title: 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.
abstract: 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.
  
  
  OBJECTIVE
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Alfred Hospital, Melbourne, Australia.
authors.forename: Camila
authors.initials: C
authors.lastname: Savian
authors.forename: Jennifer
authors.initials: J
authors.lastname: Paratz
authors.forename: Andrew
authors.initials: A
authors.lastname: Davies
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration / Q000379:methods*; D012120:Respiration Disorders / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D012129:Respiratory Function Tests; D015656:Respiratory Mechanics / Q000502:physiology*; D016037:Single-Blind Method; D013183:Sputum / Q000378:metabolism; D016896:Treatment Outcome