Manual hyperinflation causes norepinephrine release

Benefits and risks of manual hyperinflation in intubated and mechanically ventilated intensive care unit patients: a systematic review

“…We included 13 interventional studies (six randomized controlled trials of MH [5,20-24], two randomized crossover trials comparing MH with endotracheal suctioning [25,26], four randomized crossover trials comparing MH with hyperinflation by the mechanical ventilator [27-30], and one randomized crossover trial comparing two different manual-ventilation bags [31]), and six observational studies [7,8,32-35]. Physiological end points were respiratory mechanics [20-22,25,27-31], arterial oxygenation [5,20-24,26-28,30,31], and clearance of airway secretions [5,26,27,29-31].…”

“…Clinical end points included duration of mechanical ventilation [21,23], length of stay [21,23], and incidence of pneumonia [23]. Reported side effects included effects on heart rate and systemic blood pressure [7,8,20,26,32-34], cardiac output [7,8,32,33,35], and pulmonary artery pressures and central venous pressures [32,33,35]. …”

“…However, in another study of postcardiac surgery patients, this could not be confirmed [24], nor in studies of patients with atelectasis [5], nor in a study of brain-injury patients [23]. Notably, although no effect of MH on arterial oxygenation was found in a study of patients with acute lung injury [20], another study found MH to improve arterial oxygenation in patients with indirect acute lung injury but not in patients with direct acute lung injury [7,33]. MH was not superior to hyperinflation by the mechanical ventilator with respect to arterial oxygenation [27-30].…”

“…In addition, disconnection of a critically ill patient from the ventilator could be seen as a rather unsafe intervention [6]. Because MH may cause short-term hyperinflation, one could even consider MH to be dangerous in hemodynamically unstable patients [7,8]. Also, MH could be disadvantageous in patients with respiratory failure.…”

Can the Flutter Valve improve respiratory mechanics and sputum production in mechanically ventilated patients? A randomized crossover trial

“…19,20,21,[36][37][38][39] In our study, although mean airway pressure (Pmean) increased during FLUTTER and CTRL interventions (because of the increase in inspiratory pressure up to 25 cmH 2 O in both interventions), all patients presented hemodynamic stability (MAP > 60 mm Hg), and no significant changes were observed in HR and MAP during the interventions. These findings are similar to those reported by Singer et al 37 and Berney and Denehy, 38 who used manual and ventilator-induced hyperinflation maneuvers, respectively.…”