{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T14:48:19Z","timestamp":1790261299670,"version":"4.1.0"},"reference-count":36,"publisher":"FapUNIFESP (SciELO)","issue":"3","license":[{"start":{"date-parts":[[2019,1,1]],"date-time":"2019-01-01T00:00:00Z","timestamp":1546300800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2019,1,1]],"date-time":"2019-01-01T00:00:00Z","timestamp":1546300800000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2019,1,1]],"date-time":"2019-01-01T00:00:00Z","timestamp":1546300800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. bras. pneumol."],"abstract":"<jats:p>ABSTRACT  Objective: To investigate the effects of manual chest compression (MCC) on the expiratory flow bias during the positive end-expiratory pressure-zero end-expiratory pressure (PEEP-ZEEP) airway clearance maneuver applied in patients on mechanical ventilation. The flow bias, which influences pulmonary secretion removal, is evaluated by the ratio and difference between the peak expiratory flow (PEF) and the peak inspiratory flow (PIF).  Methods: This was a crossover randomized study involving 10 patients. The PEEP-ZEEP maneuver was applied at four time points, one without MCC and the other three with MCC, which were performed by three different respiratory therapists. Respiratory mechanics data were obtained with a specific monitor.  Results: The PEEP-ZEEP maneuver without MCC was enough to exceed the threshold that is considered necessary to move secretion toward the glottis (PEF \u2212 PIF difference &gt; 33 L\/min): a mean PEF \u2212 PIF difference of 49.1 \u00b1 9.4 L\/min was achieved. The mean PEF\/PIF ratio achieved was 3.3 \u00b1 0.7. Using MCC with PEEP-ZEEP increased the mean PEF \u2212 PIF difference by 6.7 \u00b1 3.4 L\/min. We found a moderate correlation between respiratory therapist hand grip strength and the flow bias generated with MCC. No adverse hemodynamic or respiratory effects were found.  Conclusions: The PEEP-ZEEP maneuver, without MCC, resulted in an expiratory flow bias superior to that necessary to facilitate pulmonary secretion removal. Combining MCC with the PEEP-ZEEP maneuver increased the expiratory flow bias, which increases the potential of the maneuver to remove secretions.<\/jats:p>","DOI":"10.1590\/1806-3713\/e20180058","type":"journal-article","created":{"date-parts":[[2019,3,9]],"date-time":"2019-03-09T19:18:19Z","timestamp":1552159099000},"source":"Crossref","is-referenced-by-count":16,"title":["Effects of manual chest compression on expiratory flow bias during the positive end-expiratory pressure-zero end-expiratory pressure maneuver in patients on mechanical ventilation"],"prefix":"10.1590","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2752-6497","authenticated-orcid":false,"given":"Ana Carolina Otoni","family":"Oliveira","sequence":"first","affiliation":[{"name":"Universidade Federal do Tri\u00e2ngulo Mineiro,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4193-7946","authenticated-orcid":false,"given":"Daiane Menezes","family":"Lorena","sequence":"additional","affiliation":[{"name":"Universidade Federal do Tri\u00e2ngulo Mineiro,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7244-2973","authenticated-orcid":false,"given":"L\u00edvia Corr\u00eaa","family":"Gomes","sequence":"additional","affiliation":[{"name":"Universidade Federal do Tri\u00e2ngulo Mineiro,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3794-3366","authenticated-orcid":false,"given":"Bianca Lorrane Reges","family":"Amaral","sequence":"additional","affiliation":[{"name":"Universidade Federal do Tri\u00e2ngulo Mineiro,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1179-6254","authenticated-orcid":false,"given":"M\u00e1rcia Souza","family":"Volpe","sequence":"additional","affiliation":[{"name":"Universidade Federal de S\u00e3o Paulo,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"530","published-online":{"date-parts":[[2019]]},"reference":[{"issue":"10","key":"ref1","first-page":"1328","article-title":"Secretion management in the mechanically ventilated patient","volume":"52","author":"Branson RD","year":"2007","journal-title":"Respir Care"},{"issue":"6","key":"ref2","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1378\/chest.68.6.774","article-title":"Effect of cuffed endotracheal tubes on tracheal mucous velocity","volume":"68","author":"Sackner MA","year":"1975","journal-title":"Chest"},{"issue":"2","key":"ref3","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1097\/01.CCM.0000299741.32078.E9","article-title":"Following tracheal intubation, mucus flow is reversed in the semirecumbent position possible role in the pathogenesis of ventilator-associated pneumonia","volume":"36","author":"Li Bassi G","year":"2008","journal-title":"Crit Care 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of manual rib-cage compression versus PEEP-ZEEP maneuver on respiratory system compliance and oxygenation in patients receiving mechanical ventilation","volume":"21","author":"Santos FR","year":"2009","journal-title":"Rev Bras Ter Intensiva"},{"issue":"2","key":"ref15","first-page":"186","article-title":"Applicability of bag squeezing and zeep maneuvers in mechanically ventilated patients","volume":"22","author":"Lobo DM","year":"2010","journal-title":"Rev Bras Ter Intensiva"},{"issue":"4","key":"ref16","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1197\/S0894-1130(03)00154-6","article-title":"Figure-of-eight method of measuring hand size reliability and concurrent validity","volume":"16","author":"Pellecchia GL","year":"2003","journal-title":"J Hand Ther"},{"issue":"3","key":"ref17","first-page":"209","article-title":"Hand grip strength evaluation methods and factors influencing this measure","volume":"12","author":"Dias JA","year":"2010","journal-title":"Rev Bras 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