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manual vs. ventilator hyperinflation - I'm interested in hearing if the bandwagon for VHI is gathering momentum? Are people out there using it? Instead of MHI or as an adjunct? Or in a different subset of ICU patients - if so, how do you decide who gets which treatment strategy?
Then of course there is the question of VHI vs. recruitment manoevres ... Any thoughts or comments welcome
Shane- I personally prefer MHI as I can get a good feel for what is happening in the lungs. I worked with ITU consultants who wanted us to use MHI more aggressively than has traditionally used. They taught me a recruitment manoeuvre which certainly worked to keep sats at an acceptable level following treatment for patients who were quite PEEP dependent. I am working academically now but I believe there is a move to more VHI. I would be interested to see any research comparing the two techniques.
there is a paper out there on this (as usual not at hand).
i'm totally with MHI for the tactile feedback and various option syou have for changing the characteristics of the breaths delivered.
i might be getting this wrong here, but i find that most ventilators can do a nice inspiratory hold but not an actual larger tidal volume. is this therefore largely limited to having the right equipment?
Thanks Marty & Fiona for your thoughts. I too have historically favoured MHI for the same reasons listed (anyone would think we all came from the same uni with the similarity of our ideas!), but see a potential opportunity to expand and 'own' our role with VHI as a physio technique.
I think the paper that Marty was referring was: Berney, S. and L. Denehy (2002). "A comparison of the effects of manual and ventilator hyperinflation on static lung compliance and sputum production in intubated and ventilated intensive care patients." Physiotherapy Research International 7(2): 100-108.
I think there is scope to further research VHI, even if to only describe the technique and its usage and benefits in certain patients, and allow subsequent benchmarking.
mhi is easier to use (although our nurses hate it here in singapore, because they have to make sure they decontaminate the laerdal bags regularly). it is also an "assessment" tool for lung compliance.
vhi requires the anaesthetist's consent because we have to adjust the tidal volume and switching the simv rate down. some ventilator settings are locked with password. also american-trained intensivists don't usually like it despite explanation. they are very much into low tidal volume ventilation and if we say we want to do vhi, they invariably associate it with recruitment manoeuvre. then they will want us to look into plateau pressures and applying cpap in excess of 40 cm h2o, and they have to be present etc.... but if the patient is peep-dependent and/or has airborne precautions in closed suction circuit, may be useful.