Abstract

Background: Lung expansion techniques (LETs) are a key component of pulmonary rehabilitation. Nevertheless, these can be limited in tracheostomized patients because of the infraglottic position of tracheostomy cannulas. We propose a novel pulmonary re-expansion device (PED) allows deep inspiration with a post-inspiratory pause for a few seconds by means of a unidirectional valve and an occlusion/flow release cap. Is equipped with a relief valve that opens at 60 cm H2O in cases in which this threshold is attained. We aimed to evaluate the impact on lung volume and pressure in spontaneously breathing tracheostomized patients subjected to LETs. A single-arm pilot interventional study was conducted in an adult intensive care unit, including spontaneously breathing tracheostomized patients. Findings: 80 treatments were performed on 10 patients with tracheostomies with PED over a period of 3 months. The maximal inspiratory volume (MIV) was significantly increased by using PED (MIV-PED) at both day 1 (725 [600 - 820] mL vs. 1,550 [1,250 - 1,700] mL, P < .001) and day 3 [870 [750 - 950] mL vs. 1,662 [1,550 - 1,900] mL, P < .001). Inspiratory pause pressure (PIP -PED) did not significantly change from day 1 to day 3 (18 [14 - 20] cm H2O vs. 14 [12 - 22] cm H2O, P = 0.36). The use of the PED in tracheostomy patients acted as an artificial glottis by performing a novel pulmonary re-expansion maneuver, increased volumes and intrapulmonary pressure with prolongation of maximum inspiration were achieved.

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