 2.7 L/s (160 L/min). Cough augmentation
      techniques such as LVR are supposed to be used to reinforce cough effectiveness, particularly
      for patients with prolonged mechanical ventilation. So, the importance and strength of this
      study are to assess the effects of the LVR technique as a cough augmentation mean on CPF of
      post-extubated patients with an ineffective cough which can cause risky respiratory
      complications may lead to death in confronting to effects of traditional chest physiotherapy
      and suctioning and therefore, their therapy or management program can be precisely and
      appropriately planned. Moreover, the identification of effective, safe measures to optimize
      cough efficacy is, therefore, key to improving quality of life and minimizing morbidity &
      mortality rates in those patients. Additionally, as a secondary purpose to determine how much
      the LVR method, for augmenting CPF. is useful in enhancing the success of extubation and
      reducing the rate of re-intubation that indicated if extubation failure occurred.
    

Intervention name(s): Lung volume recruitment technique; Traditional chest physiotherapy
Intervention type(s): Device; Other
Intervention description(s): A self inflating Ambu bag with one way valve , augmentation volume of air within 3 to 4 successive breaths and holding few seconds then coughing; Positioning of the patient according the drainage position for each lobe of each lung and applying airway hygiene techniques such as percussion and vibration
Other intervention name(s): Air stacking or breath stacking technique
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Care Provider)
Primary purpose: Treatment
Keywords: Cough peak flow; Lung volume recruitment; Air stacking; Cough efficacy; Post extubated patient; Respiratory therapy; Intensive care unit; Mechanical ventilation