BACKGROUND/OBJECTIVES: Prematurity is a leading cause of infant mortality and mechanical ventilation increases respiratory complication risk. The effects of secretion removal techniques in premature infants remain a topic of ongoing debate. The aim of the study is to compare two secretion removal techniques in premature infants on mechanical ventilation. METHODS: The participants were randomized into conventional chest physiotherapy (CPT; n = 22) or expiratory flow increase technique (EFIT; n = 21) groups. Each participant completed four sessions on consecutive days with a minimum of one and a maximum of two sessions per day. We assessed peripheral oxygen saturation (SpO2), heart (HR) and respiratory rates (RR), tidal volume (VT), and pain levels at specific time points: before the intervention, immediately after the intervention, 5 min after the intervention, and 10 min after the intervention. The partial Eta squared (np2) was reported to measure the effect size. RESULTS: HR and RR increased post-intervention in both groups (p < 0.001; HR np2 = 0.51; RR np2 = 0.38); post hoc comparisons showed EFIT group decreased RR from the first to last session (p = 0.045). Both groups exhibited increased VT and SpO2 in all sessions (p < 0.001; VT np2 = 0.40; SpO2 np2 = 0.50). The EFIT group had higher SpO2 values (p = 0.013; np2 = 0.15) and lower pain scores (p < 0.001; np2 = 0.46) post-intervention compared to CPT. CONCLUSIONS: CPT and EFIT resulted in similar effects on short-term respiratory parameters and heart rate; however, EFIT had advantages, including lower RR, higher SpO2, and reduced pain, suggesting it may be a more effective, comfortable neonatal respiratory treatment.

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