Download PDF
Semin Respir Crit Care Med 2022; 43(03): 390-404
DOI: 10.1055/s-0042-1744307
Review Article

An Update on Cardiorespiratory Physiotherapy during Mechanical Ventilation

Oystein Tronstad
1   Critical Care Research Group, Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Australia
2   Physiotherapy Department, The Prince Charles Hospital, Brisbane, Australia
,
Joan-Daniel Martí
3   Cardiac Surgery Critical Care Unit, Institut Clinic Cardiovascular, Hospital Clínic, Barcelona, Spain
4   Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
,
George Ntoumenopoulos
5   Department of Physiotherapy, St. Vincent's Hospital, Sydney, Australia
,
Rik Gosselink
6   Department Rehabilitation Sciences, University of Leuven, University Hospitals Leuven, Belgium
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Physiotherapists are integral members of the multidisciplinary team managing critically ill adult patients. However, the scope and role of physiotherapists vary widely internationally, with physiotherapists in some countries moving away from providing early and proactive respiratory care in the intensive care unit (ICU) and focusing more on early mobilization and rehabilitation. This article provides an update of cardiorespiratory physiotherapy for patients receiving mechanical ventilation in ICU. Common and some more novel assessment tools and treatment options are described, along with the mechanisms of action of the treatment options and the evidence and physiology underpinning them. The aim is not only to summarize the current state of cardiorespiratory physiotherapy but also to provide information that will also hopefully help support clinicians to deliver personalized and optimal patient care, based on the patient's unique needs and guided by accurate interpretation of assessment findings and the current evidence. Cardiorespiratory physiotherapy plays an essential role in optimizing secretion clearance, gas exchange, lung recruitment, and aiding with weaning from mechanical ventilation in ICU. The physiotherapists' skill set and scope is likely to be further optimized and utilized in the future as the evidence base continues to grow and they get more and more integrated into the ICU multidisciplinary team, leading to improved short- and long-term patient outcomes.

Keywords

assessment - cardiorespiratory physiotherapy - intensive care - mechanical ventilation - treatment


Publication History

Article published online:
22 April 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Via G, Storti E, Gulati G, Neri L, Mojoli F, Braschi A. Lung ultrasound in the ICU: from diagnostic instrument to respiratory monitoring tool. Minerva Anestesiol 2012; 78 (11) 1282-1296
    PubMedSearch in Google Scholar
  • 2 Volpicelli G, Elbarbary M, Blaivas M. et al. International Liaison Committee on Lung Ultrasound (ILC-LUS) for International Consensus Conference on Lung Ultrasound (ICC-LUS). International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med 2012; 38 (04) 577-591
    CrossrefPubMedSearch in Google Scholar
  • 3 Xirouchaki N, Kondili E, Prinianakis G, Malliotakis P, Georgopoulos D. Impact of lung ultrasound on clinical decision making in critically ill patients. Intensive Care Med 2014; 40 (01) 57-65
    CrossrefPubMedSearch in Google Scholar
  • 4 Leech M, Bissett B, Kot M, Ntoumenopoulos G. Lung ultrasound for critical care physiotherapists: a narrative review. Physiother Res Int 2015; 20 (02) 69-76
    CrossrefPubMedSearch in Google Scholar
  • 5 Hayward SA, Janssen J. Use of thoracic ultrasound by physiotherapists: a scoping review of the literature. Physiotherapy 2018; 104 (04) 367-375
    CrossrefPubMedSearch in Google Scholar
  • 6 Hayward S, Smith M, Innes S. Diagnostic thoracic ultrasound imaging - an exploration of respiratory physiotherapists' interest and use in clinical practice: a national survey. Ultrasound 2020; 28 (01) 14-22
    CrossrefPubMedSearch in Google Scholar
  • 7 Vieira R, Segura-Grau E, Magalhães J, Dos Santos J, Patrão L. Lung ultrasound as a tool to guide respiratory physiotherapy. J Clin Ultrasound 2020; 48 (07) 431-434
    CrossrefPubMedSearch in Google Scholar
  • 8 Cavaliere F, Biasucci D, Costa R, Soave M, Addabbo G, Proietti R. Chest ultrasounds to guide manual reexpansion of a postoperative pulmonary atelectasis: a case report. Minerva Anestesiol 2011; 77 (07) 750-753
    PubMedSearch in Google Scholar
  • 9 Caruana LR, Paratz J, Chang AT, Fraser JF. Electrical impedance tomography in the clinical assessment of lung volumes following recruitment manoeuvres. Phys Ther Rev 2011; 16: 66-74
    CrossrefPubMedSearch in Google Scholar
  • 10 Lobo B, Hermosa C, Abella A, Gordo F. Electrical impedance tomography. Ann Transl Med 2018; 6 (02) 26
    CrossrefPubMedSearch in Google Scholar
  • 11 Spadaro S, Mauri T, Böhm SH. et al. Variation of poorly ventilated lung units (silent spaces) measured by electrical impedance tomography to dynamically assess recruitment. Crit Care 2018; 22 (01) 26
    CrossrefPubMedSearch in Google Scholar
  • 12 Liu S, Tan L, Möller K. et al. Identification of regional overdistension, recruitment and cyclic alveolar collapse with electrical impedance tomography in an experimental ARDS model. Crit Care 2016; 20 (01) 119
    CrossrefPubMedSearch in Google Scholar
  • 13 Bissett B, Van Haren F. Response to letter to editor: electrical impedance tomography and inspiratory muscle training in ICU patients. Aust Crit Care 2019; 32 (02) 81-82
    CrossrefPubMedSearch in Google Scholar
  • 14 Linnane MP, Caruana LR, Tronstad O. et al. A comparison of the effects of manual hyperinflation and ventilator hyperinflation on restoring end-expiratory lung volume after endotracheal suctioning: a pilot physiologic study. J Crit Care 2019; 49: 77-83
    CrossrefPubMedSearch in Google Scholar
  • 15 Eimer C, Freier K, Weiler N, Frerichs I, Becher T. The effect of physical therapy on regional lung function in critically ill patients. Front Physiol 2021; 12: 749542
    CrossrefPubMedSearch in Google Scholar
  • 16 Davies P, Yasin S, Gates S, Bird D, Silvestre C. Clinical scenarios of the application of electrical impedance tomography in paediatric intensive care. Sci Rep 2019; 9 (01) 5362
    CrossrefPubMedSearch in Google Scholar
  • 17 McAlinden B, Kuys S, Schibler A, Hough JL. Chest physiotherapy improves regional lung volume in ventilated children. Crit Care 2020; 24 (01) 440
    CrossrefPubMedSearch in Google Scholar
  • 18 McConville JF, Kress JP. Weaning patients from the ventilator. N Engl J Med 2012; 367 (23) 2233-2239
    CrossrefPubMedSearch in Google Scholar
  • 19 Vassilakopoulos T, Zakynthinos S, Roussos Ch. Respiratory muscles and weaning failure. Eur Respir J 1996; 9 (11) 2383-2400
    Search in Google Scholar
  • 20 Dres M, Goligher EC, Heunks LMA, Brochard LJ. Critical illness-associated diaphragm weakness. Intensive Care Med 2017; 43 (10) 1441-1452
    CrossrefPubMedSearch in Google Scholar
  • 21 Le Neindre A, Philippart F, Luperto M. et al. Diagnostic accuracy of diaphragm ultrasound to predict weaning outcome: a systematic review and meta-analysis. Int J Nurs Stud 2021; 117: 103890
    CrossrefPubMedSearch in Google Scholar
  • 22 Matamis D, Soilemezi E, Tsagourias M. et al. Sonographic evaluation of the diaphragm in critically ill patients. Technique and clinical applications. Intensive Care Med 2013; 39 (05) 801-810
    CrossrefPubMedSearch in Google Scholar
  • 23 Zambon M, Cabrini L, Beccaria P, Zangrillo A, Colombo S. Ultrasound in critically ill patients: focus on diaphragm. Intensive Care Med 2013; 39 (05) 986
    CrossrefPubMedSearch in Google Scholar
  • 24 Goldstone J, Moxham J. Assisted ventilation. 4. Weaning from mechanical ventilation. Thorax 1991; 46 (01) 56-62
    CrossrefPubMedSearch in Google Scholar
  • 25 Vassilakopoulos T, Zakynthinos S, Roussos C. The tension-time index and the frequency/tidal volume ratio are the major pathophysiologic determinants of weaning failure and success. Am J Respir Crit Care Med 1998; 158 (02) 378-385
    Search in Google Scholar
  • 26 Vanpee G, Hermans G, Segers J, Gosselink R. Assessment of limb muscle strength in critically ill patients: a systematic review. Crit Care Med 2014; 42 (03) 701-711
    CrossrefPubMedSearch in Google Scholar
  • 27 Laveneziana P, Albuquerque A, Aliverti A. et al. ERS statement on respiratory muscle testing at rest and during exercise. Eur Respir J 2019; 53 (06) 53
    CrossrefPubMedSearch in Google Scholar
  • 28 McIlwaine M, Bradley J, Elborn JS, Moran F. Personalising airway clearance in chronic lung disease. Accessed February 18, 2022 at: https://pureadmin.qub.ac.uk/ws/portalfiles/portal/127533855/Personalising.pdf
    PubMed
  • 29 Franks LJ, Walsh JR, Hall K, Jacuinde G, Yerkovich S, Morris NR. Comparing the performance characteristics of different positive expiratory pressure devices. Respir Care 2019; 64 (04) 434-444
    CrossrefPubMedSearch in Google Scholar
  • 30 Piccin VS, Calciolari C, Yoshizaki K. et al. Effects of different mechanical ventilation strategies on the mucociliary system. Intensive Care Med 2011; 37 (01) 132-140
    CrossrefPubMedSearch in Google Scholar
  • 31 Trawöger R, Kolobow T, Cereda M, Sparacino ME. Tracheal mucus velocity remains normal in healthy sheep intubated with a new endotracheal tube with a novel laryngeal seal. Anesthesiology 1997; 86 (05) 1140-1144
    CrossrefPubMedSearch in Google Scholar
  • 32 Teff Z, Priel Z, Gheber LA. The forces applied by cilia depend linearly on their frequency due to constant geometry of the effective stroke. Biophys J 2008; 94 (01) 298-305
    CrossrefPubMedSearch in Google Scholar
  • 33 Konrad F, Schreiber T, Brecht-Kraus D, Georgieff M. Mucociliary transport in ICU patients. Chest 1994; 105 (01) 237-241
    CrossrefPubMedSearch in Google Scholar
  • 34 Sackner MA, Hirsch J, Epstein S. Effect of cuffed endotracheal tubes on tracheal mucous velocity. Chest 1975; 68 (06) 774-777
    CrossrefPubMedSearch in Google Scholar
  • 35 Gal TJ. Effects of endotracheal intubation on normal cough performance. Anesthesiology 1980; 52 (04) 324-329
    CrossrefPubMedSearch in Google Scholar
  • 36 Berney S, Denehy L, Pretto J. Head-down tilt and manual hyperinflation enhance sputum clearance in patients who are intubated and ventilated. Aust J Physiother 2004; 50 (01) 9-14
    CrossrefPubMedSearch in Google Scholar
  • 37 Branson RD. Secretion management in the mechanically ventilated patient. Respir Care 2007; 52 (10) 1328-1342 , discussion 1342–1347
    PubMedSearch in Google Scholar
  • 38 Stilma W, Schultz MJ, Paulus F. Preventing mucus plugging in invasively ventilated intensive care unit patients-routine or personalized care and ‘primum non nocere’. J Thorac Dis 2018; 10 (12) E817-E818
    CrossrefPubMedSearch in Google Scholar
  • 39 Li Bassi G, Zanella A, Cressoni M, Stylianou M, Kolobow T. Following tracheal intubation, mucus flow is reversed in the semirecumbent position: possible role in the pathogenesis of ventilator-associated pneumonia. Crit Care Med 2008; 36 (02) 518-525
    CrossrefPubMedSearch in Google Scholar
  • 40 Button BM, Button B. Structure and function of the mucus clearance system of the lung. Cold Spring Harb Perspect Med 2013; 3 (08) a009720
    CrossrefPubMedSearch in Google Scholar
  • 41 Kim CS, Rodriguez CR, Eldridge MA, Sackner MA. Criteria for mucus transport in the airways by two-phase gas-liquid flow mechanism. J Appl Physiol (1985) 1986; 60 (03) 901-907
    CrossrefPubMedSearch in Google Scholar
  • 42 Kim CS, Iglesias AJ, Sackner MA. Mucus clearance by two-phase gas-liquid flow mechanism: asymmetric periodic flow model. J Appl Physiol (1985) 1987; 62 (03) 959-971
    CrossrefPubMedSearch in Google Scholar
  • 43 Volpe MS, Adams AB, Amato MB, Marini JJ. Ventilation patterns influence airway secretion movement. Respir Care 2008; 53 (10) 1287-1294
    PubMedSearch in Google Scholar
  • 44 Li Bassi G, Saucedo L, Marti JD. et al. Effects of duty cycle and positive end-expiratory pressure on mucus clearance during mechanical ventilation*. Crit Care Med 2012; 40 (03) 895-902
    CrossrefPubMedSearch in Google Scholar
  • 45 Chicayban LM, Zin WA, Guimarães FS. Can the flutter valve improve respiratory mechanics and sputum production in mechanically ventilated patients? A randomized crossover trial. Heart Lung 2011; 40 (06) 545-553
    CrossrefPubMedSearch in Google Scholar
  • 46 Li Bassi G, Martí JD, Comaru T. et al. Short-term appraisal of the effects and safety of manual versus ventilator hyperinflation in an animal model of severe pneumonia. Respir Care 2019; 64 (07) 760-770
    CrossrefPubMedSearch in Google Scholar
  • 47 Restrepo RD, Braverman J. Current challenges in the recognition, prevention and treatment of perioperative pulmonary atelectasis. Expert Rev Respir Med 2015; 9 (01) 97-107
    CrossrefPubMedSearch in Google Scholar
  • 48 Grant CA, Fraser JF, Dunster KR, Schibler A. The assessment of regional lung mechanics with electrical impedance tomography: a pilot study during recruitment manoeuvres. Intensive Care Med 2009; 35 (01) 166-170
    CrossrefPubMedSearch in Google Scholar
  • 49 Ray K, Bodenham A, Paramasivam E. Pulmonary atelectasis in anaesthesia and critical care. Contin Educ Anaesth Crit Care Pain 2013; 14: 236-245
    CrossrefPubMedSearch in Google Scholar
  • 50 Restrepo RD, Walsh BK. American Association for Respiratory Care. Humidification during invasive and noninvasive mechanical ventilation: 2012. Respir Care 2012; 57 (05) 782-788
    CrossrefPubMedSearch in Google Scholar
  • 51 Al Ashry HS, Modrykamien AM. Humidification during mechanical ventilation in the adult patient. BioMed Res Int 2014; 2014: 715434
    CrossrefPubMedSearch in Google Scholar
  • 52 Lang JK, Paykel MS, Haines KJ, Hodgson CL. Clinical practice guidelines for early mobilization in the ICU: a systematic review. Crit Care Med 2020; 48 (11) e1121-e1128
    CrossrefPubMedSearch in Google Scholar
  • 53 Hodgson CL, Schaller SJ, Nydahl P, Timenetsky KT, Needham DM. Ten strategies to optimize early mobilization and rehabilitation in intensive care. Crit Care 2021; 25 (01) 324
    CrossrefPubMedSearch in Google Scholar
  • 54 Jolley SE, Moss M, Needham DM. et al. Acute Respiratory Distress Syndrome Network Investigators. Point Prevalence Study of Mobilization Practices for Acute Respiratory Failure Patients in the United States. Crit Care Med 2017; 45 (02) 205-215
    CrossrefPubMedSearch in Google Scholar
  • 55 Sibilla A, Nydahl P, Greco N. et al. Mobilization of mechanically ventilated patients in Switzerland. J Intensive Care Med 2020; 35 (01) 55-62
    CrossrefPubMedSearch in Google Scholar
  • 56 Pathmanathan N, Beaumont N, Gratrix A. Respiratory physiotherapy in the critical care unit. Contin Educ Anaesth Crit Care Pain 2014; 15: 20-25
    CrossrefPubMedSearch in Google Scholar
  • 57 Güner CK, Kutlutürkan S. Role of head-of-bed elevation in preventing ventilator-associated pneumonia bed elevation and pneumonia. Nurs Crit Care 2021
    PubMedSearch in Google Scholar
  • 58 Spooner AJ, Corley A, Sharpe NA. et al. Head-of-bed elevation improves end-expiratory lung volumes in mechanically ventilated subjects: a prospective observational study. Respir Care 2014; 59 (10) 1583-1589
    CrossrefPubMedSearch in Google Scholar
  • 59 Imber DA, Pirrone M, Zhang C, Fisher DF, Kacmarek RM, Berra L. Respiratory management of perioperative obese patients. Respir Care 2016; 61 (12) 1681-1692
    CrossrefPubMedSearch in Google Scholar
  • 60 Clini E, Ambrosino N. Early physiotherapy in the respiratory intensive care unit. Respir Med 2005; 99 (09) 1096-1104
    CrossrefPubMedSearch in Google Scholar
  • 61 Wanless S, Aldridge M. Continuous lateral rotation therapy - a review. Nurs Crit Care 2012; 17 (01) 28-35
    CrossrefPubMedSearch in Google Scholar
  • 62 Schieren M, Wappler F, Klodt D. et al. Continuous lateral rotational therapy in thoracic trauma–a matched pair analysis. Injury 2020; 51 (01) 51-58
    CrossrefPubMedSearch in Google Scholar
  • 63 Schieren M, Piekarski F, Dusse F. et al. Continuous lateral rotational therapy in trauma-A systematic review and meta-analysis. J Trauma Acute Care Surg 2017; 83 (05) 926-933
    CrossrefPubMedSearch in Google Scholar
  • 64 Langer T, Brioni M, Guzzardella A. et al. PRONA-COVID Group. Prone position in intubated, mechanically ventilated patients with COVID-19: a multi-centric study of more than 1000 patients. Crit Care 2021; 25 (01) 128
    CrossrefPubMedSearch in Google Scholar
  • 65 Behesht Aeen F, Pakzad R, Goudarzi Rad M, Abdi F, Zaheri F, Mirzadeh N. Effect of prone position on respiratory parameters, intubation and death rate in COVID-19 patients: systematic review and meta-analysis. Sci Rep 2021; 11 (01) 14407
    CrossrefPubMedSearch in Google Scholar
  • 66 Panigada M, Berra L, Greco G, Stylianou M, Kolobow T. Bacterial colonization of the respiratory tract following tracheal intubation-effect of gravity: an experimental study. Crit Care Med 2003; 31 (03) 729-737
    CrossrefPubMedSearch in Google Scholar
  • 67 Stiller K. Physiotherapy in intensive care: towards an evidence-based practice. Chest 2000; 118 (06) 1801-1813
    CrossrefPubMedSearch in Google Scholar
  • 68 Hodgson C, Denehy L, Ntoumenopoulos G, Santamaria J, Carroll S. An investigation of the early effects of manual lung hyperinflation in critically ill patients. Anaesth Intensive Care 2000; 28 (03) 255-261
    CrossrefPubMedSearch in Google Scholar
  • 69 Ntoumenopoulos G, Presneill JJ, McElholum M, Cade JF. Chest physiotherapy for the prevention of ventilator-associated pneumonia. Intensive Care Med 2002; 28 (07) 850-856
    CrossrefPubMedSearch in Google Scholar
  • 70 Ahmed F, Shafeeq AM, Moiz JA, Geelani MA. Comparison of effects of manual versus ventilator hyperinflation on respiratory compliance and arterial blood gases in patients undergoing mitral valve replacement. Heart Lung 2010; 39 (05) 437-443
    CrossrefPubMedSearch in Google Scholar
  • 71 Lemes DA, Zin WA, Guimaraes FS. Hyperinflation using pressure support ventilation improves secretion clearance and respiratory mechanics in ventilated patients with pulmonary infection: a randomised crossover trial. Aust J Physiother 2009; 55 (04) 249-254
    CrossrefPubMedSearch in Google Scholar
  • 72 Savian C, Paratz J, Davies A. Comparison of the effectiveness of manual and ventilator hyperinflation at different levels of positive end-expiratory pressure in artificially ventilated and intubated intensive care patients. Heart Lung 2006; 35 (05) 334-341
    CrossrefPubMedSearch in Google Scholar
  • 73 Dennis D, Jacob W, Budgeon C. Ventilator versus manual hyperinflation in clearing sputum in ventilated intensive care unit patients. Anaesth Intensive Care 2012; 40 (01) 142-149
    CrossrefPubMedSearch in Google Scholar
  • 74 Berney S, Denehy L. A comparison of the effects of manual and ventilator hyperinflation on static lung compliance and sputum production in intubated and ventilated intensive care patients. Physiother Res Int 2002; 7 (02) 100-108
    CrossrefPubMedSearch in Google Scholar
  • 75 Paulus F, Binnekade JM, Vroom MB, Schultz MJ. Benefits and risks of manual hyperinflation in intubated and mechanically ventilated intensive care unit patients: a systematic review. Crit Care 2012; 16 (04) R145
    CrossrefPubMedSearch in Google Scholar
  • 76 Paratz J, Lipman J, McAuliffe M. Effect of manual hyperinflation on hemodynamics, gas exchange, and respiratory mechanics in ventilated patients. J Intensive Care Med 2002; 17: 317-324
    CrossrefPubMedSearch in Google Scholar
  • 77 Anderson A, Alexanders J, Sinani C, Hayes S, Fogarty M. Effects of ventilator vs manual hyperinflation in adults receiving mechanical ventilation: a systematic review of randomised clinical trials. Physiotherapy 2015; 101 (02) 103-110
    CrossrefPubMedSearch in Google Scholar
  • 78 Gosselink R, Bott J, Johnson M. et al. Physiotherapy for adult patients with critical illness: recommendations of the European Respiratory Society and European Society of Intensive Care Medicine Task Force on physiotherapy for critically ill patients. Intensive Care Med 2008; 34 (07) 1188-1199
    CrossrefPubMedSearch in Google Scholar
  • 79 Stiller K, Geake T, Taylor J, Grant R, Hall B. Acute lobar atelectasis. A comparison of two chest physiotherapy regimens. Chest 1990; 98 (06) 1336-1340
    PubMedSearch in Google Scholar
  • 80 Maa SH, Hung TJ, Hsu KH. et al. Manual hyperinflation improves alveolar recruitment in difficult-to-wean patients. Chest 2005; 128 (04) 2714-2721
    CrossrefPubMedSearch in Google Scholar
  • 81 Goñi-Viguria R, Yoldi-Arzoz E, Casajús-Sola L. et al. Respiratory physiotherapy in intensive care unit: bibliographic review [in Spanish]. Enferm Intensiva (Engl Ed) 2018; 29 (04) 168-181
    CrossrefPubMedSearch in Google Scholar
  • 82 Comellini V, Nava S, Artigas A. Respiratory physiotherapy in critically ill patients. ICU Management Pract 2019; 19: 100-108
    PubMedSearch in Google Scholar
  • 83 Clement AJ, Hübsch SK. Chest physiotherapy by the ‘bag squeezing’ method: a guide to technique. Physiotherapy 1968; 54 (10) 355-359
    PubMedSearch in Google Scholar
  • 84 Hodgson C, Ntoumenopoulos G, Dawson H, Paratz J. The Mapleson C circuit clears more secretions than the Laerdal circuit during manual hyperinflation in mechanically-ventilated patients: a randomised cross-over trial. Aust J Physiother 2007; 53 (01) 33-38
    CrossrefPubMedSearch in Google Scholar
  • 85 Maxwell L, Ellis ER. The effects of three manual hyperinflation techniques on pattern of ventilation in a test lung model. Anaesth Intensive Care 2002; 30 (03) 283-288
    CrossrefPubMedSearch in Google Scholar
  • 86 Dennis DM, Jacob WJ, Samuel FD. A survey of the use of ventilator hyperinflation in Australian tertiary intensive care units. Crit Care Resusc 2010; 12 (04) 262-268
    PubMedSearch in Google Scholar
  • 87 Hayes K. Ventilator hyperinflation: a survey of current physiotherapy practice in Australia and New Zealand. New Zealand J Physiotherap 2011; 39: 124-130
    PubMedSearch in Google Scholar
  • 88 O'Donnell K. A survey of hyperinflation techniques in ICU based physiotherapists in the UK. Physiotherapy 2019; 105: 178
    CrossrefPubMedSearch in Google Scholar
  • 89 Volpe MS, Guimarães FS, Morais CC. Airway clearance techniques for mechanically ventilated patients: insights for optimization. Respir Care 2020; 65 (08) 1174-1188
    CrossrefPubMedSearch in Google Scholar
  • 90 Thomas PJ. The effect of mechanical ventilator settings during ventilator hyperinflation techniques: a bench-top analysis. Anaesth Intensive Care 2015; 43 (01) 81-87
    CrossrefPubMedSearch in Google Scholar
  • 91 Ribeiro BS, Lopes AJ, Menezes SLS, Guimarães FS. Selecting the best ventilator hyperinflation technique based on physiologic markers: a randomized controlled crossover study. Heart Lung 2019; 48 (01) 39-45
    CrossrefPubMedSearch in Google Scholar
  • 92 Naue WDS, Herve BB, Vieira FN. et al. Comparison of bronchial hygiene techniques in mechanically ventilated patients: a randomized clinical trial. Rev Bras Ter Intensiva 2019; 31 (01) 39-46
    PubMedSearch in Google Scholar
  • 93 Ntoumenopoulos G, Shannon H, Main E. Do commonly used ventilator settings for mechanically ventilated adults have the potential to embed secretions or promote clearance?. Respir Care 2011; 56 (12) 1887-1892
    CrossrefPubMedSearch in Google Scholar
  • 94 Spapen HD, De Regt J, Honoré PM. Chest physiotherapy in mechanically ventilated patients without pneumonia-a narrative review. J Thorac Dis 2017; 9 (01) E44-E49
    CrossrefPubMedSearch in Google Scholar
  • 95 Hassan A, Lai W, Alison J, Huang S, Milross M. Effect of intrapulmonary percussive ventilation on intensive care unit length of stay, the incidence of pneumonia and gas exchange in critically ill patients: a systematic review. PLoS One 2021; 16 (07) e0255005
    CrossrefPubMedSearch in Google Scholar
  • 96 Kallet RH. Adjunct therapies during mechanical ventilation: airway clearance techniques, therapeutic aerosols, and gases. Respir Care 2013; 58 (06) 1053-1073
    CrossrefPubMedSearch in Google Scholar
  • 97 Berlinski A. Be aware of intrapulmonary percussive ventilation. Respir Care 2019; 64 (05) 612-613
    CrossrefPubMedSearch in Google Scholar
  • 98 Lin Y-p, Tung HH, Wang T-J. Comparative study of high frequency chest wall oscillation and traditional chest physical therapy in intensive care unit patients. J Comprehens Nurs Res Care 2019; 2: 115
    PubMedSearch in Google Scholar
  • 99 Nicolini A, Grecchi B, Ferrari-Bravo M, Barlascini C. Safety and effectiveness of the high-frequency chest wall oscillation vs intrapulmonary percussive ventilation in patients with severe COPD. Int J Chron Obstruct Pulmon Dis 2018; 13: 617-625
    CrossrefPubMedSearch in Google Scholar
  • 100 Kuyrukluyildiz U, Binici O, Kupeli İ. et al. What is the best pulmonary physiotherapy method in ICU?. Can Respir J 2016; 2016: 4752467
    CrossrefPubMedSearch in Google Scholar
  • 101 Ntoumenopoulos G. High frequency chest wall oscillation or chest physiotherapy after lung resection?. Crit Care Med 2013; 41 (01) e8-e9
    CrossrefPubMedSearch in Google Scholar
  • 102 Ciesla ND. Chest physical therapy for patients in the intensive care unit. Phys Ther 1996; 76 (06) 609-625
    CrossrefPubMedSearch in Google Scholar
  • 103 Martí JD, Li Bassi G, Rigol M. et al. Effects of manual rib cage compressions on expiratory flow and mucus clearance during mechanical ventilation. Crit Care Med 2013; 41 (03) 850-856
    CrossrefPubMedSearch in Google Scholar
  • 104 Borges LF, Saraiva MS, Saraiva MAS, Macagnan FE, Kessler A. Expiratory rib cage compression in mechanically ventilated adults: systematic review with meta-analysis. Rev Bras Ter Intensiva 2017; 29 (01) 96-104
    CrossrefPubMedSearch in Google Scholar
  • 105 Guimarães FS, Lopes AJ, Constantino SS, Lima JC, Canuto P, de Menezes SL. Expiratory rib cage compression in mechanically ventilated subjects: a randomized crossover trial [corrected]. Respir Care 2014; 59 (05) 678-685
    CrossrefPubMedSearch in Google Scholar
  • 106 Shannon H, Stiger R, Gregson RK, Stocks J, Main E. Effect of chest wall vibration timing on peak expiratory flow and inspiratory pressure in a mechanically ventilated lung model. Physiotherapy 2010; 96 (04) 344-349
    CrossrefPubMedSearch in Google Scholar
  • 107 King M, Phillips DM, Gross D, Vartian V, Chang HK, Zidulka A. Enhanced tracheal mucus clearance with high frequency chest wall compression. Am Rev Respir Dis 1983; 128 (03) 511-515
    CrossrefPubMedSearch in Google Scholar
  • 108 Chilvers MA, Rutman A, O'Callaghan C. Functional analysis of cilia and ciliated epithelial ultrastructure in healthy children and young adults. Thorax 2003; 58 (04) 333-338
    CrossrefPubMedSearch in Google Scholar
  • 109 Li SK, Silva YR. Investigation of the frequency and force of chest vibration performed by physiotherapists. Physiother Can 2008; 60 (04) 341-348
    CrossrefPubMedSearch in Google Scholar
  • 110 McCarren B, Alison JA. Physiological effects of vibration in subjects with cystic fibrosis. Eur Respir J 2006; 27 (06) 1204-1209
    CrossrefPubMedSearch in Google Scholar
  • 111 McCarren B, Alison JA, Herbert RD. Manual vibration increases expiratory flow rate via increased intrapleural pressure in healthy adults: an experimental study. Aust J Physiother 2006; 52 (04) 267-271
    CrossrefPubMedSearch in Google Scholar
  • 112 Homnick DN. Mechanical insufflation-exsufflation for airway mucus clearance. Respir Care 2007; 52 (10) 1296-1305 , discussion 1306–1307
    PubMedSearch in Google Scholar
  • 113 Bach JR. Amyotrophic lateral sclerosis: prolongation of life by noninvasive respiratory AIDS. Chest 2002; 122 (01) 92-98
    CrossrefPubMedSearch in Google Scholar
  • 114 Gomez-Merino E, Bach JR. Duchenne muscular dystrophy: prolongation of life by noninvasive ventilation and mechanically assisted coughing. Am J Phys Med Rehabil 2002; 81 (06) 411-415
    CrossrefPubMedSearch in Google Scholar
  • 115 Sánchez-García M, Santos P, Rodríguez-Trigo G. et al. Preliminary experience on the safety and tolerability of mechanical “insufflation-exsufflation” in subjects with artificial airway. Intensive Care Med Exp 2018; 6 (01) 8
    CrossrefPubMedSearch in Google Scholar
  • 116 Ferreira de Camillis ML, Savi A, Goulart Rosa R. et al. Effects of mechanical insufflation-exsufflation on airway mucus clearance among mechanically ventilated ICU subjects. Respir Care 2018; 63 (12) 1471-1477
    CrossrefPubMedSearch in Google Scholar
  • 117 Coutinho WM, Vieira PJC, Kutchak FM, Dias AS, Rieder MM, Forgiarini Jr LA. Comparison of mechanical insufflation-exsufflation and endotracheal suctioning in mechanically ventilated patients: effects on respiratory mechanics, hemodynamics, and volume of secretions. Indian J Crit Care Med 2018; 22 (07) 485-490
    CrossrefPubMedSearch in Google Scholar
  • 118 Martínez-Alejos R, Martí JD, Li Bassi G. et al. Effects of mechanical insufflation-exsufflation on sputum volume in mechanically ventilated critically ill subjects. Respir Care 2021; 66 (09) 1371-1379
    CrossrefPubMedSearch in Google Scholar
  • 119 Guérin C, Bourdin G, Leray V. et al. Performance of the coughassist insufflation-exsufflation device in the presence of an endotracheal tube or tracheostomy tube: a bench study. Respir Care 2011; 56 (08) 1108-1114
    CrossrefPubMedSearch in Google Scholar
  • 120 Sancho J, Servera E, Marín J, Vergara P, Belda FJ, Bach JR. Effect of lung mechanics on mechanically assisted flows and volumes. Am J Phys Med Rehabil 2004; 83 (09) 698-703
    CrossrefPubMedSearch in Google Scholar
  • 121 Volpe MS, Naves JM, Ribeiro GG, Ruas G, Amato MBP. Airway clearance with an optimized mechanical insufflation-exsufflation maneuver. Respir Care 2018; 63 (10) 1214-1222
    CrossrefPubMedSearch in Google Scholar
  • 122 Branson RD, Benditt JO. Optimizing mechanical insufflation-exsufflation - much more than cough peak flow. Respir Care 2020; 65 (02) 265-268
    CrossrefPubMedSearch in Google Scholar
  • 123 American Association for Respiratory Care. AARC clinical practice guidelines. Endotracheal suctioning of mechanically ventilated patients with artificial airways 2010. Respir Care 2010; 55 (06) 758-764
    PubMedSearch in Google Scholar
  • 124 Maggiore SM, Lellouche F, Pignataro C. et al. Decreasing the adverse effects of endotracheal suctioning during mechanical ventilation by changing practice. Respir Care 2013; 58 (10) 1588-1597
    CrossrefPubMedSearch in Google Scholar
  • 125 Guglielminotti J, Alzieu M, Maury E, Guidet B, Offenstadt G. Bedside detection of retained tracheobronchial secretions in patients receiving mechanical ventilation: is it time for tracheal suctioning?. Chest 2000; 118 (04) 1095-1099
    CrossrefPubMedSearch in Google Scholar
  • 126 Vanner R, Bick E. Tracheal pressures during open suctioning. Anaesthesia 2008; 63 (03) 313-315
    CrossrefPubMedSearch in Google Scholar
  • 127 Russian CJ, Gonzales JF, Henry NR. Suction catheter size: an assessment and comparison of 3 different calculation methods. Respir Care 2014; 59 (01) 32-38
    CrossrefPubMedSearch in Google Scholar
  • 128 Oh H, Seo W. A meta-analysis of the effects of various interventions in preventing endotracheal suction-induced hypoxemia. J Clin Nurs 2003; 12 (06) 912-924
    CrossrefPubMedSearch in Google Scholar
  • 129 Van de Leur JP, Zwaveling JH, Loef BG, Van der Schans CP. Endotracheal suctioning versus minimally invasive airway suctioning in intubated patients: a prospective randomised controlled trial. Intensive Care Med 2003; 29 (03) 426-432
    CrossrefPubMedSearch in Google Scholar
  • 130 Caruso P, Denari S, Ruiz SAL, Demarzo SE, Deheinzelin D. Saline instillation before tracheal suctioning decreases the incidence of ventilator-associated pneumonia. Crit Care Med 2009; 37 (01) 32-38
    CrossrefPubMedSearch in Google Scholar
  • 131 Paratz JD, Stockton KA. Efficacy and safety of normal saline instillation: a systematic review. Physiotherapy 2009; 95 (04) 241-250
    CrossrefPubMedSearch in Google Scholar
  • 132 American Thoracic Society, Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005; 171 (04) 388-416
    CrossrefPubMedSearch in Google Scholar
  • 133 Bissett B, Leditschke IA, Green M, Marzano V, Collins S, Van Haren F. Inspiratory muscle training for intensive care patients: A multidisciplinary practical guide for clinicians. Aust Crit Care 2019; 32 (03) 249-255
    CrossrefPubMedSearch in Google Scholar
  • 134 Bissett B, Gosselink R, van Haren FMP. Respiratory muscle rehabilitation in patients with prolonged mechanical ventilation: a targeted approach. Crit Care 2020; 24 (01) 103
    CrossrefPubMedSearch in Google Scholar
  • 135 Goligher EC, Fan E, Herridge MS. et al. Evolution of diaphragm thickness during mechanical ventilation. impact of inspiratory effort. Am J Respir Crit Care Med 2015; 192 (09) 1080-1088
    CrossrefPubMedSearch in Google Scholar
  • 136 Goligher EC, Brochard LJ, Reid WD. et al. Diaphragmatic myotrauma: a mediator of prolonged ventilation and poor patient outcomes in acute respiratory failure. Lancet Respir Med 2019; 7 (01) 90-98
    CrossrefPubMedSearch in Google Scholar
  • 137 Schepens T, Dres M, Heunks L, Goligher EC. Diaphragm-protective mechanical ventilation. Curr Opin Crit Care 2019; 25 (01) 77-85
    CrossrefPubMedSearch in Google Scholar
  • 138 Vorona S, Sabatini U, Al-Maqbali S. et al. Inspiratory muscle rehabilitation in critically ill adults. A systematic review and meta-analysis. Ann Am Thorac Soc 2018; 15 (06) 735-744
    CrossrefPubMedSearch in Google Scholar
  • 139 da Silva Guimarães B, de Souza LC, Cordeiro HF. et al. Inspiratory muscle training with an electronic resistive loading device improves prolonged weaning outcomes in a randomized controlled trial. Crit Care Med 2021; 49 (04) 589-597
    CrossrefPubMedSearch in Google Scholar
  • 140 Van Hollebeke M, Gosselink R, Langer D. Training specificity of inspiratory muscle training methods: a randomized trial. Front Physiol 2020; 11: 576595
    CrossrefPubMedSearch in Google Scholar
  • 141 Van Hollebeke M, Poddighe D, Gojevic T. et al. Measurement validity of an electronic training device to assess breathing characteristics during inspiratory muscle training in patients with weaning difficulties. PLoS One 2021; 16 (08) e0255431
    CrossrefPubMedSearch in Google Scholar
  • 142 Wallace S, McGrath BA. Laryngeal complications after tracheal intubation and tracheostomy. BJA Educ 2021; 21 (07) 250-257
    CrossrefPubMedSearch in Google Scholar
  • 143 Sutt A-L, Caruana LR, Dunster KR, Cornwell PL, Anstey CM, Fraser JF. Speaking valves in tracheostomised ICU patients weaning off mechanical ventilation–do they facilitate lung recruitment?. Crit Care 2016; 20: 91
    CrossrefPubMedSearch in Google Scholar
  • 144 O'Connor LR, Morris N, Paratz J. The safety and efficacy of prolonged use of one-way speaking valves. Aust Crit Care 2021; 34 (04) 319-326
    CrossrefPubMedSearch in Google Scholar
  • 145 Li J, Perez A, Schehl J, Albers A, Husain IA. The association between upper airway patency and speaking valve trial tolerance for patients with tracheostomy: a clinical retrospective study and an in vitro study. Am J Speech Lang Pathol 2021; 30 (04) 1728-1736
    CrossrefPubMedSearch in Google Scholar
  • 146 O'Connor LR, Morris NR, Paratz J. Physiological and clinical outcomes associated with use of one-way speaking valves on tracheostomised patients: a systematic review. Heart Lung 2019; 48 (04) 356-364
    CrossrefPubMedSearch in Google Scholar
  • 147 Zaga CJ, Berney S, Vogel AP. The feasibility, utility, and safety of communication interventions with mechanically ventilated intensive care unit patients: a systematic review. Am J Speech Lang Pathol 2019; 28 (03) 1335-1355
    CrossrefPubMedSearch in Google Scholar
  • 148 Hoit JD, Banzett RB, Lohmeier HL, Hixon TJ, Brown R. Clinical ventilator adjustments that improve speech. Chest 2003; 124 (04) 1512-1521
    CrossrefPubMedSearch in Google Scholar
  • 149 Silva YR, Greer TA, Morgan LC, Li F, Farah CS. A comparison of 2 respiratory devices for sputum clearance in adults with non-cystic fibrosis bronchiectasis. Respir Care 2017; 62 (10) 1291-1297
    CrossrefPubMedSearch in Google Scholar
  • 150 Hansen LG, Warwick WJ, Hansen KL. Mucus transport mechanisms in relation to the effect of high frequency chest compression (HFCC) on mucus clearance. Pediatr Pulmonol 1994; 17 (02) 113-118
    CrossrefPubMedSearch in Google Scholar
  • 151 Tambascio J, de Souza LT, Lisboa RM, Passarelli RdeC, de Souza HC, Gastaldi AC. The influence of FlutterVRP1 components on mucus transport of patients with bronchiectasis. Respir Med 2011; 105 (09) 1316-1321
    CrossrefPubMedSearch in Google Scholar