The Effectiveness of Ventilator Hyperinflation to Improve Pulmonary Oxygenation in Patients Undergoing Mechanical Ventilation
Keywords:
Mechanical ventilation, Respiratory physical therapy, Manual hyperinflation, Ventilator hyperinflation, Pulmonary oxygenationAbstract
Secretion retention is the main cause of respiratory complications in patients undergoing mechanical ventilation and results in a longer stay in hospital and treatment costs. While manual hyperinflation can be applied to aid secretion removal, improve chest expansion and elevate pulmonary oxygenation, patients are disconnected from mechanical ventilation during suction which can adversely impact pulmonary oxygenation. The ventilator hyperinflation approach was developed to improve on the limitations of manual hyperinflation. Indeed, this technique can improve secretion removal, chest compliance and pulmonary oxygenation similar to the manual hyperinflation, but without the requirement to be removed from mechanical ventilation. The objective of this academic article was to compare the relative effectiveness of the ventilator and manual hyperinflation approaches in patients using mechanical ventilation. From the literature review, ventilator hyperventilation was more effective at improving pulmonary oxygenation than manual hyperinflation as patients were not required to be disconnected from mechanical ventilation, which prevented the loss of positive end-expiratory pressure and improved pulmonary oxygenation. The ventilator hyperinflation was safe with patients using mechanical ventilation.
References
Ahmed, F., Shafeeq, A.M., Moiz, J.A., & Geelani, M.A. (2010). Comparison of effects of manual versus ventilator hyperinflation on respiratory compliance and arterial blood gases in patients undergoing mitral valve replacement. Heart Lung, 39(5), 437-443. doi: 10.1016/j.hrtlng.2009.10.006.
Anderson, A., Alexanders, J., Sinani, C., Hayes, S., & Fogarty, M. (2015). Effects of ventilator vs manual hyperinflation in adults receiving mechanical ventilation: a systematic review of randomized clinical trials. Physiotherapy, 101(2), 103-110. doi: 10.1016/ j.physio.2014.07.006.
Berney, S., & Denehy, L. (2002). A comparison of the effects of manual and ventilator hyperinflation on static lung compliance and sputum production in intubated and ventilated intensive care patients. Physiotherapy Research International, 7(2), 100-108. doi: 10.1002/pri.246.
Clement, A.J., & Hübsch, S.K. (1968). Chest physiotherapy by the bag squeezing method: a guide to technique. Physiotherapy, 54(10), 355-359.
Dennis, D., Jacob, R., & Budgeon, C. (2012). Ventilator versus manual hyperinflation in clearing sputum in ventilated intensive care unit patients. Anaesth Intensive Care, 40, 142-149. doi: 10.1177/0310057X1204000117.
Hedenstierna, G., Tokics, L., Lundquist, H., Andersson, T., Strandberg, A., & Brismar, B. (1994). Phrenic nerve stimulation during halothane anesthesia. Effects of atelectasis. Anesthesiology, 80, 751-760. doi: 10.1097/00000542-199404000-00006.
Hess, D.R., & Kacmarek, R.B. (2014). Chapter 13: FiO2, positive end-expiratory pressure, and mean airway pressure. In D. R. Hess & R.B. Kacmarek (Eds.), Essentials of mechanical ventilation. (pp.132-142). United States of America: McGraw-Hill Medical.
Hess, D.R., MacIntyre, N.R., Mishoe, S.C., Galvin, W.F., & Adams, A.B. (2016). Chapter 2 mechanical ventilation. In D. R. Hess & N. R. MacIntyre (Eds.), Respiratory care: principles and practice. (pp.462-500). United States of America: Jones & Bartlett Learning.
Hugonnet, S., Eggimann, P., Borst, F., Maricot, P., Chevrolet, J.C., & Pittet, D. (2004). Impact of ventilator-associated pneumonia on resource utilization and patient outcome. Infection Control & Hospital Epidemiology, 25(12), 1090-1096. doi: 10.1086/502349.
Jacob, W., Dennis, D., Jacques, A., Marsh, L., Woods, P., & Hebden-Todd, T. (2021). Ventilator hyperinflation determined by peak airway pressure delivered: a randomized crossover trial. Nursing in Critical Care, 26(1), 14-19. doi: 10.1111/nicc.12498.
Konrad, F., Schreiber, T., Brecht-Kraus, D., & Georgieff, M. (1994). Mucociliary transport in ICU patients. Chest, 105(1), 237-241. doi: 10.1378/chest.105.1.237.
Lemes, D.A., Zin, W.A., & Guimaraes, F.S. (2009). Hyperinflation using pressure support ventilation improves secretion clearance and respiratory mechanics in ventilated patients with pulmonary infection: a randomized crossover trial. Australian Journal of Physiotherapy, 55(4), 249-254. doi: 10.1016/s0004-9514(09)70004-2.
Lindberg, P., Gunnarsson, L., Tokics, L., Secher, E., Lundquist, H., Brismar B, & Hedenstierna, G. (1992). Atelectasis and lung function in the postoperative period. Acta Anaesthesiologica Scandinavica, 36(6), 546-553. doi: 10.1111/j.1399-6576.1992.tb03516.x.
Ntoumenopoulos, G. (2014) Clinical Impact of Secretion Retention. Current Respiratory Medicine Reviews, 10(3), 158-162). doi: 10.2174/1573398X1003150120095050.
Pathmanathan, N., Beaumont, N., & Gratrix, A. (2014). Respiratory physiotherapy in the critical care unit. Continuing Education in Anaesthesia Critical Care & Pain, 15(1), 20-25. doi: 10.1093/bjaceaccp/mku005.
Paulus, F.J., Binnekade, J.M., Vroom, M.B., & Schultz, M.J. (2012). Benefits and risks of manual hyperinflation in intubated and mechanically ventilated intensive care unit patients: a systematic review. Critical Care, 16(4), R145. doi: 10.1186/cc11457.
Ribeiro, B.S., Lopes, A.J., Menezes, S.L.S., & Guimarães, F.S. (2019). Selecting the best ventilator hyperinflation technique based on physiologic markers: A randomized controlled crossover study. Heart Lung, 48(1), 39-45. doi: 10.1016/j.hrtlng.2018.09.006.
Savian, C., Paratz, J., & Davies, A. (2006). 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. Heart Lung, 35(5), 334-341. doi: 10.1016/j.hrtlng.2006.02.003.
Downloads
Published
Issue
Section
License
Copyright (c) 2022 Christian University of Thailand
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
