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Performance of manual hyperinflation: a skills lab study among trained intensive care unit nurses

Frederique Paulus, Jan M. Binnekade, Pauline Middelhoek, Margreeth B. Vroom, Marcus J. Schultz

Med Sci Monit 2009; 15(8): CR418-422

ID: 878141

Published: 2009-08-01

Background: The aim of manual hyperinflation (MH) is to mobilize airway secretions and prevent sputum plugging in intubated and mechanically ventilated patients. With MH, the nurse applies a larger than normal breath with a slow inspiratory flow and, after an inspiratory pause, a high expiratory flow is created by completely releasing the resuscitation bag.
Material and Method: This was a prospective observational study in a skills lab of a university hospital. Intensive care unit nurses performed MH procedures for an imaginary patient in three different compliance settings. Data were collected via direct video recordings and an air-flow analyzer.
Results: One hundred nurses participated. Video recordings demonstrated inappropriate performance of MH, reflected by the appearance of inspirations which were too rapid (53% of cases), absence of holds (60%), and absence of complete release of the resuscitation bag (78%). In the majority of cases the applied volumes were too large according to what was advised in the local guideline (80%). Peak inspiratory flow was 70 (range: 55-89) l/min for all compliance settings and peak expiratory flows were low: for over-compliant (46, range: 42-51), normal (51, range: 45-57), and noncompliant lungs (58, range: 52-64 l/min).
Conclusions: Performance of MH by certified ICU nurses is far from appropriate. These results emphasize the necessity for clearer guidelines with explicit directions for this frequently applied procedure, if it is decided to practice it in the daily care of intubated and mechanically ventilated patients.

Keywords: Respiration, Artificial - methods, Nurses - standards, Male, Lung Compliance, Laboratories, Intubation, Intratracheal, Intensive Care Units