Effects of expiratory ribcage compression before endotracheal suctioning on arterial blood gases in patients receiving mechanical ventilation

Aim and objectives: To investigate the effects of expiratory ribcage compression (ERCC) before endotracheal suctioning on the arterial blood gases (ABG) in patients receiving mechanical ventilation. Background: Endotracheal suctioning is one of the most frequently used methods for airway clearance in patients receiving mechanical ventilation. Chest physiotherapy techniques such as ERCC before endotracheal suctioning can be used as a means to facilitate mobilizing and removing airway secretions and improving alveolar ventilation. Design: A prospective, randomized, controlled cross-over design. Methods: A randomized controlled cross-over trial with a convenience sample of 70 mechanically ventilated patients was conducted from 2006 to 2007. The patients received endotracheal suctioning with (experiment-period) or without (control-period) an antecedent 5-min expiratory ribcage. All the patients experienced both periods with at least a 3-h washed-out interval between the two periods. ABG were measured 5 min before and 25 min after endotracheal suctioning. Results: The statistical tests showed that the levels of partial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO(2)), partial pressure of carbon dioxide (PaCO2) and arterial oxygen saturation (SaO(2)) in the experimental period at 25 min after the intervention were significantly different from the control period. The tests also revealed that the levels of these variables at 25 min after suctioning were also significantly different from baseline values. However, these differences were clinically significant only for PaO2/FiO(2). Conclusion: By improving the levels of PaO2/FiO(2), ERCC can reduce the patients' need for oxygen and hence it can at least reduce the side effects of oxygen therapy. Relevance to clinical practice: Improving PaO2/FiO(2) levels means less need for oxygen therapy. Hence, by applying ERCC we can at least minimize the side effects of oxygen therapy.