Manual hyperinflation in airway clearance in pediatric patients: a systematic review

Abstract

ObjectiveTo perform an assessment of the available literature on manual hyperinflation as a respiratory physical therapy technique used in pediatric patients, with the main outcome of achieving airway clearance. MethodsWe reviewed articles included in the Lilacs (Latin American and Caribbean Literature on Health Sciences/Literatura Latino Americana e do Caribe em Ciências da Saúde), Cochrane Library, Medline (via Virtual Health Library and PubMed), SciELO (Scientific Electronic Library), and PEDro (Physiotherapy Evidence Database) databases from 2002 to 2013 using the following search terms: "physiotherapy (techniques)", "respiratory therapy", "intensive care", and "airway clearance". The selected studies were classified according to the level of evidence and grades of recommendation (method of the Oxford Centre for Evidence-Based Medicine) by two examiners, while a third examiner repeated the search and analysis and checked the classification of the articles. ResultsThree articles were included for analysis, comprising 250 children (aged 0 to 16 years). The main diagnoses were acute respiratory failure, recovery following heart congenital disease and upper abdominal surgery, bone marrow transplantation, asthma, tracheal reconstruction, brain injury, airway injury, and heterogeneous lung diseases. The studies were classified as having a level of evidence 2C and grade of recommendation C. ConclusionsManual hyperinflation appeared useful for airway clearance in the investigated population, although the evidence available in the literature remains insufficient. Therefore, controlled randomized studies are needed to establish the safety and efficacy of manual hyperinflation in pediatric patients. However, manual hyperinflation must be performed by trained physical therapists only.

Manual hyperinflation and the role of physical therapy in intensive care and emergency units

“…MHI is a treatment technique commonly used by physical therapists in intensive care units for passive lung inflation, intensification of elastic recoil forces, enhancement of the peak expiratory flow, and consequent clearance of secretions accumulated in the airways [20]. According to Ambrozin et al [21], MHI consists of slow deep inspirations, followed by an inspiratory hold and a quick pressure release using a manual resuscitation bag.…”

“…The use of MHI in pediatric patients seems to be useful to clear the airways of children with acute respiratory failure or in recovery following heart congenital disease and upper abdominal surgery, bone marrow transplantation, asthma, tracheal reconstruction, brain injury, airway injury, and heterogeneous lung diseases. This technique increases spontaneous tidal volume and improves chest x-ray appearance and the oxygenation index (PaO2 / FiO2) [20]. As regards the monitoring of passive pulmonary mechanics in infants, obtained by complete relaxation of the respiratory muscles after the use of respiratory techniques such as HMI, it is necessary to induce the Hering-Breuer reflex, triggered by the rapid obstruction of the airway (for 1 second) at the end of normal inspiration to compare the improvement achieved with the technique [29].…”

Expressão de dor após atendimento de fisioterapia em recém-nascidos prematuros: estudo observacional

“…As manobras de higiene brônquica ou manobras desobstrutivas, favorecem o deslocamento das secreções e a subida para regiões mais externas dos pulmões por meio do aumento do fluxo expiratório, promovendo a tosse e deslocando as secreções 6,7 . Quando a tosse é ineficiente ou na presença de tubo endotraqueal a aspiração de secreções se faz necessária e finaliza o processo de remoção das secreções mobilizadas com o uso dessa técnica 8,9 .…”

Chest Physiotherapy in the Pediatric Intensive Care Unit

“…Physiotherapists working in adult intensive care units often use manual hyperinflation techniques in conjunction with other manipulations to expand the lung and loosen secretions, and in some centers the technique is commonly used for critically ill children and infants as well. [79][80][81][82] Manual hyperinflation usually consists of a series of deep manual inflations (ideally to a predetermined set pressure or volume) with brief inspiratory holds, followed by a rapid release of the bag to enhance expiratory flow. 2 Manual hyperinflation aims to prevent or treat lung collapse, improve oxygenation and compliance, and promote secretion clearance.…”

“…Only three studies relating to manual hyperinflation in children were identified for inclusion in a systematic review: two observational studies and one randomized crossover trial. 76,82,87 The crossover trial did not analyze different CPT modalities separately and therefore no conclusions can be made regarding the effects of manual hyperinflation itself. 7 Therefore, there is insufficient evidence regarding the safety or efficacy of manual hyperinflation in critically ill infants and children and there are reasons for concern for implementing this modality in this population, as outlined further later.…”