Effects of ventilator vs manual hyperinflation in adults receiving mechanical ventilation: a systematic review of randomised clinical trials

Anderson, Alvin G.; Alexanders, Jenny; Sinani, Charikleia; Hayes, Stephen; Fogarty, Mike

doi:10.1016/j.physio.2014.07.006

Cited by 24 publications

(14 citation statements)

References 15 publications

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“…One systematic review of randomized clinical trials compared the ventilator and manual hyperinflation techniques and found no differences between manual and mechanical hyperinflation, in sputum wet weight, pulmonary compliance, oxygenation and cardiovascular stability (Anderson et al 2015). A randomized crossover study with eight patients with spinal muscular atrophy and congenital myopathy during an acute respiratory tract infection found that MI-E with MAC decreases the treatment time, improves the auscultation scores and increases the patient-reported effectiveness on the visual analogue scale .…”

Section: Other Outcomes Of Cough Augmentationmentioning

confidence: 99%

A Review on Cough Augmentation Techniques: Assisted Inspiration, Assisted Expiration and Their Combination

Spinou

2020

Physiol Res

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Cough is an important mechanism of airway clearance. In patients who present weak and ineffective cough, augmentation techniques aim to assist or simulate the maneuver. These techniques target different phases of the cough cycle, mainly the inspiratory and expiratory phases, through assisted inspiration, assisted expiration and their combination. They include the manual hyperinflation, ventilator hyperinflation, glossopharyngeal breathing, manually assisted cough and mechanical insufflator-exsufflator, each applied individually or in different combinations. The aim of this review is to investigate the effectiveness and safety of cough augmentation techniques. Findings support that all commonly used techniques can theoretically improve airway clearance, as they generate higher cough peak flows compared to unassisted cough. Still, the studies assessing cough augmentation present considerable limitations and the direct comparison of different techniques is challenging. Current evidence indicate that cough peak flow shows higher increase with the combination of assisted inspiration and expiration, and improvement is greater in patients with lower unassisted values. Associated adverse events are infrequent.

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Section: Other Outcomes Of Cough Augmentationmentioning

confidence: 99%

A Review on Cough Augmentation Techniques: Assisted Inspiration, Assisted Expiration and Their Combination

Spinou

2020

Physiol Res

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“…While this study is the first to investigate the effects of MHI and VHI on restoring EELV post-ES, multiple previous studies [10,11,15,20,21] have compared their effects on pulmonary compliance, oxygenation and haemodynamics. Consistent with these previous studies, we did not observe adverse haemodynamic events associated with MHI or VHI.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…Manual hyperinflation (MHI) and ventilator hyperinflation (VHI) are interventions commonly performed with the objectives of improving oxygenation, facilitating secretion clearance and increasing EELV [10,11]. MHI involves disconnection from MV to deliver large tidal volumes via a manual resuscitation bag [12,13].…”

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confidence: 99%

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A comparison of the effects of manual hyperinflation and ventilator hyperinflation on restoring end-expiratory lung volume after endotracheal suctioning: A pilot physiologic study

Linnane

Caruana

Tronstad

et al. 2019

Journal of Critical Care

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Purpose: Endotracheal suctioning (ES) of mechanically ventilated patients decreases end-expiratory lung volume (EELV). Manual hyperinflation (MHI) and ventilator hyperinflation (VHI) may restore EELV post-ES but it remains unknown which method is most effective. The primary aim was to compare the efficacy of MHI and VHI in restoring EELV post-ES. Materials and Methods:ES was performed on mechanically ventilated intensive care patients, followed by MHI or VHI, in a randomised crossover design. The washout period between interventions was one hour. End-expiratory lung impedance (EELI), measured by electrical impedance tomography, was recorded at baseline, during ES, during hyperinflation and 1, 5, 15 and 30 minutes post-hyperinflation.Results: Nine participants were studied. ES decreased EELI by 1672z (95% CI, 1204 to 2140) from baseline. From baseline, MHI increased EELI by 1154z (95% CI, 977 to 1330) while VHI increased EELI by 769z (95% CI, 457 to 1080). Five minutes post-VHI, EELI remained 528z (95% CI, 4 to 1053) above baseline. Fifteen minutes post-MHI, EELI remained 351z (95% CI, 111 to 592) above baseline. At subsequent time-points, EELI returned to baseline.Conclusions: MHI and VHI effectively restore EELV above baseline post-ES and should be considered post suctioning.

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“…Tem como vantagens o controle das pressões utilizadas e a prevenção dos efeitos negativos da desconexão do ventilador quando comparada à hiperinsuflação utilizando a bolsa de reanimação manual 5,9 . Além disso, possui efeito similar à hiperinsuflação com bolsa de reanimação na quantidade de secreção pulmonar aspirada 11 . Entre as desvantagens da hiperinsuflação com a bolsa de reanimação estão estiramento do parênquima pulmonar; inflamação pulmonar; aumento da pressão intratorácica e, por consequência, diminuição do retorno venoso, alteração da pré-carga cardíaca e débito cardíaco; e diminuição da complacência estática e da oxigenação arterial [12][13][14][15][16][17] .…”

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Hiperinsuflação pulmonar com ventilador mecânico como manobra de higiene brônquica

Adorna¹,

Vieira²,

Naue³

et al. 2016

cbr

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Introdução: O paciente em ventilação mecânica (VM) tem comumente acúmulo de secreção brônquica. A hiperinsuflação mecânica, como manobra de higiene brônquica, é uma alternativa para minimizar este problema, facilitando o deslocamento de secreção das vias aéreas periféricas para as superiores e dessa forma facilitando sua aspiração. Objetivos: Verificar a eficácia da manobra de hiperinsuflação com ventilador mecânico na quantidade de secreção aspirada, e efeitos ventilatórios e hemodinâmicos. Método: Ensaio clínico randomizado cruzado, realizado no Centro de Terapia Intensiva do Hospital de Clínicas de Porto Alegre (HCPA), comparando um protocolo de aspiração versus um protocolo de hiperinsuflação com o ventilador mecânico, onde foram avaliados os seguintes parâmetros pré e pós-aplicação do protocolo: pressão de pico (Ppico), complacência dinâmica (Cdin), frequência cardíaca (FC) volume corrente (VC), frequência respiratória (FR), pressão arterial média (PAM), saturação periférica de oxigênio (SpO2) e quantidade de secreção aspirada (Sec). O estudo foi aprovado pelo Comitê de ética em Pesquisa HCPA 11-0367. Resultados: Foram avaliados 20 pacientes, entre novembro de 2011 e junho de 2013. A manobra de hiperinsuflação causou um amento da média da Ppico, Cdin e FC em relação à aspiração, diferentemente o VC, FR, PAM, SpO2, e Sec apresentaram um incremento na média maior pós manobra de aspiração. Identificação do paciente Sexo masculino 13 (65%) Idade 61,6* (±13,6)** APACHE 25,4* (±17)** Dias em VM 7,1* (±6,1)** * média, **desvio padrão. Parâmetros distribuídos em média e desvio padrão. Aspiração Técnica ∆ (Aspiração-Técnica) Valor de p Ppico (cmH2O) ↑0,05 ±0,6 ↑0,25, ±1,4 0,2 ±1,5 0,425 VC (ml) ↑34,1±88,9 ↑15,8 ±76,4 -18,3 ±12,4 0,367 Cdin (ml/H2O) ↑0,7 ±3,5 ↑1,7 ±18,1 1,06 ±14,5 0,688 FR (rpm) ↑0,3 ±2,9 ↓0,05 ±5,2 -0,4 ±2,4 0,966 FC (bpm) ↑1 ±6,9 ↑2,05 ±7,6 1,05 ±1,7 0,244 SpO2 (%) ↑0,1 ±3,4 ↓0,15 ±1,9 -1,1 ±3,7 0,728 PAM (mm/Hg) ↑5,3 ±8,1 ↑5,3 ±15,4 -0,05 ±7,2 0,140 Secreção (g) 1,7 ±2,2 1,3 ±1,6 0,4 ±2,6 0,614 g=gramas, bpm=batimentos por minuto, rpm=respirações por minuto. Conclusão: A manobra de hiperinsuflação não se mostrou superior à manobra de aspiração quanto à quantidade de secreção aspirada e não causou repercussões ventilatórias e hemodinâmicas significativas. Palavra-chave: fisioterapia, higiene brônquica, hiperinsuflação pulmonar. Projeto 11-0367

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Effects of ventilator vs manual hyperinflation in adults receiving mechanical ventilation: a systematic review of randomised clinical trials

Cited by 24 publications

References 15 publications

A Review on Cough Augmentation Techniques: Assisted Inspiration, Assisted Expiration and Their Combination

A Review on Cough Augmentation Techniques: Assisted Inspiration, Assisted Expiration and Their Combination

A comparison of the effects of manual hyperinflation and ventilator hyperinflation on restoring end-expiratory lung volume after endotracheal suctioning: A pilot physiologic study

Hiperinsuflação pulmonar com ventilador mecânico como manobra de higiene brônquica

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