Performance of manual hyperinflation: a skills lab study among trained intensive care unit nurses.
BACKGROUND
The aim of manual hyperinflation (MH) is to mobilize airway secretions and prevent sputum plugging in intubated and mechanically ventilated patients. With MH, the nurse applies a larger than normal breath with a slow inspiratory flow and, after an inspiratory pause, a high expiratory flow is created by completely releasing the resuscitation bag.


METHODS
This was a prospective observational study in a skills lab of a university hospital. Intensive care unit nurses performed MH procedures for an imaginary patient in three different compliance settings. Data were collected via direct video recordings and an air-flow analyzer.


RESULTS
One hundred nurses participated. Video recordings demonstrated inappropriate performance of MH, reflected by the appearance of inspirations which were too rapid (53% of cases), absence of holds (60%), and absence of complete release of the resuscitation bag (78%). In the majority of cases the applied volumes were too large according to what was advised in the local guideline (80%). Peak inspiratory flow was 70 (range: 55-89) l/min for all compliance settings and peak expiratory flows were low: for over-compliant (46, range: 42-51), normal (51, range: 45-57), and noncompliant lungs (58, range: 52-64 l/min).


CONCLUSIONS
Performance of MH by certified ICU nurses is far from appropriate. These results emphasize the necessity for clearer guidelines with explicit directions for this frequently applied procedure, if it is decided to practice it in the daily care of intubated and mechanically ventilated patients.
Paulus
Frederique
F
Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. f.paulus@amc.uva.nl
Binnekade
Jan M
JM
Middelhoek
Pauline
P
Vroom
Margreeth B
MB
Schultz
Marcus J
MJ
D000328:Adult; D002983:Clinical Competence; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal; D007753:Laboratories; D008170:Lung Compliance; D008297:Male; D009726:Nurses / Q000592:standards*; D012121:Respiration, Artificial / Q000295:instrumentation / Q000379:methods*; D015656:Respiratory Mechanics; D012122:Ventilators, Mechanical; D014741:Video Recording