Chest Physiotherapy Effects on Intracranial Pressure

Study Overview
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Brief Summary
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The investigators will study the effects of a chest physiotherapy technique (rapid thoracic compression) on the intracranial pressure of individuals with acute cerebral injury and with need of intubated mechanical ventilation

Detailed Description
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Patients with acute brain injury often require invasive mechanical ventilation connection, increasing the risk of developing complications such as respiratory secretions retention. The abdomino-thoracic compression is a manual chest physiotherapy technique that can improve clearance of secretions in these patients. Although today the scientific evidence is contradictory, the manual abdomino-thoracic compression may be associated with increased intracranial pressure in patients with acute brain injury. Objectives: The aim of this work to study the effects of manual abdomino-thoracic compression technique in intracranial pressure in mechanically ventilated patients. Furthermore, the effects of the technique in different volumes and flows recorded by the ventilator and the relationship between the pressure applied in the intervention group and the different variables will also be studied. Methodology: It will be a randomized clinical trial, single-blind in the application of the techniques. Patients with acute brain injury in invasive mechanical ventilation will be included, randomized into two groups. In the control group, a technique of passive ankle mobilization will be applied and in the intervention group it will be performed the manual abdomino-thoracic compression technique. The data of the primary variable, intracranial pressure will be collected with a monitoring system and continuous recording (Integra Camino). A descriptive analysis of the values collected from the variables in the study will be performed, studying the measures of central tendency. In the presence of normal distribution will be presented mean and standard deviation, and median and interquartile range in case of non-observation of normal distribution. The normality of the samples will be verified with the Kolmogorov-Smirnov test. The verification of the hypothesis in study will be assessed using the Student T test for independent samples in case of sample normality and by the Wilcoxon test otherwise. A multiple linear regression analysis will be performed: considering as a dependent variable the differences in intracranial pressure, difference or volume / minute gain and expiratory flow and between the covariates, the type of technique, the pressure applied in the technique under study, the type of brain injury, age, sex, etc.

Official Title
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the Effects of Manual Thoracic Compression Technique in Intracranial Pressure in Mechanically Ventilated Patients With Acute Cerebral Injury

Conditions
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Acute Brain Injury

Intervention / Treatment
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* Procedure: rapid thoracic compression technique
* Procedure: metatarsophalangeal joint passive mobilization


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: intubated patients for 48 hours in vc, pc, vcrp hemodynamically stable (MAP>65mmHg) respiratory stability (PEEP<10cmH2O and FiO2<60%) ICP stable (0<icp<20mmHg) RASS of <3 informed consent signed Exclusion Criteria: thoracic fractures abdominal injuries that limits local pressure systemic or local changes that undergoes with abdominal volume increase inferior limbs fractures that contraindicates passive mobilization techniques

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Basic Science
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: control<br>will be performed metatarsophalangeal joint passive mobilization | Procedure: metatarsophalangeal joint passive mobilization<br>* it will be performed a metatarsophalangeal joint passive mobilization technique on the patient<br>|
| Experimental: experimental<br>rapid thoracic compression technique will be applied | Procedure: rapid thoracic compression technique<br>* in the expiratory time of the ventilation set, it will be applied a rapid thoracic compression<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| intracranial pressure changes | with Camino ICP monitoring | 5 minutes before start procedure, immediately after procedure, 5 minutes after the end of procedure and 10 minutes after the end of procedure | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| oxygen saturation changes | with philips monitoring device | 5 minutes before start procedure, immediately after procedure, 5 minutes after the end of procedure and 10 minutes after the end of procedure | 
| peak expiratory flow changes | with maquet servo u and servo i ventilators, the purpose is to identify the best peak expiratory flow before and during the procedure, and to compare them. | all the respiratory cycles will be recorded 30 seconds before procedure and during the procedure | 
| heart rate changes | with philips monitoring device | 5 minutes before start procedure, immediately after procedure, 5 minutes after the end of procedure and 10 minutes after the end of procedure | 
| cerebral perfusion pressure changes | with philips monitoring device | 5 minutes before start procedure, immediately after procedure, 5 minutes after the end of procedure and 10 minutes after the end of procedure | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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intracranial pressure increase, chest physiotherapy, ventilated patients, mechanical ventilation