Head-down tilt and manual hyperinflation enhance sputum clearance in patients who are intubated and ventilated.
The purpose of this prospective randomised cross-over study was to measure peak expiratory flow rates during manual hyperinflation and to determine if the addition of a head-down tilt to physiotherapy treatment increased sputum production in patients who are intubated and ventilated. Twenty patients who were intubated, ventilated and haemodynamically stable were randomised to a sequence of physiotherapy treatment in a flat side-lying or a head-down tilt position. Peak expiratory flow rates were measured for each breath during manual hyperinflation using a Vitalograph peak flow meter. Sputum wet weight was collected for each treatment position and static pulmonary compliance was measured before and immediately following physiotherapy treatment. There was a significant increase in peak expiratory flow (p < 0.001) and sputum production (p = 0.008) in the head-down tilt position. The mean difference and 95% confidence intervals for expiratory flow were 0.17 (0.15 to 0.19) l/sec and for the wet weight of sputum 1.97 (0.84 to 3.10) g. The peak expiratory flow rate was sufficient to produce annular flow in both flat side-lying (1.97 +/- 0.09) l/sec and in the head-down tilt position (2.14 +/- 0.08) l/sec. Static pulmonary compliance improved significantly following physiotherapy treatment (p = 0.003). The mean difference and 95% confidence intervals pre- and post-treatment for static pulmonary compliance were 5.18 (2.14 to 8.22) ml/cmH(2)O. The results suggest that addition of a head-down tilt to physiotherapy treatment, including manual hyperinflation, in patients who are intubated and ventilated, increases sputum production and improves peak expiratory flow.
Department Physiotherapy, Austin Hospital, Heidelberg, VIC, 3084, Australia. sue.berney@austin.org.au
Susan
S
Berney
Linda
L
Denehy
Jeff
J
Pretto
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018592:Cross-Over Studies; D015916:Drainage, Postural / Q000379:methods*; D005260:Female; D018475:Head-Down Tilt; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D010366:Peak Expiratory Flow Rate; D011187:Posture; D011446:Prospective Studies; D015656:Respiratory Mechanics; D012138:Respiratory Therapy / Q000379:methods*; D013183:Sputum / Q000378:metabolism*; D016896:Treatment Outcome