![]() ![]() Respecto al resto de técnicas existe mayor controversia. Las técnicas de FR que han demostrado mejores resultados son la ventilación mecánica no invasiva para el paciente no intubado y la hiperinsuflación manual para el paciente intubado. El resto de métodos de FR aplicados de forma aislada no han demostrado una clara eficacia. En el paciente intubado, la hiperinsuflación manual y la aspiración de secreciones son métodos eficaces para la prevención de complicaciones respiratorias. En cambio, la ventilación mecánica no invasiva muestra clara evidencia de su beneficio. Las técnicas de expansión pulmonar, tos, vibración, percusión, drenaje postural, espirometría incentivada y los sistemas oscilatorios y no oscilatorios presentan controversia en cuanto a la eficacia como método de fisioterapia respiratoria. Los límites fueron el idioma, la evidencia de los últimos 15 años y la edad. ![]() Se llevó a cabo una revisión narrativa de la literatura en las bases de datos Pubmed, Cinahl y Cochrane Library. Por ello se realizó esta revisión bibliográfica, con el objetivo de describir los métodos de FR más eficaces para la prevención y tratamiento de las complicaciones pulmonares en los pacientes ingresados en unidades de cuidados intensivos, diferenciando paciente intubado y no intubado. La principal intervención para prevenirlas y tratarlas es la fisioterapia respiratoria (FR), práctica habitual en el día a día de enfermería. Los pacientes ingresados en unidades de cuidados intensivos son susceptibles de complicaciones pulmonares por múltiples causas (enfermedad de base, inmovilización, riesgo de infección, etc.). In future research, more precise descriptions are needed about physiological aims and specific instructions of how the treatments have been performed to assure as good treatment quality as possible and to be able to evaluate and compare treatment effects. There is no consensus regarding optimal treatment frequency and number of cycles included in each treatment session and must also be individualized. Based on the information given in this article the instructions have to be adjusted to give the optimal effect. As the different PEP techniques are being used by diverse patient groups it is not possible to give standard instructions. It is therefore necessary to give the right instructions to obtain the desired effects. Different breathing patterns during PEP increase or reduce expiratory flow, result in movement of EPP centrally or peripherally and can increase or decrease lung volume. In clinical practice, the instruction how to use an expiratory resistance is of major importance since it varies. The aim of this article is to describe the purpose, performance, clinical application and underlying physiology of PEP when it is used to increase lung volumes, decrease hyperinflation or improve airway clearance. Effects on pulmonary outcomes have been discussed in several publications, but the expected underlying physiology of the effect is seldom discussed. Pursed lips breathing and a variety of devices can be used to create the resistance giving the increased expiratory pressure. ![]() ![]() The use of the Flutter Valve in mechanically ventilated patients with respiratory infection increased the removal of lung secretions, mucus production, static compliance of the respiratory system, and arterial oxygenation without showing clinically relevant adverse hemodynamic effects.īreathing out against resistance, in order to achieve positive expiratory pressure (PEP), is applied by many patient groups. Our results demonstrated that two 15-minute series of FLUTTER intervention followed by tracheal suctioning increased static compliance of the respiratory system, arterial oxygenation, secretion removal, and PF, without producing significant hemodynamic alterations. To our knowledge, there is no study addressing the use of Flutter Valve in mechanically ventilated patients. No significant differences were observed in baseline respiratory mechanics (Cst,rs, Rrs, Rinit,rs, PF, and expiratory flow at 75% of tidal volume [Flow Discussion There was a higher secretion production in the FLUTTER intervention (5.1 ±. Table 2 shows the clinical data of the participants. All enrolled subjects completed the study and tolerated the experimental protocol. The data from 20 patients were collected between February 2008 and July 2009. The protocol was approved by the university ethics committee in clinical research, and informed consent was obtained from each patient’s next of kin in all instances (in addition to the Sample Characteristics The study took place at the adult intensive care service of a tertiary referral hospital between February 2008 and August 2009. We carried out a randomized crossover study to test the hypothesis that the Flutter Valve can improve respiratory mechanics and sputum production in mechanically ventilated patients. ![]()
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