Author, date and country | Patient group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
---|---|---|---|---|---|
K Hayes et al 2011 Australia and New Zealand | Senior physiotherapists working in ICU in Australia or New Zealand | Postal Survey | Not applicable – survey of current clinical practice amongst senior physiotherapists | 21% used VHI in practice. | Only requested one response per ICU. Further studies are required to define optimal parameters and promote standardised delivery. |
Main barriers cited: lack of training and lack of medical approval. | |||||
91% of respondents used Manual Hyperinflation (MHI). | |||||
Most commonly cited indication for VHI was sputum retention. | |||||
Almost half of respondents used VHI did not have a protocol. | |||||
S. Berney and L Denehy 2002 Australia | 20 intubated and ventilated adult patients | MHI versus VHI in prospective, randomised, controlled crossover study | Sputum wet weight | No significant difference between the sputum production in either technique. | This is the first study to look at the effects of VHI on static lung compliance so results cannot be compared. |
Static compliance | Both VHI and MHI significantly improved static lung compliance | ||||
C. Savian, J Paratx and A. Davies 2006 Australia | 14 intubated and ventilated adult patients | MHI versus VHI in single blind randomised crossover study. | Sputum wet weight | No significant difference in: sputum production, improvements in pO2:Fio2, or levels of PEEP between the two techniques. | Arterial blood gases 30 minutes after treatment could not be obtained for ethical reasons. Patient group did not have a large secretion load. |
Peak expiratory flow rate (PEFR) | Trend towards a lower PEF in patients on a PEEP of 10 using VHI. | ||||
Static compliance | VHI improved static respiratory system compliance. | ||||
Oxygenation | |||||
Mean arterial pressure (MAP) and Heart Rate (HR) | |||||
PaCO2 | |||||
D Dennis et al 2012 Australia | 48 intubated and ventilated adult patients who had atelectasis or consolidation on chest X Ray. | MHI versus VHI in crossover trial | Sputum wet weight | No significant difference in sputum cleared between MHI and VHI. | Future studies needed to explore physiotherapy techniques combined with VHI for recruitment. |
MHI resulted in a higher peak airway pressure | |||||
No significant difference in measures of gas exchange, respiratory and hemodynamic status. | |||||
F Ahmed et al 2010 India | 30 post-operative patients, who had undergone mitral valve replacement for rheumatic heart disease. | MHI vs VHI in paralysed patients. Randomised, 2 group intervention study | Static compliance | VHI is as effective as MHI in improving pulmonary compliance. | Oesophageal balloon was not used in the measurement of compliance. Both methods were volume dependent. Specific brand of MHI bag used. Clinical significance on patient outcomes are unclear, further research is needed. |
Dynamic compliance | VHI maintained improvements in static lung compliance above baseline for a longer duration compared to MHI. | ||||
Oxygenation | Improved Pa02:Fi02 ratio in MHI. | ||||
pH | |||||
paCO2 | |||||
A Anderson et al 2015 United Kingdom | 4 Randomised Controlled Trials | MHI versus VHI: Systematic Review | Sputum wet weight | 3 studies found no difference in sputum weight. | Publication Bias. Only included studies from a 20-year period. Lack of long term follow up (past 30 minutes) in all four studies. Co-intervention bias |
Dynamic and static pulmonary compliance | 3 studies found no significant difference in static lung compliance. | ||||
Oxygenation | |||||
Cardiovascular stability | Nil reported adverse events. | ||||
D Lemes et al 2009 Brazil | 30 mechanically ventilated patients with pulmonary infection. | VHI in side lying versus side-lying alone in randomised crossover trial | Sputum volume | VHI more efficient in secretion clearance.VHI more efficient in secretion clearance. | Assessor not blinded. Clinically relevant outcomes were not considered. Different VHI protocols should be compared to establish most advantageous procedure. |
Static compliance | Respiratory compliance increased in VHI group. | ||||
Total resistance of respiratory system | No significant difference in the change in respiratory resistance between the two interventions. | ||||
No adverse effects noted in either group | |||||
G. Ntoumenopoulos and E. Main 2011 United Kingdom | 20 intubated and ventilated adult patients. | Observational | Peak inspiratory flow (PIF) and peak expiratory flow (PEF) on baseline vPeak inspiratory flow (PIF) and peak expiratory flow (PEF) on baseline ventilation settings. entilation settings. | At baseline settings, all patients had an inspiratory flow bias. | Small sample size. Short ventilation observation period. No information on presence of airway secretions. Did not assess changes in PIF:PEF bias with changes in ventilator. |