TABLE 1.
Summary of randomized studies on hyperinflation
| Author (reference), study design | Description of groups and interventions | Outcome measures | Summary of main results |
|---|---|---|---|
| Barker and Adams (16), RCT | Sample: Patients in ICU with ALI requiring MV (pressure support) (n=17)
Group 1 (n=5): OS in supine with 30° elevation Group 2 (n=5): OS in ASL with 0° elevation Group 3 (n=7): OS with manual hyperinflation in ASL (0° elevation) All patients were hyperoxygenated |
PaO2 PaCO2 Heart rate Blood pressure SvO2 Dynamic compliance |
No significant difference between groups for any outcome measure
Disconnection of patients with ALI from MV can result in significant derecruitment of the lungs. The use of manual hyperinflation does not appear to override the loss of PEEP and the derecruitment effects |
| Choi and Jones (17), RCO | Sample: Patients with VAP on MV (n=15)
Intervention 1: OS with manual hyperinflation Intervention 2: OS alone |
Static lung compliance
Airway resistance |
Compliance was greater with intervention 1 immediately and 30 min after suctioning (P<0.001). Lower airway resistance with intervention 1 up to 30 min (P=0.02) |
| Berney and Denehy (18), RCO | Sample: Patients in ICU requiring MV (n=20)
Intervention 1: OS, foot of the bed elevated to 35°–45°, six sets of 6 manual hyperinflation breaths Intervention 2: OS, ventilator hyperinflation All patients received six sets of 6 hyperinflations with 30 s of VT breathing between sets Suctioned after every second set |
Sputum wet weight
Static lung compliance |
No significant difference in the sputum weight between interventions.
Both interventions improved pulmonary compliance (P<0.001) |
| Metz et al (19), RCO | Sample: Patients in ICU requiring MV for acute respiratory failure (n=16)
Intervention 1: Standard off-ventilator suction Intervention 2: Suctioning through an adaptor with intermittent ETT clamping All patients received hyperoxygenation before and hyperoxygenation and hyperinflation postsuctioning |
PaO2 | No between-group comparisons reported
Within group changes were significant (P<0.05) up to 60 min postsuctioning with intervention 1 causing a decrease in PaO2 and intervention 2 causing an increase in PaO2 |
ALI Acute lung injury; ASL Alternate side lying; CS Closed suctioning; ETT Endotracheal tube; ICU Intensive care unit; MV Mechanical ventilation; OS Open suctioning; PaCO2 Arterial pressure of carbon dioxide; PaO2 Arterial pressure of oxygen; PEEP Positive end-expiratory pressure; RCO Randomized crossover study; RCT Randomized controlled trial; SvO2 Mixed venous oxygen saturation; VAP Ventilator-associated pneumonia; VT Tidal volume