Advertisement

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

      Highlights

      • 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.

      Abstract

      Introduction

      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.

      Methods

      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.

      Results

      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).

      Conclusion

      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.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Heart & Lung: The Journal of Cardiopulmonary and Acute Care
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Konrad F
        • Schreiber T
        • Brecht-Kraus D
        • Georgieff M.
        Mucociliary transport in ICU patients.
        Chest. 1994; 105: 237-421
        • Li Bassi G
        • Saucedo L
        • Marti J-D
        • Rigol M
        • Esperatti M
        • Luque N
        • et al.
        Effects of duty cycle and positive end-expiratory pressure on mucus clearance during mechanical ventilation.
        Crit Care Med. 2012; 40: 895-902
        • Hess DR.
        Airway clearance: physiology, pharmacology, techniques, and practice.
        Respir Care. 2007; 52: 1392-1396
        • Gonçalves MR
        • Honrado T
        • Winck JC
        • Paiva JA.
        Effects of mechanical insufflation-exsufflation in preventing respiratory failure after extubation: a randomized controlled trial.
        Crit Care. 2012; 16: R48
        • Volpe MS
        • Guimarães FS
        • Morais CCA.
        Airway clearance techniques for mechanically ventilated patients: insights for optimization.
        Respir Care. 2020; 65 (–118): 1174
        • Berney S
        • Denehy L.
        A comparison of the effects of manual and ventilator hyperinflation on static lung compliance and sputum production in intubated and ventilated intensive care patients.
        Physiother Res Int. 2002; 7: 100-108
        • Savian C
        • Paratz J
        • Davies A.
        Comparison of the effectiveness of manual and ventilator hyperinflation at different levels of positive end expiratory pressure in artificially ventilated and intubated intensive care patients.
        Heart & Lung. 2006; 35: 334-341
        • Lemes DA
        • Zin WA
        • Guimarães FS.
        Hyperinflation using pressure support ventilation improves secretion clearance and respiratory mechanics in ventilated patients with pulmonary infection: a randomised crossover trial.
        Aust J Physiother. 2009; 55 (2009): 249-254
        • Ahmed F
        • Shafeeq AM
        • Moiz JA
        • Geelani MA.
        Comparison of effects of manual versus ventilator hyperinflation on respiratory compliance and arterial blood gases in patients undergoing mitral valve replacement.
        Heart & Lung. 2010; 39: 437-443
        • Naue WS
        • Silva ACT
        • Güntzel AM
        • Condessa RL
        • Oliveira RP
        • SRR
        Increasing pressure support does not enhance secretion clearance if applied during manual chest wall vibration in intubated patients: a randomised trial.
        J Physiother. 2011; 57: 21-26
        • Dennis D
        • Jacob W
        • Budgeon C
        Ventilator versus manual hyperinflation in clearing sputum in ventilated intensive care unit patients.
        Anaesth Intensive Care. 2012; 40: 142-149
        • Silva ARB
        • Fluhr SA
        • Bezerra AL
        • Júnior MAVC
        • França EET
        • Andrade FMD.
        Expiratory peak flow and respiratory system resistance in mechanically ventilated patients undergoing two different forms of manually assisted cough.
        Rev Bras Ter Intensiva. 2012; 24: 58-63
        • Naue WS
        • Junior LAF
        • Dias AS
        • Vieira SRR.
        Chest compression with a higher level of pressure support ventilation: effects on secretion removal, hemodynamics, and respiratory mechanics in patients on mechanical ventilation*.
        J Bras Pneumol. 2014; 40: 55-60
        • Adorna EL
        • Vieira FN
        • Naue WS
        • Dias AS
        • Vieira SRR.
        Hyperinflation with mechanical ventilation as a bronchial hygiene maneuver.
        Clin Biomed Res. 2016; 36: 242-247
        • Assmann CB
        • Vieira PJC
        • Kutchak F
        • Rieder MM
        • Forgiarini SGI
        • Junior LAF.
        Lung hyperinfation by mechanical ventilation versus isolated tracheal aspiration in the bronchial hygiene of patients undergoing mechanical ventilation.
        Rev Bras Ter Intensiva. 2016; 28: 27-32
        • Chicayban LM.
        Acute effects of ventilator hyperinflation with increased inspiratory time on respiratory mechanics: randomized crossover clinical trial.
        Rev Bras Ter Intensiva. 2019; 31: 289-295
        • Naue WS
        • Herve BB
        • Vieira FN
        • Deponti GN
        • Martins LF
        • Dias AS
        • et al.
        Comparison of bronchial hygiene techniques in mechanically ventilated patients: a randomized clinical trial.
        Rev Bras Ter Intensiva. 2019; 31: 39-46
        • Jacob W
        • Dennis D
        • Jacques A
        • Marsh L
        • Woods P
        • Hebden-Todd T.
        Ventilator hyperinflation determined by peak airway pressure delivered: A randomized crossover trial.
        Nurs Crit Care. 2020; https://doi.org/10.1111/nicc.12498
        • Volpe MS
        • Adams AB
        • Amato MB
        • Marini JJ.
        Ventilation patterns influence airway secretion movement.
        Respir Care. 2008; 5312871294
        • Ntoumenopoulos G
        • Shannon H
        • Main E.
        Do commonly used ventilator settings for mechanically ventilated adults have the potential to embed secretions or promote clearance?.
        Respir Care. 2011; 56: 1887-1892
        • Anderson A
        • Alexanders J
        • Sinani C
        • Hayes S
        • Fogarty M.
        Effects of ventilator vs manual hyperinflation in adults receiving mechanical ventilation: a systematic review of randomised clinical trials.
        Physiotherapy. 2015; 101: 103-110
        • Page MJ
        • McKenzie JE
        • Bossuyt PM
        • Boutron I
        • Hoffmann TC
        • Mulrow CD
        • et al.
        The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.
        BMJ. 2020; 372: n71
        • Cochrane Collaboration
        Cochrane Handbook for Systematic Reviews of Interventions (version 5.1).
        2011 (Accessed 27 July 2018)
        • Higgins JP
        • Thompson SG
        • Deeks JJ
        • Altman DG.
        Measuring inconsistency in meta-analysis.
        BMJ. 2003; 327: 557-560
        • Maher CG
        • Sherrington C
        • Herbert RD
        • Moseley AM
        • Elkins M.
        Reliability of the PEDro scale for rating quality of randomized controlled trials.
        Phys Ther. 2003; 83: 713-721
        • Guyatt G
        • Oxman AD
        • Akl EA
        • et al.
        GRADE guidelines.
        J Clin Epidemiol. 2011; 64: 383-394
      1. Collaboration TC. Available at: www.cochrane.org.

        • Li Bassi G
        • Saucedo L
        • Marti JD
        • Rigol M
        • Esperatti M
        • Luque N
        • et al.
        Effects of duty cycle and positive end-expiratory pressure on mucus clearance during mechanical ventilation.
        Crit Care Med. 2012; 40: 895-902
        • Bassi GL
        • Martı JD
        • Comaru T
        • Aguilera-Xiol E
        • Rigol M
        • Ntoumenopoulos G
        • et al.
        Short-term appraisal of the effects and safety of manual versus ventilator hyperinflation in an animal model of severe pneumonia.
        Respir Care. 2019; 64: 760-770