AIM: Manual hyperinflation and expiratory rib-cage compression are physiotherapeutic techniques used to remove airway secretions in intensive care patients. This study was performed to investigate the effects of manual hyperinflation with or without expiratory rib-cage compression on lung compliance, gas exchange, and secretion clearance in mechanically ventilated patients. METHODS: Twenty-two intubated, mechanically ventilated, and hemodynamically stable intensive care unit patients were studied in a controlled, randomized, case-crossover trial. The patients received manual hyperinflation, with or without expiratory rib-cage compression, with a minimum 3-h interval between the two interventions. Manual hyperinflation with or without expiratory rib-cage compression was performed for 5 min before endotracheal suctioning. Respiratory mechanics and hemodynamic variables were measured 5 min before (baseline) and then 5 and 20 min after the interventions. Arterial blood gases were determined 5 min before (baseline) and 20 min after the interventions. Secretion clearance was measured as sputum weight. The two measurements were obtained on the same day. RESULTS: No significant differences were observed in gas exchange and secretion clearance between the two interventions. In each case, static lung compliance and tidal volume improved significantly at 5 min post-intervention (p < 0.01), whereas at 20 min post-intervention, only static lung compliance had improved significantly above baseline (p < 0.01). CONCLUSIONS: Our results suggest that the addition of expiratory rib-cage compression to manual hyperinflation does not improve lung compliance, gas exchange, or secretion clearance in mechanically ventilated critically ill patients.

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