Effects of Expiratory Rib-Cage Compression on Oxygenation, Ventilation, and Airway-Secretion Removal in Patients Receiving Mechanical Ventilation

BACKGROUND: Expiratory rib-cage compression, a chest physiotherapy technique, is well known as the “squeezing” technique in Japan.

OBJECTIVE: To determine the effects of rib-cage compression on airway-secretion removal, oxygenation, and ventilation in patients receiving mechanical ventilation.

SETTING: An intensive care unit of an emergency and critical care center at a tertiary-care teaching hospital in Tokyo, Japan.

METHODS: Thirty-one intubated, mechanically ventilated patients in an intensive care unit were studied in a randomized, crossover trial. The patients received endotracheal suctioning with or without rib-cage compression, with a minimum 3-hour interval between the 2 interventions. Rib-cage compression was performed for 5 min before endotracheal suctioning. Arterial blood gas and respiratory mechanics were measured 5 min before endotracheal suctioning (baseline) and 25 min after suctioning. The 2 measurement periods were carried out on the same day.

RESULTS: There were no significant differences in the ratio of arterial partial pressure of oxygen to fraction of inspired oxygen, P_aCO2, or dynamic compliance of the respiratory system between the 2 periods (before and after endotracheal suctioning). Moreover, there were no significant differences in airway-secretion removal between the 2 periods.

CONCLUSIONS: This study suggests that rib-cage compression prior to endotracheal suctioning does not improve airway-secretion removal, oxygenation, or ventilation after endotracheal suctioning in this unselected population of mechanically ventilated patients.