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

Abstract

Introduction: Although manual hyperinflation (MHI) is a physical therapy technique commonly used in intensive care and emergency units, there is little consensus about its use. Objective: To investigate the knowledge of physical therapists working in intensive care and emergency units about manual hyperinflation. Methods: Data were collected through self-administered questionnaires on manual hyperinflation. Data collection took place between September 2014 and January 2015, in Itabuna and Ilhéus, Bahia, Brazil. Results: The study sample was composed of 32 physical therapists who had between 4 months and 10 years working experience. All respondents affirmed that they used the technique in their professional practice. However, only 34.4% reported it to be a routine practice. 90.6% stated that the most common patient position during manual hyperinflation is “supine”. Participants were almost unanimous (93.8%) in citing secretion removal and cough stimulation as perceived benefits of MHI. High peak airway pressure was identified as being a precaution to treatment with MHI by 84.4% of participants, whilst 100% of the sample agreed that an undrained pneumothorax was a contraindication to MHI. Conclusion: The most common answers to the questionnaire were: supine position during MHI; secretion removal and cough stimulation as perceived benefits; high peak airway pressure as a precaution; and an undrained pneumothorax as a contraindication.

Manual and ventilator hyperinflation parameters used by intensive care physiotherapists in Sri Lanka: An online survey

“…In this study, the majority of the participants used the hyperinflation technique in ICU. Similar results were observed in several studies in other countries; Australia [ 16 ], New Zealand [ 30 ] United Kingdom [ 19 ] and Brazil [ 29 ]…”

“…Section two consisted of questions related to the use of MHI and was assessed by a questionnaire developed by the research team based on the literature [ 16 , 19 , 29 ]. This section assessed the person responsible for performing the hyperinflation; the indication or selection criteria to use hyperinflation; the aim/s of the hyperinflation technique; the device used for MHI; FiO02 used; number of breaths per set used during the application of MHI; total duration of the treatment; the position of the patient, precautions and contraindications for MHI; the technique used; using peak expiratory valve for PEEP dependent patient; setting maximum inspiratory pressure /peak inspiratory pressure during the application; and measuring PIP during MHI.…”

“…The MHI part of the questionnaire was created based on available literature [ 16 , 19 , 29 ], while the VHI part was taken from a previously used questionnaire. Both parts were reviewed by a research team comprising five academicians who are registered physiotherapists and one academician who is a registered nurse.…”

Rehabilitation Needs of Patients with Covid-19 in Acute Phase

“…In Paulus et al's review [26] there are no indications for the use of this technique in unstable, intubated and mechanically ventilated patients. Manual hyperinflation does not appear to be associated with a reduction in the duration of mechanical ventilation, permanence in the ICU and prevention of ventilator-associated pneumonia [26], and further studies are necessary to investigate the use of MHI by physical therapists for better understanding benefits and intrinsic risks [27]. Very interesting is a review investigating the role of physiotherapy in reducing the symptoms of post-intensive care syndrome (PICS) [28].…”

Role of N-Acetylcysteine in Clearance of Secretions in Mechanical Ventilated Patients

“…Impaired clearance of the airway is one of the bigger reason of acute respiratory failure and admission in intensive care unit. In intensive care unit usually manual methods are used to facilitate airway clearance and some of them are confirmed as effective (1). Mucous plugs those are retained secretions in tracheobronchial tree are often observed in patients who are mechanically ventilated due to depressed mucociliary clearance, cough reflex and more production of sputum (2).…”