Benefits and risks of manual hyperinflation in intubated and mechanically ventilated intensive care unit-patients: a systematic review
Critical Care, 08/09/2012
Evidence Based Medicine
Paulus F et al. – Studies have failed to show Manual hyperinflation (MH) benefits critically ill intubated and mechanically ventilated patients. MH is infrequently associated with short–term side–effects.Methods
- The authors performed a search in the databases of Medline, Embase and the Cochrane Library from January 1990 to April 2012.
- They systematically reviewed the literature on evidence for postulated benefits and risks of MH in critically ill intubated and mechanically ventilated patients.
- The search identified 50 articles, of which 19 were considered relevant.
- The authors included 13 interventional studies and 6 observational studies.
- The number of studies evaluating physiological effects of MH is limited.
- Trials differed too much to permit meta-analysis.
- It is uncertain whether MH was applied similarly in the retrieved studies.
- Finally, most studies are underpowered to show clinical benefit of MH.
- Use of MH is associated with short-term improvements in lung compliance, oxygenation and secretion clearance, without changes in outcomes.
- MH has been reported to be associated with short-term and probably clinically insignificant side-effects, including decreases in cardiac output, alterations of heart rates and increased central venous pressures.