• Caio Ca Morais, Shirley L Campos, Catarina Sfr Lima, Lucas Jf Monte, BandeiraMonique C de PontesMCPPhysiotherapy Department, Universidade Federal de Pernambuco, Recife, Brazil., Daniella C Brandão, Eduardo Lv Costa, Andrea Aliverti, Marcelo Bp Amato, and AndradeArmèle Dornelas deADPhysiotherapy Department, Universidade Federal de Pernambuco, Recife, Brazil. armeledornelas@yahoo.com armele.andrade@ufpe.br..
• Physiotherapy Department, Universidade Federal de Pernambuco, Recife, Brazil.
• Respir Care. 2021 Feb 1; 66 (2): 240247240-247.

BackgroundPatients with decreased consciousness are prone to prolonged bed rest and respiratory complications. If effective in reducing atelectasis, lung expansion maneuvers could be used to prevent these complications. In comatose, bedridden subjects, we aimed to assess the acute effect on regional lung aeration of 2 lung expansion techniques: expiratory positive airway pressure and the breath-stacking maneuver. Our secondary aim was to evaluate the influence of these lung expansion techniques on regional ventilation distribution, regional ventilation kinetics, respiratory pattern, and cardiovascular system.MethodsWe enrolled 10 subjects status post neurosurgery, unable to follow commands, and with prolonged bed rest. All subjects were submitted to both expansion techniques in a randomized order. Regional lung aeration, ventilation distribution, and regional ventilation kinetics were measured with electrical impedance tomography.ResultsLung aeration increased significantly during the application of both expiratory positive airway pressure and breath-stacking (P < .001) but returned to baseline values seconds afterwards. The posterior lung regions had the largest volume increase (P < .001 for groups). Both maneuvers induced asynchronous inflation and deflation between anterior and posterior lung regions. There were no significant differences in cardiovascular variables.ConclusionsIn comatose subjects with prolonged bed rest, expiratory positive airway pressure and breath-stacking promoted brief increases in lung aeration. (ClinicalTrials.gov registration NCT02613832.).Copyright © 2021 by Daedalus Enterprises.

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