Effects of manual hyperinflation, clinical practice versus expert recommendation, on displacement of mucus simulant: A laboratory study

Effects of manual hyperinflation, clinical practice versus expert recommendation, on displacement of mucus simulant: A laboratory study

Author Volpe, Marcia S. Autor UNIFESP Google Scholar
Naves, Juliane M. Google Scholar
Ribeiro, Gabriel G. Google Scholar
Ruas, Gualberto Google Scholar
Tucci, Mauro R. Google Scholar
Abstract Introduction Manual hyperinflation (MH), a maneuver applied in mechanically ventilated patients to facilitate secretion removal, has large variation in its performance. Effectiveness of MH is usually evaluated by its capacity to generate an expiratory flow bias. The aim of this study was to compare the effects of MH-and its resulting flow bias D applied according to clinical practice versus according to expert recommendation on mucus movement in a lung model simulating a mechanically ventilated patient. Methods Twelve physiotherapists were asked to apply MH, using a self-inflating manual resuscitator, to a test lung as if to remove secretions under two conditions: according to their usual clinical practice (pre-instruction phase) and after verbal instruction to perform MH according to expert recommendation was given (post-instruction phase). Mucus simulant movement was measured with a photodensitometric technique. Peak inspiratory flow (PIF), peak inspiratory pressure (P-IP), inspiratory time (T-INSP), tidal volume (V-T) and peak expiratory flow (PEF) were measured continuously. Results It was found that MH performed post-instruction delivered a smaller VT (643.1 +/- 57.8 ml) at a lower P-IP (15.0 +/- 1.5 cmH(2)O), lower PIF (38.0 +/- 9.6 L/min), longer T-INSP (1.84 +/- 0.54 s) and lower PEF (65.4 +/- 6.7L/min) compared to MH pre-instruction. In the pre-instruction phase, MH resulted in a mean PIF/PEF ratio of 1.73 +/- 0.38 and mean PEF-PIF difference of -54.6 +/- 28.3 L/min, both out of the range for secretion removal. In the post-instruction phase both indexes were in the adequate range. Consequently, the mucus simulant was moved outward when MH was applied according to expert recommendation and towards the test lung when it was applied according to clinical practice. Conclusions Performance of MH during clinical practice with PIF higher than PEF was ineffective to clear secretion in a lung model simulating a mechanically ventilated patient. In order to remove secretion, MH should result in an adequate expiratory flow bias.
xmlui.dri2xhtml.METS-1.0.item-coverage San Francisco
Language English
Date 2018
Published in Plos One. San Francisco, v. 13, n. 2, p. -, 2018.
ISSN 1932-6203 (Sherpa/Romeo, impact factor)
Publisher Public Library Science
Extent -
Origin http://dx.doi.org/10.1371/journal.pone.0191787
Access rights Open access Open Access
Type Article
Web of Science ID WOS:000424814300011
URI https://repositorio.unifesp.br/handle/11600/54131

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