Does experience influence the performance of neonatal and pediatric manual hyperinflation?
BACKGROUND
Manual hyperinflation (MH) is used to improve mucociliary clearance and alveolar expansion in mechanically ventilated patients. Despite the popularity of MH, studies with adults have shown considerable variability in the results from its use. This study assessed if professional  training on the application of MH influences its performance.


METHODS
An experimental study was conducted with physiotherapists, including 11 with previous professional experience (experienced) and 11 without previous experience (inexperienced). They applied MH in a test lung model using  self-inflating bags in 2 sizes (infant and pediatric) from 3 manufacturers (Hudson, Laerdal, and JG Moriya). The test lung simulated the lung mechanics of a newborn and a pediatric patient in 2 different clinical situations: at normal and reduced compliance. The professionals were instructed  to perform MH as described in the literature. Measurements of inspiratory volume, peak inspiratory pressure, peak inspiratory flow, and peak expiratory flow were recorded using a pneumotachograph in each condition.


RESULTS
The delivered peak inspiratory flow was higher in the experienced  group (P = .03) than in the inexperienced group. This result was observed in both neonatal and pediatric self-inflating bags. There was no difference in the parameters delivered between the experienced and inexperienced groups.


CONCLUSIONS
The experienced and inexperienced groups were  similar in their overall MH performance; the only difference was the observation of the highest PIF in the results from the experienced group.
Graduate Program of Child and Adolescent Health, Department of Pediatrics, Faculty of Medical Sciences, Universidade Estadual de Campinas, Campinas, São Paulo, Brazil. pricilaufjf@yahoo.com.br
Pricila Mara
PM
Novais de Oliveira
Armando Augusto
AA
Almeida-Junior
Celize Cruz Bresciani
CC
Almeida
Maria Angela
MA
Gonçalves de Oliveira Ribeiro
José Dirceu
JD
Ribeiro
D000328:Adult; D000704:Analysis of Variance; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012121:Respiration, Artificial / Q000592:standards*; D015656:Respiratory Mechanics; D012138:Respiratory Therapy / Q000592:standards*; D018709:Statistics, Nonparametric; D012122:Ventilators, Mechanical