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2 () (). () ". Expiratory rib cage )" (compression (Squeezing) ().. (Forced expiratory volume). (). (-) (). () (). () (). (). (). (). () (). (). / /

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5 ( ). ( ). ( ).. ( ) ) ( ). (. ( )... " ". SPSS / /

6 1. " " " P=0/000 ).(2 )(P=0/000 P=0/ P=0/000 ).(P=0/000 P=0/ (3 ) / / / ± / / ± / () ( /) ( /) ( /) ( ) (/) () ( /) () (/) (/) (/) (/) (/). () () ** (SIMV) (Spont V) (PSV) 2 1 **. / /

7 25 5 O2Sat p-value / / / / / / O2Sat p-value / / ) ( / ± / / ± / / ± / / ± / / ± / / ± / Paco2 Pao2/Fio2.2 ) ( / ± / / ± / / ± / / ± / / ± / / ± / Pao2/Fio2 (mmhg) Paco2 (mmhg) O2Sat (%) Paco2 Pao2/Fio / ± / - / ± / / ± / - / ± / Pao2/Fio2 (mmhg) Paco2 (mmhg) / / ± / / ± / O2Sat (%) " Unoki (20). (2005) Unoki " / /

8 Ishikawa Miyagawa (16). ) (. (2005) Unoki (20). Mizutani Unoki 2004 Toyooka (21).. (21). Kozier.. (3). Unoki Routhen. (23). ( 40) ". ". / /

9 (18).. " ".. ( )... MacLean 73/3 (24). 109/3. ) ( Unoki. (20). (2005). Watts. / /

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11 11- Marini JJ, Pierson DJ, Hudson LD. Acute lobar atelectasis: a prospective comparison of fiber optic bronchoscope and respiratory therapy. Am Rev Respire Dis; (6): Uzieblo M, Welsh R, Pursel SE. Chmielewski GW. Incidence and significance of lobar atelectasis in thoracic surgical patients. Am Surg; (5): Ignatavicius DD, Workman LM. Medical Surgical Nursing. Philadelphia: W.B. Saunders; p Smeltzer S, Bare B. Textbook of Medical- Surgical Nursing. 10th ed. Philadelphia: Lippincott Company; 2004.p. 608, 610, 613, Glass A, Grap J. Ten tips for safer suctioning. AJN;1995.5: Miyagawa T, Ishikawa A. Physical therapy for respiratory disturbances: new perspectives of chest physical therapy. Jpn J Phys Ther; (10): Takekawa Y. Nursing care for patients under mechanical ventilation. J of Jpn Soc Respir Care; (2): Watts JIM. Thoracic compression for asthma. Chest; (3): Miyagawa T. Strategies for airway clearance. lung perspect;1995.3(2): Unoki T, Kawasaki Y, Mizutani T, Fujino Y, Yanagisawa Y, Ishimatsu S. Effects of expiratory ribcage compression on oxygenation, ventilation, and airway-secretion removal in patients receiving mechanical ventilation. Respir Care; (11): 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; (8): Craven RF, Hirnle CJ. Fundamentals of Nursing: Human Health and Function. 4th ed. Philadelphia: Lippincott Williams & Wilkins; p Rothen HU, Sporre B, Engberg G, Wegenius G, Hedenstierna G. Re-expansion of atelectasis during. 1- Black JM, Hawks JH. Medical-Surgical Nursing: Clinical Management for Positive Outcomes.7th ed. Philadelphia: Elsevier; p. 1887, 1888, Lewis SM, Heitkemper MM, Dirksen SR. Medical-Surgical Nursing: Assessment and Management of Clinical Problems.5th ed. Philadelphia: Mosby; 2000.p. 1895, 1925, Kozier B, Erb G, Berman A, Snyder SJ. Fundamentals of Nursing. 7th ed. New Jersey: Pearson education; 2004.p. 1292, Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL. Harrison's Principles of Internal Medicine. 16th ed. New York: McGraw-Hill Company; p.1498, Stone K. The effect of hyperinflation and endotracheal suctioning on cardiopulmonary homodynamic. Nurs Res; (2): Potter PA, Perry AG. Basic Nursing: Essentials for Practice. 5th ed. Philadelphia: Mosby; p Woodrow P. Intensive Care Nursing: A Framework for Practice. London: Routledge Taylor & Fransis Group; p. 48-9, Monahan FD, Sands JK, Neighbors M, Marek J, Green C. Phipps Medical- Surgical nursing: Health and illness perspectives. 8th ed. Philadelphia: Mosby; p. 616, Adam K, Osborne S. Critical Care Nursing: Science and Practice. London: Oxford Medical Publication; p. 47, Moore T, Woodrow P. High Dependency Nursing Care. London: Routledge Taylor & Fransis Group; p / /

12 general anaesthesia: a computed tomography study. Br J Anaesth; (6): MacLean D, Drummond G, Macpherson C, McLaren G, Prescott R. Maximum expiratory airflow during chest physiotherapy on ventilated patients before and after the application of an abdominal binder. Intensive Care Med; (6): Phipps WJ, Monahan FD, Sands JK. Medical Surgical Nursing: Health and Illness Perspectives. 7th ed. Philadelphia: Mosby; 2003.p. 142, / /

13 The Effects of Expiratory Rib Cage Compression before Endotracheal Suctioning on Arterial Blood Gases in Patients Under Mechanical Ventilation M. Kohan 1 Ms A. Najaf Yarandi 2 Ms H. Peyrovi 3 PhD F. Hoseini 4 MS Abstract Background & Aim: Endotracheal suctioning is one of the most frequently used methods for airway clearance in patients under mechanical ventilation. Chest physiotherapy techniques such as expiratory rib cage compression before endotracheal suctioning can be used as a means to facilitate mobilizing and removing airway secretions and improving alveolar ventilation. This study was carried out to determine the effects of expiratory rib cage compression before endotracheal suctioning on arterial blood gases in patients mechanically ventilated patients. Material & Method: This research was a clinical trial study with a crossover design. The subjects consisted of 70 (35 females, 35 males) mechanically ventilated patients who were admitted to medical and surgical intensive care units and emergency department of Hazrat- Rasool Hospital in Tehran. Subjects were selected with consecutive sampling. The patients received endotracheal suctioning with and without rib cage compression, with a minimum 3- hours interval between the two interventions. Expiratory rib cage compression was performed for 5 minutes before endotracheal suctioning. Arterial blood gases were measured 5 minutes before and 25 minutes after endotracheal suctioning. Data were recorded on the data recording sheet. Data were analyzed using Wilcoxon and paired t-tests. Results: There were a statistically significant differences in the ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (Pao2/Fio2), Paco2, and arterial oxygen saturation (Sao2) between before and after endotracheal suctioning in both methods (endotracheal suctioning with and without rib cage compression) (p=0.000). Moreover, there were statistically significant differences in the ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (P=0.000), Paco2 (P=0.048), and arterial oxygen saturation (P=0.000) between the two methods. Conclusion: Findings showed that expiratory rib cage compression before endotracheal suctioning improves arterial blood gases exchanges in patients under mechanical ventilation, so, performing expiratory rib cage compression before endotracheal suctioning in these patients is recommended. Key Words: Pulmunary Ventilation, Suction, Thorax, Blood Pressure, Patients. Accepted for Publication: 26 Desember 2007 Submited for Publication: 26 May MS in Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences and Health Services, Tehran, Iran (Corresponding Author). 2 MS in Medical Surgical Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences and Health Services. 3 Assistant Professor in Nursing Education, School of Nursing and Midwifery, Iran University of Medical Sciences and Health Services. 4 MS in Statistics, School of Management and Medical Information, Iran University of Medical Sciences and Health Services. 49 Iran Journal of Nursing Volume 20, Number 51, Autumn 2007