Lung Recruitment During Chest Physiotherapy in Mechanically Ventilated Patients
Trial Parameters
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Brief Summary
In intensive care, respiratory physiotherapy is an integral part of the daily care of patients under invasive mechanical ventilation. Its goals are to improve the clearance of bronchial secretions to allow for the resolution of atelectasis and alveolar recruitment, thereby enhancing respiratory mechanics and gas exchange. The most widespread technique in France is external expiratory compression of the chest. The effectiveness of this technique depends on the selection of patients (it seems to be more effective in patients with higher secretion levels) and on the practical implementation of the technique (favoring brief and vigorous compressions at the beginning of expiration). However, the effect of the artificial ventilator settings, particularly the ventilatory mode used during the respiratory physiotherapy session, has never been evaluated. The two most commonly used ventilatory modes worldwide are Volume Assist Control Ventilation (V-ACV) and pressure support ventilation (PSV). In this unit, respiratory physiotherapy under artificial ventilation is performed daily on patients with artificial ventilation with abundant secretions, regardless of the ventilatory mode.
Eligibility Criteria
Inclusion Criteria: * Patient under assisted ventilation (in V-ACV or PSV) triggering all ventilator cycles * Patient deemed " secretive ": requiring ≥ 2 tracheal aspirations every 3 hours * Patient (or relative) who has given consent to participate in the research * Patient covered by social security Exclusion Criteria: * Age under 18 years * Legal guardian required * Recent cardiac and/or thoracic and/or abdominal surgery (\< 3 months) * Rib fracture(s) * Pneumothorax and/or presence of a chest drain * Recent neurosurgery (\< 3 months) and/or proven or suspected increased intracranial pressure (ICP) * Hemodynamic instability defined as: noradrenaline ≥ 1mg/h, adrenaline ≥ 0.5 mg/h, dobutamine ≥ 5γ/kg/min. * Respiratory instability defined as: PEEP \> 10 cmH2O and/or PaO2/FiO2 \< 150 mm Hg * Pregnancy * Hemoptysis * Sever skin lesions (e.g., burns, Lyell's syndrome) * Patient under foreign health insurance