Vibratory Massage in Mechanically Ventilated Patients. A Pilot Study on Heart- and Lung-Transplanted Patients and Patients with Coronary Artery Bypass Grafting

Author(s): Fieguth, H., Stevernagel, B., Brix, J., Konitzer, M., Schneider, B., Fischer, G.

Abstract: Introduction: The manual vibratory massage is part of the pneumotherapeutic concept besides autogenic drainage, the thorax-extend positioning, the 'pursed lips', pack grips and special exercises applied to improve the costo-abdominal and costo-sternal mechanism of respiration.Objective: Our aim was to examine the influence of manual vibratory massage on the respiratory situation of postoperative patients under mechanical ventilation with special interest on pulmonary ventilation and perfusion and cerebral blood flow velocity. Material and Methods: Manual vibratory massage was carried out postoperatively at the intensive care unit on eight patients: 3 patients had undergone a heart transplantation, 3 a lung Transplantation and 2 a coronary artery bypass grafting (mean age: 53.6±8 years). With the aid of continuous monitoring we examined the changes of the respiration parameters and the cerebral blood flow velocity (measured by transcranial Doppler sonography). The vibratory massage was carried out with a frequency of 8-10/s for 15 min, 71/2 min on each side of the thorax, starting from the lower and progressing to the upper costal arch. 10 min before, during and 10 min after the massage, the parameters peripheral oxygen saturation, central venous pressure, mean arterial pressure, heart rate, lung resistance and compliance, tidal volume, respiration rate and cerebral blood flow velocity were recorded at two-minute intervals. Moreover, before and after vibratory massage arterial blood gases were determined. In four of the eight patients, it was possible to determine pulmonary arterial pressure, pulmonary capillary wedge pressure as well as pulmonary vascular resistance. Results: During the vibratory massage we could prove a significant increase of the mean tidal volume by 30% (p=0.008) and an associated decrease of the respiration rate by 8.7% (n.s.). The percutaneous oxygen saturation significantly increased too, from 92 to 93.6% (p=0.02). Central venous pressure significantly decreased by 11% (p = 0.04) and pulmonary vessel resistance was reduced by 18.3% with a significance of p=0.001. The pulmonary resistance decreased significantly from 10.5 to 9.2 H20/1/s at the end of the observation period. Conclusion: Vibratory massage seems to improve pulmonary mechanism and perfusion, thus reducing ventilation perfusion mismatch and increasing oxygen saturation.

Keyword(s): Vibrationsmassage

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