Document Detail

Comparison of the effectiveness of manual and ventilator hyperinflation at different levels of positive end-expiratory pressure in artificially ventilated and intubated intensive care patients.
MedLine Citation:
PMID:  16963365     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Manual hyperinflation (MHI) and ventilator hyperinflation (VHI) are two methods of recruitment maneuvers used in ventilated patients to improve lung compliance and secretion mobilization. The use of VHI may minimize the adverse effects of disconnection from the ventilator, but it is uncertain whether high levels of positive end-expiratory pressure (PEEP) would decrease the peak expiratory flow rate (PEFR) and consequently affect secretion clearance. OBJECTIVES: The aim of this study was to compare the effectiveness of MHI and VHI in terms of clearing pulmonary secretions (sputum wet weight and PEFR), improving static respiratory system compliance and oxygenation (arterial oxygen tension/fraction of inspired oxygen), and altering mean arterial pressure, heart rate, and carbon dioxide output at different levels of PEEP. METHODS: This was a randomized crossover study involving 14 general intensive care patients who were intubated and mechanically ventilated. RESULTS: Sputum production was similar in both techniques and levels of PEEP. There were no differences in improvement in oxygenation and static respiratory system compliance between MHI and VHI. However, VHI increased Cst significantly at 30 minutes posttreatment (P = .012), and a significant difference was observed between levels 5 and 7.5 cmH(2)O (P = .02) of PEEP for MHI. MHI generated higher PEFR than VHI (P < .05). No adverse change in heart rate or mean arterial pressure was observed during either technique; however, VCO(2) was significantly different for techniques (P = .045) and over time (P = .05). CONCLUSION: The VHI technique seems to promote greater improvements in respiratory mechanics with less metabolic disturbance compared with MHI. Other variables such as sputum production, hemodynamics, and oxygenation were affected similarly by both techniques.
Camila Savian; Jennifer Paratz; Andrew Davies
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Heart & lung : the journal of critical care     Volume:  35     ISSN:  0147-9563     ISO Abbreviation:  Heart Lung     Publication Date:    2006 Sep-Oct
Date Detail:
Created Date:  2006-09-11     Completed Date:  2007-01-19     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0330057     Medline TA:  Heart Lung     Country:  United States    
Other Details:
Languages:  eng     Pagination:  334-41     Citation Subset:  AIM; IM    
Alfred Hospital, Melbourne, Australia.
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MeSH Terms
Aged, 80 and over
Cross-Over Studies
Intensive Care*
Intubation, Intratracheal
Middle Aged
Positive-Pressure Respiration / methods*
Respiration Disorders / etiology,  physiopathology,  therapy*
Respiratory Function Tests
Respiratory Mechanics / physiology*
Single-Blind Method
Sputum / metabolism
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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