title: Hemodynamic effects of intermittent manual lung hyperinflation in patients with septic shock.
abstract: OBJECTIVE
  The purposes of this study were to investigate the hemodynamic changes induced by intermittent manual lung hyperinflation (MHI) and to assess if these changes are adverse enough to warrant prohibition of MHI as a routine procedure in the care of patients with septic shock.
  
  
  METHODS
  The study's design was experimental prospective.
  
  
  METHODS
  The settings were university hospital intensive care units.
  
  
  METHODS
  Subjects included 13 consecutive mechanically ventilated patients with septic shock who met the inclusion criteria.
  
  
  RESULTS
  Phasic MHI-related increments in mean inspiratory airway pressure were concordant to changes in mean pulmonary artery pressure (MPAP) (r(2) = 0.67) with a 0.6 mm Hg rise in MPAP per cm H(2)O airway pressure. The magnitude of MPAP changes was not reflected in magnitude of stroke volume index (SVI) (r(2) = 0.06). On average, MHI did not induce statistically significant hemodynamic changes and mean values returned to baseline level within 15 minutes. SVI during MHI increased slightly in 9 patients, from 37 +/- 15 (mean +/- SD) to 41 +/- 17 mL/m(2) (P <.05), and decreased in 4, from 60 +/- 10 to 50 +/- 14 mL/m(2) (not significant). Patients with an increase in SVI had lower baseline values for SVI, cardiac index, and left ventricular stroke work index (P <.05) and higher values for systemic vascular resistance index compared with patients with a decrease in SVI (P <.05). Left ventricular stroke work index was higher in patients with a decrease in SVI than in patients with an increase in SVI (52 +/- 9 vs 34 +/- 8; P <.05). Tidal volume increased from 499 +/- 176 mL before MHI to 587 +/- 82 mL, 5 minutes after MHI (P <.05) with a return to baseline values within 15 minutes after the procedure.
  
  
  CONCLUSIONS
  The hemodynamic effects of intermittent MHI in patients with septic shock are relatively small and insignificant and seem to be related to the cardiovascular state before the procedure. The risk of inducing hemodynamic changes with MHI should not be considered as a contraindication in patients with septic shock who are mechanically ventilated.
authors.affiliation: Department of Internal Medicine, Cardiovascular Research Institute Amsterdam, The Netherlands.
authors.forename: W T
authors.initials: WT
authors.lastname: Jellema
authors.forename: A B
authors.initials: AB
authors.lastname: Groeneveld
authors.forename: J
authors.initials: J
authors.lastname: van Goudoever
authors.forename: K H
authors.initials: KH
authors.lastname: Wesseling
authors.forename: N
authors.initials: N
authors.lastname: Westerhof
authors.forename: M J
authors.initials: MJ
authors.lastname: Lubbers
authors.forename: J
authors.initials: J
authors.lastname: Kesecioglu
authors.forename: J J
authors.initials: JJ
authors.lastname: Van Lieshout
mesh_terms: D000328:Adult; D002302:Cardiac Output; D000075202:Contraindications; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods*; D012772:Shock, Septic / Q000503:physiopathology* / Q000628:therapy*; D013318:Stroke Volume; D014655:Vascular Resistance; D016277:Ventricular Function, Left