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Linnane MP, Caruana LR, Tronstad O, Corley A, Spooner AJ, Barnett AG, Thomas PJ, Walsh JR. A comparison of the effects of manual hyperinflation and ventilator hyperinflation on restoring end-expiratory lung volume after endotracheal suctioning: A pilot physiologic study. J Crit Care 2018; 49:77-83. [PMID: 30388492 DOI: 10.1016/j.jcrc.2018.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 10/18/2018] [Accepted: 10/19/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Endotracheal suctioning (ES) of mechanically ventilated patients decreases end-expiratory lung volume (EELV). Manual hyperinflation (MHI) and ventilator hyperinflation (VHI) may restore EELV post-ES but it remains unknown which method is most effective. The primary aim was to compare the efficacy of MHI and VHI in restoring EELV post-ES. MATERIALS AND METHODS ES was performed on mechanically ventilated intensive care patients, followed by MHI or VHI, in a randomised crossover design. The washout period between interventions was 1 h. End-expiratory lung impedance (EELI), measured by electrical impedance tomography, was recorded at baseline, during ES, during hyperinflation and 1, 5, 15 and 30 min post-hyperinflation. RESULTS Nine participants were studied. ES decreased EELI by 1672z (95% CI, 1204 to 2140) from baseline. From baseline, MHI increased EELI by 1154z (95% CI, 977 to 1330) while VHI increased EELI by 769z (95% CI, 457 to 1080). Five minutes post-VHI, EELI remained 528z (95% CI, 4 to 1053) above baseline. Fifteen minutes post-MHI, EELI remained 351z (95% CI, 111 to 592) above baseline. At subsequent time-points, EELI returned to baseline. CONCLUSIONS MHI and VHI effectively restore EELV above baseline post-ES and should be considered post suctioning.
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Affiliation(s)
- Matthew P Linnane
- Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Brisbane, QLD 4032, Australia; Physiotherapy Department, The Prince Charles Hospital, Brisbane, QLD 4032, Australia.
| | - Lawrence R Caruana
- Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Brisbane, QLD 4032, Australia; Physiotherapy Department, The Prince Charles Hospital, Brisbane, QLD 4032, Australia.
| | - Oystein Tronstad
- Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Brisbane, QLD 4032, Australia; Physiotherapy Department, The Prince Charles Hospital, Brisbane, QLD 4032, Australia.
| | - Amanda Corley
- Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Brisbane, QLD 4032, Australia.
| | - Amy J Spooner
- Institute of Health and Biomedical Innovation, School of Public Health, Queensland University of Technology, Brisbane, QLD 4000, Australia.
| | - Adrian G Barnett
- Institute of Health and Biomedical Innovation, School of Public Health, Queensland University of Technology, Brisbane, QLD 4000, Australia.
| | - Peter J Thomas
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, QLD 4006, Australia.
| | - James R Walsh
- Physiotherapy Department, The Prince Charles Hospital, Brisbane, QLD 4032, Australia; School of Allied Health Sciences, Griffith University, Gold Coast, QLD 4215, Australia.
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