Selecting the best ventilator hyperinflation technique based on physiologic markers: A randomized controlled crossover study

• Published in: Heart & lung Vol. 48; no. 1; pp. 39 - 45
• Main Authors: Ribeiro, Beatriz S., Lopes, Agnaldo J., Menezes, Sara L.S., Guimarães, Fernando S.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-01-2019
• Subjects: Airway clearance techniques; Critical care; Cross-Over Studies; Female; Home Care Services; Humans; Intermittent Positive-Pressure Ventilation - methods; Middle Aged; Physical Therapy Modalities; Respiratory Insufficiency - physiopathology; Respiratory Insufficiency - therapy; Respiratory mechanics; Respiratory Mechanics - physiology; Respiratory therapy; Treatment Outcome; Ventilator hyperinflation; Respiratory therapy; PIFR; PC-CMV3; VC-CMV50; PEFR; Airway clearance techniques; PEEP; Cst; Critical care; Respiratory mechanics; RASS; HR; Physical therapy modalities; MHI; VC-CMV20; Rrs; VHI; PSV25; Ventilator hyperinflation; PSV10; MAP; MPAW; PC-CMV1
• ISSN: 0147-9563; 1527-3288
• DOI: 10.1016/j.hrtlng.2018.09.006

Ventilator hyperinflation (VHI) is effective in improving respiratory mechanics, secretion removal, and gas exchange in mechanically ventilated subjects; however, there are no recommendations for the best ventilator settings to perform the technique.
To compare six modes of VHI, concerning physiological markers of efficacy and safety criteria to support the selection of optimal settings.
Thirty mechanically ventilated patients underwent six modes of VHI in a randomized order. The delivered volume, expiratory flow bias criteria, overdistension, patient–ventilator asynchronies and hemodynamic variables were assessed during the interventions.
Volume-controlled ventilation with inspiratory flow of 20 lpm (VC-CMV20) and pressure support ventilation (PSV) achieved the best effectiveness scores (P < 0.05). The target peak pressure of 40 cmH2O was associated with a high incidence of overdistension. PSV showed a lower incidence of patient–ventilator asynchronies.
The modes VC-CMV20 and PSV are the most effective for VHI. Alveolar overdistension and patient–ventilator asynchronies must be considered when applying VHI.