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Randomized Controlled Trial
. 2014 Apr-Jun;26(2):163-8.
doi: 10.5935/0103-507x.20140024.

Comparative analysis between the alveolar recruitment maneuver and breath stacking technique in patients with acute lung injury

[Article in English, Portuguese]
Elias Ferreira Porto  1 , Kelly Cristiani Tavolaro  1 , Claudia Kumpel  1 , Fernanda Augusta Oliveira  1 , Juciaria Ferreira Sousa  1 , Graciele Vieira de Carvalho  1 , Antonio Adolfo Mattos de Castro  1
Affiliations
Randomized Controlled Trial

Comparative analysis between the alveolar recruitment maneuver and breath stacking technique in patients with acute lung injury

[Article in English, Portuguese]
Elias Ferreira Porto et al. Rev Bras Ter Intensiva. 2014 Apr-Jun.

Abstract
in English, Portuguese

Objective: To compare the effectiveness of the alveolar recruitment maneuver and the breath stacking technique with respect to lung mechanics and gas exchange in patients with acute lung injury.

Methods: Thirty patients were distributed into two groups: Group 1 - breath stacking; and Group 2 - alveolar recruitment maneuver. After undergoing conventional physical therapy, all patients received both treatments with an interval of 1 day between them. In the first group, the breath stacking technique was used initially, and subsequently, the alveolar recruitment maneuver was applied. Group 2 patients were initially subjected to alveolar recruitment, followed by the breath stacking technique. Measurements of lung compliance and airway resistance were evaluated before and after the use of both techniques. Gas analyses were collected before and after the techniques were used to evaluate oxygenation and gas exchange.

Results: Both groups had a significant increase in static compliance after breath stacking (p=0.021) and alveolar recruitment (p=0.03), but with no significant differences between the groups (p=0.95). The dynamic compliance did not increase for the breath stacking (p=0.22) and alveolar recruitment (p=0.074) groups, with no significant difference between the groups (p=0.11). The airway resistance did not decrease for either groups, i.e., breath stacking (p=0.91) and alveolar recruitment (p=0.82), with no significant difference between the groups (p=0.39). The partial pressure of oxygen increased significantly after breath stacking (p=0.013) and alveolar recruitment (p=0.04), but there was no significant difference between the groups (p=0.073). The alveolar-arterial O2 difference decreased for both groups after the breath stacking (p=0.025) and alveolar recruitment (p=0.03) interventions, and there was no significant difference between the groups (p=0.81).

Conclusion: Our data suggest that the breath stacking and alveolar recruitment techniques are effective in improving the lung mechanics and gas exchange in patients with acute lung injury.

Objetivo: Comparar a eficácia da manobra de recrutamento alveolar e a técnica de breath stacking, na mecânica pulmonar e na troca gasosa, em pacientes com lesão pulmonar aguda.

Métodos: Trinta pacientes foram distribuídos em dois grupos: Grupo 1 - breath stacking e Grupo 2 - manobra de recrutamento alveolar. Após receberem atendimento de fisioterapia convencional, todos os pacientes receberam ambos os tratamentos, com intervalo de 1 dia entre eles. No primeiro grupo foi aplicada primeiramente a técnica de breath stacking e, posteriormente, a manobra de recrutamento alveolar. Já os pacientes do segundo Grupo 2 foram submetidos inicialmente ao recrutamento alveolar e, após, a técnica de breath stacking. Foram avaliadas as medidas de complacência pulmonar e de resistência de vias aéreas antes e após a aplicação de ambas as técnicas. Foram coletadas gasometrias arteriais pré e pós-técnicas para avaliar a oxigenação e a troca gasosa.

Resultados: Ambos os grupos apresentaram aumento significativo da complacência estática após breath stacking (p=0,021) e recrutamento alveolar (p=0,03), mas não houve diferença entre eles (p=0,95). A complacência dinâmica não aumentou para os grupos breath stacking (p=0,22) e recrutamento alveolar (p=0,074), sem diferença entre os grupos (p=0,11). A resistência de vias aéreas não diminuiu para ambos os grupos: breath stacking (p=0,91) e recrutamento alveolar (0,82), sem diferença entre os grupos p=0,39. A pressão parcial de oxigênio aumentou significantemente após breath stacking (p=0,013) e recrutamento alveolar (p=0,04); mas entre os grupos não houve diferença (p=0,073). A diferença alvéolo arterial de O2 diminuiu para ambos os grupos após intervenções breath stacking (p=0,025) e recrutamento alveolar (p=0,03), não sendo diferente entre os grupos (p=0,81).

Conclusão: Nossos dados sugerem que as técnicas breath stacking e de recrutamento alveolar são eficazes em melhorar a mecânica pulmonar e a troca gasosa em pacientes com lesão pulmonar aguda.

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Conflict of interest statement

Conflicts of interest: None.

Figures

Figure 1
Figure 1
Evaluation of static compliance of the respiratory system for the pre- and post-intervention groups. Cst - static compliance.
Figure 2
Figure 2
Evaluation of the arterial oxygen pressure in the pre- and post-intervention groups. PaO2 - partial pressure of oxygen.
Figure 3
Figure 3
Distribution of the alveolar-arterial O2 difference at two time points: before and after application of the techniques in groups I and II.
See this image and copyright information in PMC

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