Effects of ventilator hyperinflation on pulmonary function and secretion clearance in adults receiving mechanical ventilation: A systematic review with meta-analysis

• Published in: Heart & lung Vol. 56; pp. 8 - 23
• Main Authors: Martinez, Bruno Prata, Lobo, Layana Lisboa, de Queiroz, Rodrigo Santos, Saquetto, Micheli Bernardone, Júnior, Luiz Alberto Forgiarini, Correia, Helena França, da Silva e Silva, Cássio Magalhães, Alves, Iura Gonzalez Nogueira, Neto, Mansueto Gomes
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2022
• Subjects: Mechanical ventilation; Mucociliary clearence; Systematic review; Ventilator hyperinflation; Systematic review; Mucociliary clearence; Ventilator hyperinflation; Mechanical ventilation
• DOI: 10.1016/j.hrtlng.2022.05.011
• EISSN: 1527-3288
• ISSN: 0147-9563

•There is very low quality evidence that VHI versus isolated aspiration, low evidence that VHI+VB versus VB and moderate evidence that VHI+VB versus isolated aspiration, should be considered an effective method for increase the volume of secretion removed, Cdyn rs and oxigenation.•VHI shows a slight improvement in Cstat when compared to isolated aspiration.•The results of this meta-analysis suggest that VHI should not be used routinely in daily practice until the scientific literature supports, as it has not shown positive results regarding its short-term effects on the amount of secretion removed, Cdyn and oxygenation.
It is important to clarify the effect of ventilator hyperinflation(VHI) on pulmonary function and secretion clearance in adults receiving mechanical ventilation(MV). There is no published meta-analysis on the effects VHI on pulmonary function and secretion clearance in adults receiving MV.
Objective Analyze the published randomized clinical trials(RCTs) that investigated the effects of VHI on pulmonary function and secretion clearance in adults receiving MV, comparing VHI with isolated aspiration, VHI with manual hyperinflation(MHI), VHI +vibrocompression(VB) versus VB and VHI+VB versus isolated aspiration.
The following databases PubMed, LILACS, EMBASE, SciELO, PEDro database and Cochrane Central Register of Controlled Trials (CENTRAL) were consulted up to December 2021. Secretion clearance, static and dynamic compliance of the respiratory system(Cstat and Cdyn), airway resistance(Raw) and oxygenation outcomes were evaluated.
Thirteen studies met the study criteria, but only 12 studies were included on meta-analysis. There was no difference between VHI versus isolated aspiration for amount of secretions removed(0.41 SMD; 95% CI: -0.08 to 0.89; n=270), VHI versus MHI(0.51 grams; 95% CI: -0.08 to 1.11; n=256), VHI+VB versus VB(0.31 grams; 95% CI: -0.42 to 1.05; n=130) and VHI+VB versus isolated aspiration(0.54 grams; 95% CI: -0.06 to 1.14; n=132). There was difference for VHI versus isolated aspiration to Cstat (4.77 ml/cm H2O; 95% CI: 2.41 to 7.14; n= 136).
Taking into account all studies included in meta-analysis, no evidences was found that VHI was effective in increasing the amount of secretions removed, Cdyn and oxygenation, but VHI seems to show a slight improvement in Cstat when compared to isolated aspiration. No evidence was found that VHI was effective in increasing the amount of secretions removed, Cdyn and oxygenation, but VHI seems to show a slight improvement in Cstat when compared to isolated aspiration.