Can the Flutter Valve improve respiratory mechanics and sputum production in mechanically ventilated patients? A randomized crossover trial.

OBJECTIVE The Flutter Valve (Varioraw SARL, Scandipharm Inc, Birmingham, AL) has proven efficacy in hypersecretive spontaneously ventilated patients. This study was designed to evaluate whether an airway clearance protocol using the Flutter Valve can affect the therapeutic and physiologic outcomes in mechanically ventilated patients with pulmonary infection. METHODS In a randomized crossover study, sputum production, respiratory mechanics, hemodynamics, and gas exchange were evaluated from 20 mechanically ventilated patients submitted to 2 interventions. FLUTTER intervention consisted of connecting the Flutter Valve to the exhalation port of the mechanical ventilator. Control intervention (CTRL) was normal ventilation in pressure controlled mode. RESULTS Compared with CTRL, FLUTTER improved sputum production (P < .001), respiratory system static compliance (P = .02), peak expiratory flow (P = .048), expiratory flow at 75% of tidal volume (P = .005), and arterial PO(2)-to-inspired oxygen concentration ratio (P < .001). Respiratory resistance, heart rate, and mean arterial pressure remained unaltered during the interventions (P > .05). CONCLUSION The Flutter Valve improves lung secretion removal, mucus production, respiratory mechanics, and arterial oxygenation in mechanically ventilated patients with respiratory infection, without causing clinically relevant hemodynamic repercussions.