Avena et al.(2020 Avena KM, Duarte AC, Cravo SL, Sologuren MJ, Gastaldi AC. [Effects of manually assisted coughing on respiratory mechanics in patients requiring full ventilatory support]. J Bras Pneumol. 2008;34(6):380-6. Portuguese.) |
Prospective randomized study |
16 mechanically ventilated patients |
Hard and brief RCC |
No differences in peak inspiratory pressure, plateau pressure, dynamic or static compliance Decrease in pulmonary and airway resistances, as well as an increase in oxygen saturation |
No airflow measurement, volume of secretions or relation between ventilatory setting and RCC was reported |
Unoki et al.(2121 Unoki T, Mizutani T, Toyooka H. Effects of expiratory rib cage compression and/or prone position on oxygenation and ventilation in mechanically ventilated rabbits with induced atelectasis. Respir Care. 2003;48(8):75462.) |
Prospective randomized study |
40 mechanically ventilated rabbits with induced atelectasis |
Soft and gradual RCC |
No improvement on oxygenation, dynamic compliance, or mucus output |
No airflow measurement |
Kohan et al.(2323 Kohan M, Rezaei-Adaryani M, Najaf-Yarandi A, Hoseini F, MohammadTaheri N. Effects of expiratory ribcage compression before endotracheal suctioning on arterial blood gases in patients receiving mechanical ventilation. Nurs Crit Care. 2014;19(5):255-61.) |
Randomized crossover trial |
70 mechanically ventilated patients |
Soft and gradual RCC |
Gas exchange was significantly different from the baseline RCC determined a significant improvement in oxygenation |
The patients’ respiratory pathophysiologies were not uniform |
Bousarri et al.(2424 Bousarri MP, Shirvani Y, Agha-Hassan-Kashani S, Nasab NM. The effect of expiratory rib cage compression before endotracheal suctioning on the vital signs in patients under mechanical ventilation. Iran J Nurs Midwifery Res. 2014;19(3):285-9.) |
Randomized crossover trial |
50 mechanically ventilated patients |
Soft and gradual RCC |
An increase in vital signs within a normal range |
No limitation or any complication was reported |
Unoki et al.(2525 Unoki T, Kawasaki Y, Mizutani T, Fujino Y, Yanagisawa Y, Ishimatsu S, et al. Effects of expiratory rib-cage compression on oxygenation, ventilation, and airway-secretion removal in patients receiving mechanical ventilation. Respir Care. 2005;50(11):1430-7.) |
Randomized crossover trial |
31 mechanically ventilated patients |
Soft and gradual RCC |
No significant differences in gas exchange, dynamic compliance, and secretion removal |
The patients’ respiratory pathophysiology which led to mechanical ventilation was not uniform |
Martí et al.(2626 Martí JD, Li Bassi G, Rigol M, Saucedo L, Ranzani OT, Esperatti M, et al. Effects of manual rib cage compressions on expiratory flow and mucus clearance during mechanical ventilation. Crit Care Med. 2013;41(3):850-6.) |
Prospective randomized study |
9 mechanically ventilated pigs. |
Hard and brief RCC Soft and gradual RCC |
With hard RCC greater mean expiratory flow and mucus moved toward the glottis With soft RCC mucus moved toward the lungs |
The interventions were conducted by a single respiratory physiotherapist |
Unoki et al.(3838 Unoki T, Mizutani T, Toyooka H. Effects of expiratory rib cage compression combined with endotracheal suctioning on gas exchange in mechanically ventilated rabbits with induced atelectasis. Respir Care. 2004;49(8):896901.) |
Prospective randomized study |
24 mechanically ventilated rabbits with induced atelectasis |
Soft and gradual RCC |
Oxygenation, ventilation, and compliance were significantly worse No significant differences in the weight of aspirated artificial mucus |
Along with RCC, a PEEP zero intervention was added Anatomic and physiologic differences between rabbits and humans |
Ouchi et al.(3939 Ouchi A, Sakuramoto H, Unoki T, Yoshino Y, Hosino H, Koyama Y, et al. Effects of manual rib cage compressions on mucus clearance in mechanically ventilated pigs. Respir Care. 2020;65(8):1135-40.) |
Prospective randomized study |
15 mechanically ventilated pigs with induced atelectasis |
Hard and brief RCC |
Greater peak expiratory flow and mucus removal Not improve in gas exchange or radiologic findings |
The diagnosis of atelectasis may have lacked optimal sensitivity |
Sixel et al.(4343 Guimarães FS, Lopes AJ, Constantino SS, Lima JC, Canuto P, de Menezes SL. Expiratory rib cage compression in mechanically ventilated subjects: a randomized crossover trial. Respir Care. 2014;59(5):678-85.) |
Randomized crossover trial |
20 mechanically ventilated patients with pulmonary infection |
Soft and gradual RCC (none explicated) |
34.4% more secretions cleared No differences in static or effective compliance, total or initial resistance PEF and expiratory flow at 30% of expiratory tidal volume significatively increased |
Effect size was small for secretion removal and compliance, and negligible for resistance Six subjects presented expiratory flow limitation |
Gonçalves et al.(4444 Gonçalves EC, Souza HC, Tambascio J, Almeida MB, Basile Filho A, Gastaldi AC. Effects of chest compression on secretion removal, lung mechanics, and gas exchange in mechanically ventilated patients: a crossover, randomized study. Intensive Care Med. 2016;42(2):295-6.) |
Randomized crossover trial |
30 mechanically ventilated patients |
Hard and brief RCC (none explicated) |
More secretions were removed. No difference for gas exchange or pulmonary mechanics |
No detailed intervention neither the number of subjects in each group of analysis were provided |