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Clinical Investigations in Critical Care |

Manual Hyperinflation Improves Alveolar Recruitment in Difficult-to-Wean Patients*

Suh-Hwa Maa, DSN; Tzong-Jen Hung, MD; Kuang-Hung Hsu, PhD; Ya-I Hsieh, MS; Kwua-Yun Wang, MS; Chun-Hua Wang, MD; Horng-Chyuan Lin, MD
Author and Funding Information

*From the School of Nursing (Dr. Maa), Department of Business Administration (Dr. Hsu), Department and Graduate Institute of Health Care Management, and Department of Thoracic Medicine II (Drs. C-H Wang and Lin), Chang Gung University, Tao-Yuan; Department of Thoracic Medicine (Dr. Hung), Wei Gong Memorial Hospital, Miao-Li; Department of Nursing (Ms. Hsieh), Taipei Veterans General Hospital, Taipei; and School of Nursing (Ms. K-Y Wang), National Defense Medical Center, Taipei, Taiwan.

Correspondence to: Suh-Hwa Maa, DSN, School of Nursing, Chang Gung University, 259, Wen-Hwa First Rd, Kwei-San, Tao-Yuan, Taiwan, ROC; e-mail: shmaa@mail.cgu.edu.tw



Chest. 2005;128(4):2714-2721. doi:10.1378/chest.128.4.2714
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Study objectives: To investigate the effect of manual hyperinflation (MH) in patients with atelectasis associated with ventilation support.

Design: Patients were randomized to either an experimental group or a control group.

Setting: Pulmonary ICUs from two hospitals.

Patients: Twenty-three patients with atelectasis associated with ventilation support.

Interventions: The MH technique was at a rate of 8 to 13 breaths/min for a period of 20 min each session, three times per day for 5 days. The control group received their standard prescribed mechanical ventilation without supplemental MH. Sputum contents (wet/dry weight ratio, viscosity), respiratory system capacity (spontaneous tidal volume [Vt], maximal inspiratory pressure, rapid shallow breathing index [f/Vt], chest radiograph signs, and Pao2/fraction of inspired oxygen [Fio2]) were measured just prior to the MH at day 0 as baseline, and at day 3 and day 6 of the study.

Measurements and results: There were significant improvements in scores over the 6-day study in the experimental group compared to the control group in spontaneous Vt (p = 0.035) and chest radiograph signs (p = 0.040), and a trend toward improvement of f/Vt (p = 0.066) and Pao2/Fio2 (p = 0.061) after adjustment for covariates. Other outcome variables did not differ significantly between the experimental and control groups.

Conclusions: MH performed on patients with atelectasis from ventilation support significantly improved alveolar recruitment.

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