A comparison between positive and negative pressure oscillation in airway clearance chest physiotherapy for obese patients under mechanical ventilation: a cross-sectional study
Mots-clés :
airway secretion, secretion clearance, chest physiotherapy, physiotherapy, mechanical ventilation, high frequency oscillation.Résumé
Introduction: Airway clearance chest physiotherapy for patients under mechanical ventilation can use positive pressure oscillation (PPO) or negative pressure oscillation (NPO) therapy. This study compared these two therapies for obese patients.
Methods: Eight patients with body mass index ? 25, under mechanical ventilation, and suffering from retained airway secretions were included. In this crossover trial, the subjects were randomly assigned to receive either PPO or NPO therapy for 30 min; after six h, each subject received the other therapy.
Measurements and mais results: Both therapies significantly improved the arterial oxygen tension/inspired oxygen fraction (P/F) ratio (PPO: 276.2 (24.4) to 305.2 (21.3), P = 0.014; NPO: 273.5 (21.0) to 277.5 (18.2), P = 0.039) and tidal volume (Vt) (PPO: 439.5 (28.8) to 457.6 (28.3) mL, P = 0.008; NPO: 456.6 (24.7) to 461.9 (24.5) mL, P = 0.021). PaCO2 decreased significantly with PPO (43.2 (2.3) to 41.8 (2.1) mmHg, P = 0.008). Compared to NPO, PPO improved more in the P/F ratio (10.9% vs. 4.5%, P = 0.028), Vt (5.4% vs. 1.3%, P = 0.038) and PaCO2 (2.7% vs. 0.8%, P = 0.036).
Conclusions: Airway clearance chest physiotherapy with PPO is more effective for obese
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