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SPCI - Sociedade Portuguesa de Cuidados Intensivos

Revista Brasileira de Terapia Intensiva

AMIB - Associação de Medicina Intensiva Brasileira

OFFICIAL JOURNAL OF THE ASSOCIAÇÃO BRASILEIRA DE MEDICINA INTENSIVA AND THE SOCIEDADE PORTUGUESA DE CUIDADOS INTENSIVOS

ISSN: 0103-507X
Online ISSN: 1982-4335

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Naue WS, Herve BB, Vieira FN, Deponti GN, Martins LF, Dias AS, et al. Resposta para: Comparação entre técnicas de higiene brônquica em pacientes mecanicamente ventilados: ensaio clínico randomizado. Rev Bras Ter Intensiva. 2019;31(4):596-597

 

 

2019 2019;31(4):596-597
AUTHORS'' RESPONSE

10.5935/0103-507X.20190081

Reply to: Comparison of bronchial hygiene techniques in mechanically ventilated patients: a randomized clinical trial

Resposta para: Comparação entre técnicas de higiene brônquica em pacientes mecanicamente ventilados: ensaio clínico randomizado

Wagner da Silva Naue1, Bruno Barcelos Herve1, Fernando Nataniel Vieira1, Gracieli Nadalon Deponti1, Luciane de Fraga Martins1, Alexandre Simões Dias1, Silvia Regina Rios Vieira1

1 Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brazil.

Corresponding author: Wagner da Silva Naue, Serviço de Fisioterapia do Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2.350 - Santa Cecília, Zip code: 90035-007 - Porto Alegre (RS), Brazil, E-mail: [email protected]

 

To the Editor

The authors would like to express their gratitude for the comments and for the opportunity to clarify the details of the study published in the Revista Brasileira de Terapia Intensiva .(1) With respect to the perception that aspiration alone was more effective than pressure-controlled hyperinflation, it is important to note that hyperinflation was performed with an inspiratory time of 1.67 seconds and an inspiratory/expiratory ratio of 1/2 (as described in the methodology) to decrease the peak inspiratory flow relative to the peak expiratory flow and to avoid auto-PEEP. In addition, while studies in the laboratory using lung simulators and animal models suggest that volume-controlled ventilation is more effective for hyperinflation and control of the inspiratory rise time,(2,3) these models differ greatly from the sample of our study. Previous studies used ventilatory modes in which patients were ventilated with pressure-supported ventilation,(4,05) thus justifying the choice of this ventilatory mode for hyperinflation.

The randomization of the study may have caused some confusion; however, the study was not a crossover clinical trial. The crossover of aspiration with the hyperinflation technique (hyperinflation with mechanical ventilator, vibrocompression and hyperinflation with mechanical ventilator associated with vibrocompression) was performed only in the first 24 hours, according to the methodology described in the study, to evaluate the outcome of aspirated pulmonary secretion. After this period, the selected hyperinflation technique was performed, and the patients underwent mechanical ventilation twice a day until extubation or death.

We also emphasize that additional studies comparing different ventilatory modes of pulmonary hyperinflation in patients under mechanical ventilation are necessary to clarify this point.

REFERENCES

Naue WS, Herve BB, Vieira FN, Deponti GN, Martins LF, Dias AS, et al. Comparison of bronchial hygiene techniques in mechanically ventilated patients: a randomized clinical trial. Rev Bras Ter Intensiva. 2019;31(1):39-46. Link DOILink PubMed
Volpe MS, Adams AB, Amato MB, Marini JJ. Ventilation patterns influence airway secretion movement. Respir Care. 2008;53(10):1287-94. Link PubMed
Thomas PJ. The effect of mechanical ventilator settings during ventilator hyperinflation techniques: a bench-top analysis. Anaesth Intensive Care. 2015;43(1):81-7. Link DOILink PubMed
Lemes DA, Zin WA, Guimarães 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(4):249-54. Link DOILink PubMed
Naue WS, Forgiarini Junior LA, Dias AS, Vieira SR. Chest compression with a higher level of pressure support ventilation: effects on secretion removal, hemodynamics, and respiratory mechanics in patients on mechanical ventilation. J Bras Pneumol. 2014;40(1):55-60. Link DOI

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