Manual Hyperinflation Improves Alveolar Recruitment in Difficult-to-Wean Patients

Maa, Suh-Hwa; Hung, Tzong-Jen; Hsu, Kuang‐Hung; Hsieh, Ya-I; Wang, Kwua-Yun; Wang, Chunhua; Lin, Horng‐Chyuan

doi:10.1378/chest.128.4.2714

Cited by 59 publications

(78 citation statements)

References 30 publications

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“…Procedures either including or excluding the ERCC step are equally referred to as MH. In addition, some studies (5,9,13) do not clearly state whether the ERCC step was included in the MH procedure. We included the ERCC step because we decided to use the maneuver as it was originally described (7) and because the ERCC step has proven effective in improving secretion clearance, (4,25) alveolar recruitment,…”

Section: Resultsmentioning

confidence: 99%

“…In a previous study involving patients in whom MH was used in combination with significant differences were found between the control and study groups regarding the length of ICU stay (6.8 days vs. 7.4 days), duration of MV (5.2 days vs. 6.1 days), or ICU mortality (0% for both) in trauma patients. (11) The replacement of MH by a vibration step did not improve those variables in a nonrandomized study involving 17 [14][15][16][17][18] 16 [12][13][14][15][16][17][18][19][20] 16 [8][9][10][11][12][13][14][15][16][17][18][19][20][21] 16 [11][12][13][14][15][16][17][18][19][20][21] RP: respiratory physiotherapy group; C: control group; and APACHE II: Acute Physiology and Chronic Health Evaluation II. the effect size for ICU discharge or successful weaning from MV being greater than 0.45.…”

Section: Discussionmentioning

confidence: 99%

“…(5) Originally called "bag squeezing", MH consists of a series of deep breaths with a three-second inspiratory pause combined with expiratory rib cage compression (ERCC) and suctioning. (7) Although MH has been shown to have a positive effect on airway secretion clearance, (2,5,8) atelectasis, (8) and alveolar recruitment, (7,9) there is moderate evidence that MH has a short-lived beneficial effect on respiratory function. (10) The absence of more convincing evidence might be due to the lack of studies evaluating the effectiveness of MH in terms of the abovementioned variables (2,11,12) or to inconsistent definitions of MH across studies.…”

Section: Introductionmentioning

confidence: 99%

“…Procedures either including or excluding the ERCC step are equally referred to as MH. In fact, some studies (5,9,13) do not clearly state whether the ERCC step was included in the MH procedure.…”

Section: Introductionmentioning

confidence: 99%

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Hiperinsuflação manual combinada com compressão torácica expiratória para redução do período de internação em UTI em pacientes críticos sob ventilação mecânica

et al. 2012

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Objective: Although manual hyperinflation (MH) is widely used for pulmonary secretion clearance, there is no evidence to support its routine use in clinical practice. Our objective was to evaluate the effect that MH combined with expiratory rib cage compression (ERCC) has on the length of ICU stay and duration of mechanical ventilation (MV). Methods: This was a prospective randomized controlled clinical trial involving ICU patients on MV at a tertiary care teaching hospital between January of 2004 and January of 2005. Among the 49 patients who met the study criteria, 24 and 25 were randomly assigned to the respiratory physiotherapy (RP) and control groups, respectively. Of those same patients, 6 and 8, respectively, were later withdrawn from the study. During the 5-day observation period, the RP patients received MH combined with ERCC, whereas the control patients received standard nursing care. Results: The two groups were similar in terms of the baseline characteristics. The intervention had a positive effect on the duration of MV, as well as on the ICU discharge rate and Murray score. There were significant differences between the control and RP groups regarding the weaning success rate on days 2 (0.0% vs. 37.5%), 3 (0.0% vs. 37.5%), 4 (5.3% vs. 37.5%), and 5 (15.9% vs. 37.5%), as well as regarding the ICU discharge rate on days 3 (0% vs. 25%), 4 (0% vs. 31%), and 5 (0% vs. 31%). In the RP group, there was a significant improvement in the Murray score on day 5. Conclusions: Our results show that the use of MH combined with ERCC for 5 days accelerated the weaning process and ICU discharge.Keywords: Physical therapy modalities; Ventilator weaning; Length of stay. ResumoObjetivo: Embora a hiperinsuflação manual (HM) seja largamente usada para a remoção de secreções pulmonares, não há evidências para sua recomendação como rotina na prática clínica. O objetivo do estudo foi avaliar o efeito da HM combinada com compressão torácica expiratória (CTE) na duração de internação em UTI e no tempo de ventilação mecânica (VM) em pacientes sob VM. Métodos: Ensaio clínico prospectivo, randomizado e controlado com pacientes de UTI sob VM em um hospital acadêmico terciário entre janeiro de 2004 e janeiro de 2005. Dentre os 49 pacientes que preencheram os critérios do estudo, 24 e 25 foram randomicamente alocados nos grupos fisioterapia respiratória (FR) e controle, respectivamente, sendo que 6 e 8 foram retirados do estudo. Durante o período de observação de 5 dias, os pacientes do grupo FR receberam HM combinada com CTE, enquanto os controles receberam o tratamento padrão de enfermagem. Resultados: Os dois grupos apresentaram características basais semelhantes. A intervenção teve efeito positivo na duração de VM, alta da UTI e escore de Murray. Houve diferenças significativas entre os grupos controle e FR em relação à taxa de sucesso no desmame nos dias 2 (0,0% vs. 37,5%), 3 (0,0% vs. 37,5%), 4 (5,3 vs. 37,5%) e 5 (15,9% vs. 37,5%), assim como à taxa de alta da UTI nos dias 3 (0% vs. 25%), 4 (0% vs. 31%) e 5 (0% vs. 3...

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hiperinsuflação manual combinada com compressão torácica expiratória para redução do período de internação em UTI em pacientes críticos sob ventilação mecânica

et al. 2012

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“…As manobras fisioterápicas convencionais consistem na percussão torácica, vibração, drenagem postural 7,17,18 e compressão torácica 7,13,14 , as quais são aplicadas isoladamente ou em conjunto. A vibração e a percussão torácica ocupam uma posição pouco significativa.…”

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Avaliação dos efeitos de diferentes manobras de fisioterapia respitatória no desfecho de pacientes ventilados mecanicamente

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Respiratory therapy for removing bronchial secretions in mechanically ventilated adult patients

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et al. 2013

Cochrane Database of Systematic Reviews

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Manual Hyperinflation Improves Alveolar Recruitment in Difficult-to-Wean Patients

Cited by 59 publications

References 30 publications

Hiperinsuflação manual combinada com compressão torácica expiratória para redução do período de internação em UTI em pacientes críticos sob ventilação mecânica

Hiperinsuflação manual combinada com compressão torácica expiratória para redução do período de internação em UTI em pacientes críticos sob ventilação mecânica

Avaliação dos efeitos de diferentes manobras de fisioterapia respitatória no desfecho de pacientes ventilados mecanicamente

Respiratory therapy for removing bronchial secretions in mechanically ventilated adult patients

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