Manual hyperinflation improves alveolar recruitment in difficult-to-wean patients

Chest. 2005 Oct;128(4):2714-21. doi: 10.1378/chest.128.4.2714.


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 Pa(O2)/fraction of inspired oxygen [Fi(O2)]) 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 Pa(O2)/Fi(O2) (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.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Female
  • Humans
  • Intubation / methods
  • Intubation, Intratracheal / methods
  • Lung Diseases / therapy
  • Male
  • Middle Aged
  • Pulmonary Alveoli / physiopathology*
  • Pulmonary Atelectasis / etiology*
  • Pulmonary Atelectasis / physiopathology
  • Respiratory Therapy*
  • Ventilator Weaning / adverse effects*
  • Ventilator Weaning / methods