title: Manual hyperinflation of intubated and mechanically ventilated patients in Dutch intensive care units--a survey into current practice and knowledge.
abstract: BACKGROUND
  In the daily bedside routine of the intensive care, potentially hazardous interventions that lack evidence need critical consideration. Therefore we examined current practice and knowledge of basic principles of manual hyperinflation (MH) in intubated and mechanically ventilated patients among intensive care unit nurses in the Netherlands.
  
  
  METHODS
  A written survey method was used, questionnaires were sent to ICU nurses specialised in mechanical ventilation in 115 Dutch hospitals. The questions related to following domains: (1) demographics; (2) use of MH; (3) presumed benefits; (4) essential elements of the MH procedure; (5) equipment and safety.
  
  
  RESULTS
  The response rate was 77%. From responding ICUs the majority (96%) stated they performed MH; 27% as a daily routine procedure, 69% performed MH on indication only. MH was mainly performed by ICU nurses. Half of ICUs reported to have a MH guideline available. Improved oxygenation and better removal of sputum were presumed benefits of MH. While slow inspiration and rapid expiration are considered to be essential elements of MH procedures, the majority of respondents stated to use rapid inspiration and slow expiration.
  
  
  CONCLUSIONS
  This survey indicates that MH is widely used as an important item of airway management. Importantly, there is no uniformity in the performance of the procedure. Before definitive research can be developed, standards for the MH procedure should be established.
authors.affiliation: Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. f.paulus@amc.uva.nl
authors.forename: Frederique
authors.initials: F
authors.lastname: Paulus
authors.forename: Jan M
authors.initials: JM
authors.lastname: Binnekade
authors.forename: Pauline
authors.initials: P
authors.lastname: Middelhoek
authors.forename: Marcus J
authors.initials: MJ
authors.lastname: Schultz
authors.forename: Margreeth B
authors.initials: MB
authors.lastname: Vroom
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D016009:Chi-Square Distribution; D002983:Clinical Competence; D015400:Clinical Nursing Research; D002985:Clinical Protocols; D003422:Critical Care / Q000379:methods* / Q000706:statistics & numerical data; D055318:Evidence-Based Nursing; D007722:Health Knowledge, Attitudes, Practice; D006742:Hospital Bed Capacity / Q000706:statistics & numerical data; D006801:Humans; D007442:Intubation, Intratracheal / Q000451:nursing* / Q000706:statistics & numerical data; D009426:Netherlands; D009741:Nursing Staff, Hospital / Q000193:education / Q000523:psychology / Q000706:statistics & numerical data; D010102:Oxygen Inhalation Therapy / Q000379:methods; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D012121:Respiration, Artificial / Q000379:methods / Q000451:nursing / Q000706:statistics & numerical data; D013396:Suction / Q000379:methods; D011795:Surveys and Questionnaires; D013997:Time Factors