title: Hyperinflation using pressure support ventilation improves secretion clearance and respiratory mechanics in ventilated patients with pulmonary infection: a randomised crossover trial.
abstract: OBJECTIVE
  Is ventilator-induced hyperinflation in sidelying more effective than sidelying alone in removing secretions and improving respiratory mechanics in ventilated patients with pulmonary infection?
  
  
  METHODS
  Randomised crossover trial with concealed allocation and intention-to-treat analysis.
  
  
  METHODS
  30 mechanically ventilated patients with pulmonary infection in an adult intensive care unit.
  
  
  METHODS
  The experimental intervention was 30 minutes of ventilator-induced hyperinflation using pressure support ventilation in sidelying; the control intervention was 30 minutes of sidelying. Participants received both interventions on the same day, with a five-hour washout period between them.
  
  
  METHODS
  Secretion clearance was measured as sputum volume retrieved during the intervention. Respiratory mechanics were measured as static compliance and total resistance of the respiratory system before and after the intervention.
  
  
  RESULTS
  The experimental intervention cleared 1.3 ml (95% CI 0.5 to 2.2) more secretions than the control. After ventilator-induced hyperinflation in sidelying, respiratory compliance had increased 4.7 ml/cmH(2)O (95% CI 2.6 to 6.8) more than in sidelying alone. There was no difference in total resistance of the respiratory system between the interventions (mean difference 0.3 cmH(2)O/l/s, 95% CI -0.8 to 1.3).
  
  
  CONCLUSIONS
  The application of hyperinflation using pressure support ventilation in mechanically ventilated patients with pulmonary infection improves secretion clearance and increases static compliance of the respiratory system.
authors.affiliation: Universidade Federal do Rio de Janeiro, Rio de Janiero, Brazil.
authors.forename: Daniela Aires
authors.initials: DA
authors.lastname: Lemes
authors.forename: Walter Araujo
authors.initials: WA
authors.lastname: Zin
authors.forename: Fernando Silva
authors.initials: FS
authors.lastname: Guimaraes
mesh_terms: D000368:Aged; D018592:Cross-Over Studies; D015916:Drainage, Postural / Q000379:methods; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012121:Respiration, Artificial / Q000379:methods*; D015656:Respiratory Mechanics / Q000502:physiology*; D012141:Respiratory Tract Infections / Q000503:physiopathology* / Q000534:rehabilitation / Q000628:therapy*; D013183:Sputum / Q000378:metabolism*; D016896:Treatment Outcome