External stimuli in the form of vibratory massage after heart or lung transplantation

Manual vibratory massage is part of the preventive physiotherapeutic activi ties performed in intensive care units. The vibratory massage can be perfor med manually or as electrovibratory massage. The manual massage is a fast r hythmical vibration performed by the arm and shoulder muscles of the masseu r and transferred to the patient's thorax by the hand. The hand of the mass eur has to achieve a tremor with a frequency of 8 to 11 tremors/s. The aim of the pilot study was to examine the influence of manual vibratory massage on the pulmonary function of postoperative patients who were receiving mec hanical ventilation, with special interest being focused on pulmonary venti lation and perfusion and cerebral blood flow velocity. Manual vibratory mas sage was performed postoperatively in the intensive care unit on eight pati ents: three patients had undergone heart transplantation, three had undergo ne lung transplantation, and two had undergone coronary artery bypass graft ing (mean age, 53.6 +/- 8 yr). With the aid of continuous monitoring, we ex amined the changes of the respiration parameters and the cerebral blood flo w velocity (measured by transcranial Doppler sonography). The vibratory mas sage was performed with a frequency of 8 to 10 vibrations/s for 15 min, 7.5 min on each side of the thorax, starting from the lower costal arch and pr ogressing to the upper thoracic aperture. For 10 min before, during, and 10 min after the massage, the parameters of peripheral oxygen saturation, cen tral venous pressure, mean arterial pressure, heart rate, lung resistance a nd compliance, tidal volume, respiration rate, and cerebral blood flow velo city were recorded at 2-min intervals. Moreover, before and after vibratory massage, arterial blood gases were determined. In four of the eight patien ts, it was possible to determine pulmonary arterial pressure, pulmonary cap illary wedge pressure, as well as pulmonary vascular resistance. During the vibratory massage, we could prove a significant increase of the mean tidal volume by 30% (P = 0.008). The percutaneous oxygen saturation significantl y increased also, from 92 to 93.6% (P = 0.002). Central venous pressure sig nificantly decreased by 11% (P = 0.04), and pulmonary vessel resistance was reduced by 18.3% (P = 0.001). The pulmonary resistance decreased from 10.5 to 9.2 H2O/l/s (P < 0.05) by the end of the observation period. Cerebral b lood flow velocity showed no significant change. Vibratory massage seems to improve pulmonary mechanism and perfusion, thus, reducing ventilation perf usion mismatch and increasing oxygen saturation.