Airway Clearance Strategies in Mechanically Ventilated Patients

Effective clearance of bronchial secretions is crucial in patients receiving invasive mechanical ventilation to prevent atelectasis, maintain adequate gas exchange and reduce ventilator‐associated complications. Physiotherapeutic approaches range from manual techniques, such as manual hyperinflation and vibrocompression, to ventilator‐based methods, including ventilator hyperinflation and specialised pressure cycling manoeuvres. Suctioning remains the principal method for direct removal of secretions, yet adjunctive strategies aim to mobilise secretions into larger airways before aspiration. Lung recruitment manoeuvres and adjustments in positive end‐expiratory pressure (PEEP) may restore aeration lost during suctioning and promote homogeneous ventilation. Optimal application requires careful balance between inspiratory pressures, inspiratory time and patient safety. Current practice increasingly emphasises evidence-based protocols and tailored combinations of techniques to enhance secretion mobilisation, preserve respiratory mechanics and mitigate haemodynamic disturbance.

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Airway Clearance Strategies in Mechanically Ventilated Patients publication trend

The graph below shows the total number of articles in airway clearance strategies in mechanically ventilated patients across all publications each year (not limited to Nature Index journals).

Technical terms

Mechanical ventilation: Invasive respiratory support delivered via an endotracheal or tracheostomy tube connected to a ventilator.

Manual hyperinflation: Hand‐delivered breaths using a self-inflating bag to generate high tidal volumes for secretion mobilisation.

Ventilator hyperinflation: Adjusting ventilator settings to increase tidal volume or inspiratory pressure transiently for bronchial hygiene.

PEEP-ZEEP manoeuvre: Sequential elevation of positive end-expiratory pressure followed by rapid reduction to zero to create a flow bias favouring secretion movement.

Secretion clearance: Removal of mucus from the airways through manual, mechanical or suctioning methods.

Lung recruitment manoeuvre: Short-lasting increase in airway pressure to reopen collapsed alveoli and improve oxygenation.

Expiratory flow bias: A state where peak expiratory flow exceeds peak inspiratory flow, promoting proximal movement of secretions.

References

1. PEEP-ZEEP Compared with Bag Squeezing and Chest Compression in Mechanically Ventilated Cardiac Patients: Randomized Crossover Clinical Trial. International Journal of Environmental Research and Public Health (2023).
2. Lung recruitment manoeuvres are effective in regaining lung volume and oxygenation after open endotracheal suctioning in acute respiratory distress syndrome. Critical Care (2002).
3. Development of a clinical practice guideline for physiotherapy management of adults invasively ventilated with community-acquired pneumonia. Physiotherapy (2023).
4. Manual and ventilator hyperinflation parameters used by intensive care physiotherapists in Sri Lanka: An online survey. PLOS ONE (2024).