Performance of manual hyperinflation: consistency and modification of the technique by intensive care unit nurses during physiotherapy.
OBJECTIVE
To assess the consistency and safety of manual hyperinflation delivery by nurses of variable clinical experience using a resuscitator bag during physiotherapy treatment.


BACKGROUND
Manual hyperinflation involves the delivery of larger than normal gas volumes to intubated patients and is routinely used by nurses in collaboration with physiotherapists for the management of retained sputum. The aim is to deliver slow deep breaths with an inspiratory hold without unsafe airway pressures, lung volumes or haemodynamic changes. In addition, nursing staff should be able to 'feel' differences in resistance and adjust their technique accordingly.


METHODS
Prospective observational study utilising the simulation of a mechanically ventilated patient.


METHODS
Thirty-three nurses delivered manual hyperinflation to a SimMan3G mannequin who had three distinct lung scenarios applied (normal; asthma; Acute Respiratory Distress Syndrome) in randomised order during simulated physiotherapy treatment. Respiratory rate, tidal volume (Vt ), mean inspiratory flow rate (Vt /Ti), and peak airway pressure data were generated.


RESULTS
Over all scenarios, mean respiratory rate = 12·3 breaths/minute, mean Vt  = 638·6 mls, mean inflation time = 1·3 seconds and peak airway pressure exceeded 40 cm H2 O in 41% of breaths, although only in 10% of breaths during the 'normal' lung scenario.


CONCLUSIONS
Experienced nurses were able to manually hyperinflate 'normal' patients in a simulated setting safely. Despite their knowledge of barotrauma, unsafe airway pressures were delivered in some scenarios.


CONCLUSIONS
Training with regard to safe airway pressures, breath hold and adequate volumes is recommended for all nurses undertaking the procedure. Nurses and physiotherapists must closely monitor the patient's condition during manual hyperinflation thereby recognising changes with regard to lung compliance and airway resistance, with nurses responding by altering their technique. The addition of a pressure manometer in the circuit may improve patient safety when performing manual hyperinflation.
Physiotherapy Department, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.|Intensive Care Unit, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
Diane M
DM
Dennis
Intensive Care Unit, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
Christine N
CN
Duncan
Intensive Care Unit, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
Mary
M
Pinder
Centre for Applied Statistics, University of Western Australia, Nedlands, Western Australia, Australia.
Charley A
CA
Budgeon
Physiotherapy Department, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.|Intensive Care Unit, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
Wendy J
WJ
Jacob
D001249:Asthma / Q000628:therapy*; D064648:Critical Care Nursing; D005260:Female; D006801:Humans; D008297:Male; D008348:Manikins; D026741:Physical Therapy Modalities; D012121:Respiration, Artificial / Q000451:nursing*; D012128:Respiratory Distress Syndrome / Q000628:therapy*; D056152:Respiratory Rate; D012151:Resuscitation; D013990:Tidal Volume
intensive care; manual hyperinflation; physiotherapy