Document Detail

Indications for manual lung hyperinflation (MHI) in the mechanically ventilated patient with chronic obstructive pulmonary disease.
MedLine Citation:
PMID:  16541603     Owner:  NLM     Status:  MEDLINE    
Manual lung hyperinflation (MHI) can enhance secretion clearance, improve total lung/thorax compliance and assist in the resolution of acute atelectasis. To enhance secretion clearance in the intubated patient, the evidence highlights the need to maximize expiratory flow. Chronic pulmonary diseases such as chronic obstructive pulmonary disease (COPD) have often been cited as potential precautions and/or contra-indications to the use of manual lung hyperinflation (MHI). There is an absence of evidence on the effects of MHI in the patient with COPD. Research on the effects of mechanical ventilation in the patient with COPD provides a useful clinical examination of the effect of positive pressure on cardiac and pulmonary function. The potential effects of MHI in the COPD patient group were extrapolated on the basis of the MHI and mechanical ventilation literature. There is the potential for MHI to have both detrimental and beneficial effects on cardiac and pulmonary function in patients with COPD. The potential detrimental effects of MHI may include either, increased intrinsic peep through inadequate time for expiration by the breath delivery rate, tidal volume delivered or through the removal of applied external PEEP thereby causing more dynamic airway compression compromising downward expiratory flow, which may also retard bronchial mucus transport. MHI may also increase right ventricular after load through raised intrathoracic pressures with lung hyperinflation, and may therefore impair right ventricular function in patients with evidence of cor pulmonale. There is the potential for beneficial effects from MHI in the intubated COPD patient group (i.e., secretion clearance), but further research is required, especially on the effect of MHI on inspiratory and expiratory flow rate profiles in this patient group. The more controlled delivery of lung hyperinflation through the use of the mechanical ventilator may be a more optimal means of providing lung hyperinflation and should be further investigated.
G Ntoumenopoulos
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Chronic respiratory disease     Volume:  2     ISSN:  1479-9723     ISO Abbreviation:  Chron Respir Dis     Publication Date:  2005  
Date Detail:
Created Date:  2006-03-17     Completed Date:  2006-04-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101197408     Medline TA:  Chron Respir Dis     Country:  England    
Other Details:
Languages:  eng     Pagination:  199-207     Citation Subset:  IM    
Clinical Specialist Respiratory Physiotherapist, Guys and St Thomas' Trust, London, UK.
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MeSH Terms
Pulmonary Disease, Chronic Obstructive / physiopathology,  therapy*
Pulmonary Ventilation / physiology
Respiration, Artificial / methods*

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