Manual lung hyperinflation

Manual lung hyperinflation (MH) is one of a number of techniques which are employed by the physiotherapist in the critical care setting. The technique was first described with physiotherapy 30 yrs ago and commonly involves a slow, deep inspiration, inspiratory pause and fast unobstructed expiration. It is commonly employed by physiotherapists to assist in the removal of secretions and re-expand areas of atelectasis.

Lung hyperinflation is a technique used by physiotherapists to mobilize and remove excess bronchial secretions, reinflate areas of pulmonary collapse and improve oxygenation. Hyperinflation may be delivered by the ventilator or manually, by use of a manual resuscitation circuit, depending upon the respiratory and cardiovascular status of the patient. The effects of manual hyperinflation, with respect to excess bronchial secretions and static lung compliance, have been well-established.

How can you compare the effects of manual hyperinflation and ventilator hyperinflation on static pulmonary compliance and sputum clearance in stable intubated and ventilated patients?

How can you compare the Lung Hyperinflation in mobilizing and removing excessive bronchial secretions as compared to other physiotherapy techniques like postural drainage, percussion, shaking, etc.?

"How can you compare the Lung Hyperinflation in mobilizing and removing excessive bronchial secretions as compared to other physiotherapy techniques like postural drainage, percussion, shaking, etc.?"

Hi sdkashif,

I think your chosen method of comparison would be somewhat dependant issues such as the main reason for comparison i.e. clinical or research etc.., on your time, fiscal resources etc. Whilst many studies will simply use sputum collection (either dry weight or volume I think) for comparison between techniques this has obvious draw backs. Perhaps a more accurate means is the use of radioaeorsol in conjunction to imaging techniques such as scintigraphy - like the kind used to research the effects of FET. This is where the participant breaths in a substance to which radioactive markers are attached, these are then tracked using the imaging equipment.

This method allows you to actually calculate the percentage of secretions movement from different lung regions, thereby not only giving you total secretions movement but also an idea of how effective techniques are in terms of regional clearance. However this is only used in research studies owing to cost, skill required to carry out the procedure and ethics - radiation exposure. Therefore a very unrealistic measure for clinical practice but good for providing strong, objective evidence to reinforce the efficacy of clinical practice. ( van der Schans CP, Postma DS, Koeter GH, Rubin BK 1999 Physiotherapy and brochial mucus transport. European Respiratory Journal. 13: 1477-1486 provide an overview/discussion of the problems inherent in measuring respiratory interventions)

Sorry for the epic response :eek: - hope it is helpful. If you would like me to send you any info please email me on [email protected]

Best wishes,

Rachie

Hi sdkashif,
I do not have an answer to your question, however I would like to make a comment based on my clinical experience.I am a physical therapist in the USA and for the past 15 years I have practiced exclusively in the ICU( medical, cardiothoracic and surgical adult ICUs).As you probably know, in the USA we have the respiratory therapists who are responsible for the ventilator management, oxygen/breathing treatments delivery,etc...In this case, my ultimate goal as a physical therapist in the ICU is to improve mobility and minimize loss of functional independence .
In the hospital I work, we do not provide any kind of manual chest physiotherapy or manual hyperinflation. Every stable, intubated and mechanically ventilated patient gets OOB to a chair at least once daily with the nursing staff.
Once the patients are able to minimally participate with therapy and are hemodynamically stable, I start mobilizing them immediately.I do a "mobilization test", that means, if they can sit on the edge of bed, stand with a walker/ assistance and take steps in place, they start walking within their abililty to tolerate activity.
If they do not pass the "test", I work aggressively to help them be able to bear weight and take steps.
As far as airway clearance, it is amazing the amount of secretions we suction during and after mobilization. As far as lung expansion, can you think of any better way to expand your lungs by sitting up, standing, moving?
I have been absolutely fascinated by the results of early mobilization and ambulation of mechanically ventilated patients;a great majority of my patients are able to walk > 100 feet when they are weaned of the ventilator.That goes specially for patients which the cause of weaning failure is weakness.
Thoughts?
Chris

Christiane Perme, PT CCS
Board Certified Cardiovascular and Pulmonary Clinical Specialist
Senior Physical Therapist
The Methodist Hospital
6565 Fannin, M1-024
Houston, TX 77030
(713) 441-2675
FAX: (713) 441-0143
[email protected]
[email protected]