PEEP-ZEEP Maneuver for Airway Clearance in Mechanically Ventilated Patients: A Scoping Review

Abstract

A mechanical ventilator is the standard care to manage airways in intensive care unit (ICU). The inherent complications associated with mechanical ventilation are easy to prevent and control. Ventilator events, including ventilator-associated pneumonia, are crucial issues to manage in critically ill patients. Secretion retention due to compromised mucociliary function and altered lung internal milieu plays a significant concern in ICU outcomes. Physiotherapy involved in ICU plays an essential role in maintaining lung hygiene. Conventional chest physiotherapy is an extrapulmonary technique to remove secretion and maintain bronchial hygiene. Manual hyperinflation and suctioning are the methods that are highly at risk of transmitting lung infection. Generating flow bias through modification in various ventilator parameters is recently in trend to prevent bronchial hygiene-related complications. PEEP-ZEEP maneuver causes the expiratory flow bias by increasing peak expiratory flow. The present scoping review explores the safety and efficacy of the PEEP-ZEEP maneuver for airway clearance in mechanically ventilated patients. The current scoping review aims to identify the use and safety of the PEEP-ZEEP maneuver applied in mechanically ventilated patients for airway clearance. The five databases, i.e., PubMed, PEDro, Google Scholar, Cochrane, and Web of Science, have been searched till October 2022. The published experimental studies included in the review was searched using Boolean operators ('AND' and 'OR') and keywords, i.e., PEEP-ZEEP, Mechanical Ventilator, and Airway Clearance technique. PEEP-ZEEP is a safe and efficient for airway clearance in mechanically ventilated patients, with the need to explore further with a larger sample size and more defined outcomes and population.