Manual Hyperinflation in sitting?

To be frank ive never seen or done MHI for any pts in sitting in my career! Is the pt conscious not sedated? if conscious i would go for HDT(if not contraindicated) alternate side lying and regular chest PT techniques,bcos MHI would be hard on conscious pts. The PEEP value to be taken into consideration since the pt already has bil.lobar collapse. In this situation if PEEP already higher than 10 i wouldn't dare to disconnect the ventillator from ETT as it would cause further collapse..regards

Quote:

Originally Posted by salxtai

Hey, I'm still just a physio student, so apologies in advance if the question sounds silly - been trying to find an answer to it for the past hour in textbooks, online etc, to no avail. Hoping those with clinical experience may be able to help out :)

I'm writing out a treatment plans for cases that I've covered in class during the semester, and one of them has the following main points:

- Pt transferred to ICU due to pain control issues post surgery (pain 10/10, RR 38bpm, SpO2 92% on 10L via NRBM)
- Pt subsequently intubated and ventilated
- CXR shows marked bilateral lower lobe collapse

I know that sitting up / mobilising etc will improve lung volumes significantly, but I haven't got information regarding Pt position or LOC.
In a Pt that isn't intubated, I would generally sit them up and try to get them to do ACBT with focus on thoracic expansion to resolve the atelectasis.

[if LOC is poor then I would aim to position them R side-lying and MHI]

So my question is:
For someone who's intubated and ventilated (assuming sufficient LOC for safety), is it possible to sit them up and do MHI while sitting?
Or should this technique generally be kept to supine / gravity-assisted positions?

Since I'm not sure how effective sitting them up alone would be in resolving the atelectasis - the other option I thought of was R side-lying and MHI initially, then leave them at the end of the treatment session in a high sitting position.

Thanks in advance :)