Experimental study on the efficiency and safety of the manual hyperinflation maneuver as a secretion clearance technique

OBJECTIVE: To evaluate, in a lung model simulating a mechanically ventilated patient, the efficiency and safety of the manual hyperinflation (MH) maneuver as a means of removing pulmonary secretions. METHODS: Eight respiratory therapists (RTs) were asked to use a self-inflating manual resuscitat...
Ausführliche Beschreibung

Gespeichert in:

Autor*in:	Tatiana de Arruda Ortiz [verfasserIn] Germano Forti [verfasserIn] Márcia Souza Volpe [verfasserIn] Carlos Roberto Ribeiro Carvalho [verfasserIn] Marcelo Brito Passos Amato [verfasserIn] Mauro Roberto Tucci [verfasserIn]

Format:	E-Artikel
Sprache:	Englisch ; Portugiesisch

Erschienen:	2013

Schlagwörter:	Physical therapy modalities Respiratory therapy Respiratory mechanics Positive-pressure respiration

Übergeordnetes Werk:	In: Jornal Brasileiro de Pneumologia - Sociedade Brasileira de Pneumologia e Tisiologia, 2005, 39(2013), 2, Seite 205-213
Übergeordnetes Werk:	volume:39 ; year:2013 ; number:2 ; pages:205-213

Links:	Link aufrufen Link aufrufen Link aufrufen Link aufrufen Journal toc

DOI / URN:	10.1590/S1806-37132013000200012

Katalog-ID:	DOAJ070372667

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520			\|a OBJECTIVE: To evaluate, in a lung model simulating a mechanically ventilated patient, the efficiency and safety of the manual hyperinflation (MH) maneuver as a means of removing pulmonary secretions. METHODS: Eight respiratory therapists (RTs) were asked to use a self-inflating manual resuscitator on a lung model to perform MH as if to remove secretions, under two conditions: as routinely applied during their clinical practice; and after receiving verbal instructions based on expert recommendations. In both conditions, three clinical scenarios were simulated: normal lung function, restrictive lung disease, and obstructive lung disease. RESULTS: Before instruction, it was common for an RT to compress the resuscitator bag two times, in rapid succession. Proximal pressure (Pprox) was higher before instruction than after. However, alveolar pressure (Palv) never exceeded 42.5 cmH2O (median, 16.1; interquartile range [IQR], 11.7-24.5), despite Pprox values as high as 96.6 cmH2O (median, 36.7; IQR, 22.9-49.4). The tidal volume (VT) generated was relatively low (median, 640 mL; IQR, 505-735), and peak inspiratory flow (PIF) often exceeded peak expiratory flow (PEF), the median values being 1.37 L/s (IQR, 0.99-1.90) and 1.01 L/s (IQR, 0.55-1.28), respectively. A PIF/PEF ratio < 0.9 (which theoretically favors mucus migration toward the central airways) was achieved in only 16.7% of the maneuvers. CONCLUSIONS: Under the conditions tested, MH produced safe Palv levels despite high Pprox. However, the MH maneuver was often performed in a way that did not favor secretion removal (PIF exceeding PEF), even after instruction. The unfavorable PIF/PEF ratio was attributable to overly rapid inflations and low VT.
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allfields	10.1590/S1806-37132013000200012 doi (DE-627)DOAJ070372667 (DE-599)DOAJde3e70cd41e2471c8616a3bb87a9374e DE-627 ger DE-627 rakwb eng por RC705-779 Tatiana de Arruda Ortiz verfasserin aut Experimental study on the efficiency and safety of the manual hyperinflation maneuver as a secretion clearance technique 2013 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier OBJECTIVE: To evaluate, in a lung model simulating a mechanically ventilated patient, the efficiency and safety of the manual hyperinflation (MH) maneuver as a means of removing pulmonary secretions. METHODS: Eight respiratory therapists (RTs) were asked to use a self-inflating manual resuscitator on a lung model to perform MH as if to remove secretions, under two conditions: as routinely applied during their clinical practice; and after receiving verbal instructions based on expert recommendations. In both conditions, three clinical scenarios were simulated: normal lung function, restrictive lung disease, and obstructive lung disease. RESULTS: Before instruction, it was common for an RT to compress the resuscitator bag two times, in rapid succession. Proximal pressure (Pprox) was higher before instruction than after. However, alveolar pressure (Palv) never exceeded 42.5 cmH2O (median, 16.1; interquartile range [IQR], 11.7-24.5), despite Pprox values as high as 96.6 cmH2O (median, 36.7; IQR, 22.9-49.4). The tidal volume (VT) generated was relatively low (median, 640 mL; IQR, 505-735), and peak inspiratory flow (PIF) often exceeded peak expiratory flow (PEF), the median values being 1.37 L/s (IQR, 0.99-1.90) and 1.01 L/s (IQR, 0.55-1.28), respectively. A PIF/PEF ratio < 0.9 (which theoretically favors mucus migration toward the central airways) was achieved in only 16.7% of the maneuvers. CONCLUSIONS: Under the conditions tested, MH produced safe Palv levels despite high Pprox. However, the MH maneuver was often performed in a way that did not favor secretion removal (PIF exceeding PEF), even after instruction. The unfavorable PIF/PEF ratio was attributable to overly rapid inflations and low VT. Physical therapy modalities Respiratory therapy Respiratory mechanics Positive-pressure respiration Diseases of the respiratory system Germano Forti verfasserin aut Márcia Souza Volpe verfasserin aut Carlos Roberto Ribeiro Carvalho verfasserin aut Marcelo Brito Passos Amato verfasserin aut Mauro Roberto Tucci verfasserin aut In Jornal Brasileiro de Pneumologia Sociedade Brasileira de Pneumologia e Tisiologia, 2005 39(2013), 2, Seite 205-213 (DE-627)508330513 (DE-600)2223157-2 18063756 nnns volume:39 year:2013 number:2 pages:205-213 https://doi.org/10.1590/S1806-37132013000200012 kostenfrei https://doaj.org/article/de3e70cd41e2471c8616a3bb87a9374e kostenfrei http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-37132013000200205&tlng=en kostenfrei http://www.scielo.br/pdf/jbpneu/v39n2/1806-3713-jbpneu-39-2-0205.pdf kostenfrei https://doaj.org/toc/1806-3756 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 39 2013 2 205-213
spelling	10.1590/S1806-37132013000200012 doi (DE-627)DOAJ070372667 (DE-599)DOAJde3e70cd41e2471c8616a3bb87a9374e DE-627 ger DE-627 rakwb eng por RC705-779 Tatiana de Arruda Ortiz verfasserin aut Experimental study on the efficiency and safety of the manual hyperinflation maneuver as a secretion clearance technique 2013 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier OBJECTIVE: To evaluate, in a lung model simulating a mechanically ventilated patient, the efficiency and safety of the manual hyperinflation (MH) maneuver as a means of removing pulmonary secretions. METHODS: Eight respiratory therapists (RTs) were asked to use a self-inflating manual resuscitator on a lung model to perform MH as if to remove secretions, under two conditions: as routinely applied during their clinical practice; and after receiving verbal instructions based on expert recommendations. In both conditions, three clinical scenarios were simulated: normal lung function, restrictive lung disease, and obstructive lung disease. RESULTS: Before instruction, it was common for an RT to compress the resuscitator bag two times, in rapid succession. Proximal pressure (Pprox) was higher before instruction than after. However, alveolar pressure (Palv) never exceeded 42.5 cmH2O (median, 16.1; interquartile range [IQR], 11.7-24.5), despite Pprox values as high as 96.6 cmH2O (median, 36.7; IQR, 22.9-49.4). The tidal volume (VT) generated was relatively low (median, 640 mL; IQR, 505-735), and peak inspiratory flow (PIF) often exceeded peak expiratory flow (PEF), the median values being 1.37 L/s (IQR, 0.99-1.90) and 1.01 L/s (IQR, 0.55-1.28), respectively. A PIF/PEF ratio < 0.9 (which theoretically favors mucus migration toward the central airways) was achieved in only 16.7% of the maneuvers. CONCLUSIONS: Under the conditions tested, MH produced safe Palv levels despite high Pprox. However, the MH maneuver was often performed in a way that did not favor secretion removal (PIF exceeding PEF), even after instruction. The unfavorable PIF/PEF ratio was attributable to overly rapid inflations and low VT. Physical therapy modalities Respiratory therapy Respiratory mechanics Positive-pressure respiration Diseases of the respiratory system Germano Forti verfasserin aut Márcia Souza Volpe verfasserin aut Carlos Roberto Ribeiro Carvalho verfasserin aut Marcelo Brito Passos Amato verfasserin aut Mauro Roberto Tucci verfasserin aut In Jornal Brasileiro de Pneumologia Sociedade Brasileira de Pneumologia e Tisiologia, 2005 39(2013), 2, Seite 205-213 (DE-627)508330513 (DE-600)2223157-2 18063756 nnns volume:39 year:2013 number:2 pages:205-213 https://doi.org/10.1590/S1806-37132013000200012 kostenfrei https://doaj.org/article/de3e70cd41e2471c8616a3bb87a9374e kostenfrei http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-37132013000200205&tlng=en kostenfrei http://www.scielo.br/pdf/jbpneu/v39n2/1806-3713-jbpneu-39-2-0205.pdf kostenfrei https://doaj.org/toc/1806-3756 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 39 2013 2 205-213
allfields_unstemmed	10.1590/S1806-37132013000200012 doi (DE-627)DOAJ070372667 (DE-599)DOAJde3e70cd41e2471c8616a3bb87a9374e DE-627 ger DE-627 rakwb eng por RC705-779 Tatiana de Arruda Ortiz verfasserin aut Experimental study on the efficiency and safety of the manual hyperinflation maneuver as a secretion clearance technique 2013 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier OBJECTIVE: To evaluate, in a lung model simulating a mechanically ventilated patient, the efficiency and safety of the manual hyperinflation (MH) maneuver as a means of removing pulmonary secretions. METHODS: Eight respiratory therapists (RTs) were asked to use a self-inflating manual resuscitator on a lung model to perform MH as if to remove secretions, under two conditions: as routinely applied during their clinical practice; and after receiving verbal instructions based on expert recommendations. In both conditions, three clinical scenarios were simulated: normal lung function, restrictive lung disease, and obstructive lung disease. RESULTS: Before instruction, it was common for an RT to compress the resuscitator bag two times, in rapid succession. Proximal pressure (Pprox) was higher before instruction than after. However, alveolar pressure (Palv) never exceeded 42.5 cmH2O (median, 16.1; interquartile range [IQR], 11.7-24.5), despite Pprox values as high as 96.6 cmH2O (median, 36.7; IQR, 22.9-49.4). The tidal volume (VT) generated was relatively low (median, 640 mL; IQR, 505-735), and peak inspiratory flow (PIF) often exceeded peak expiratory flow (PEF), the median values being 1.37 L/s (IQR, 0.99-1.90) and 1.01 L/s (IQR, 0.55-1.28), respectively. A PIF/PEF ratio < 0.9 (which theoretically favors mucus migration toward the central airways) was achieved in only 16.7% of the maneuvers. CONCLUSIONS: Under the conditions tested, MH produced safe Palv levels despite high Pprox. However, the MH maneuver was often performed in a way that did not favor secretion removal (PIF exceeding PEF), even after instruction. The unfavorable PIF/PEF ratio was attributable to overly rapid inflations and low VT. Physical therapy modalities Respiratory therapy Respiratory mechanics Positive-pressure respiration Diseases of the respiratory system Germano Forti verfasserin aut Márcia Souza Volpe verfasserin aut Carlos Roberto Ribeiro Carvalho verfasserin aut Marcelo Brito Passos Amato verfasserin aut Mauro Roberto Tucci verfasserin aut In Jornal Brasileiro de Pneumologia Sociedade Brasileira de Pneumologia e Tisiologia, 2005 39(2013), 2, Seite 205-213 (DE-627)508330513 (DE-600)2223157-2 18063756 nnns volume:39 year:2013 number:2 pages:205-213 https://doi.org/10.1590/S1806-37132013000200012 kostenfrei https://doaj.org/article/de3e70cd41e2471c8616a3bb87a9374e kostenfrei http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-37132013000200205&tlng=en kostenfrei http://www.scielo.br/pdf/jbpneu/v39n2/1806-3713-jbpneu-39-2-0205.pdf kostenfrei https://doaj.org/toc/1806-3756 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 39 2013 2 205-213
allfieldsGer	10.1590/S1806-37132013000200012 doi (DE-627)DOAJ070372667 (DE-599)DOAJde3e70cd41e2471c8616a3bb87a9374e DE-627 ger DE-627 rakwb eng por RC705-779 Tatiana de Arruda Ortiz verfasserin aut Experimental study on the efficiency and safety of the manual hyperinflation maneuver as a secretion clearance technique 2013 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier OBJECTIVE: To evaluate, in a lung model simulating a mechanically ventilated patient, the efficiency and safety of the manual hyperinflation (MH) maneuver as a means of removing pulmonary secretions. METHODS: Eight respiratory therapists (RTs) were asked to use a self-inflating manual resuscitator on a lung model to perform MH as if to remove secretions, under two conditions: as routinely applied during their clinical practice; and after receiving verbal instructions based on expert recommendations. In both conditions, three clinical scenarios were simulated: normal lung function, restrictive lung disease, and obstructive lung disease. RESULTS: Before instruction, it was common for an RT to compress the resuscitator bag two times, in rapid succession. Proximal pressure (Pprox) was higher before instruction than after. However, alveolar pressure (Palv) never exceeded 42.5 cmH2O (median, 16.1; interquartile range [IQR], 11.7-24.5), despite Pprox values as high as 96.6 cmH2O (median, 36.7; IQR, 22.9-49.4). The tidal volume (VT) generated was relatively low (median, 640 mL; IQR, 505-735), and peak inspiratory flow (PIF) often exceeded peak expiratory flow (PEF), the median values being 1.37 L/s (IQR, 0.99-1.90) and 1.01 L/s (IQR, 0.55-1.28), respectively. A PIF/PEF ratio < 0.9 (which theoretically favors mucus migration toward the central airways) was achieved in only 16.7% of the maneuvers. CONCLUSIONS: Under the conditions tested, MH produced safe Palv levels despite high Pprox. However, the MH maneuver was often performed in a way that did not favor secretion removal (PIF exceeding PEF), even after instruction. The unfavorable PIF/PEF ratio was attributable to overly rapid inflations and low VT. Physical therapy modalities Respiratory therapy Respiratory mechanics Positive-pressure respiration Diseases of the respiratory system Germano Forti verfasserin aut Márcia Souza Volpe verfasserin aut Carlos Roberto Ribeiro Carvalho verfasserin aut Marcelo Brito Passos Amato verfasserin aut Mauro Roberto Tucci verfasserin aut In Jornal Brasileiro de Pneumologia Sociedade Brasileira de Pneumologia e Tisiologia, 2005 39(2013), 2, Seite 205-213 (DE-627)508330513 (DE-600)2223157-2 18063756 nnns volume:39 year:2013 number:2 pages:205-213 https://doi.org/10.1590/S1806-37132013000200012 kostenfrei https://doaj.org/article/de3e70cd41e2471c8616a3bb87a9374e kostenfrei http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-37132013000200205&tlng=en kostenfrei http://www.scielo.br/pdf/jbpneu/v39n2/1806-3713-jbpneu-39-2-0205.pdf kostenfrei https://doaj.org/toc/1806-3756 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 39 2013 2 205-213
allfieldsSound	10.1590/S1806-37132013000200012 doi (DE-627)DOAJ070372667 (DE-599)DOAJde3e70cd41e2471c8616a3bb87a9374e DE-627 ger DE-627 rakwb eng por RC705-779 Tatiana de Arruda Ortiz verfasserin aut Experimental study on the efficiency and safety of the manual hyperinflation maneuver as a secretion clearance technique 2013 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier OBJECTIVE: To evaluate, in a lung model simulating a mechanically ventilated patient, the efficiency and safety of the manual hyperinflation (MH) maneuver as a means of removing pulmonary secretions. METHODS: Eight respiratory therapists (RTs) were asked to use a self-inflating manual resuscitator on a lung model to perform MH as if to remove secretions, under two conditions: as routinely applied during their clinical practice; and after receiving verbal instructions based on expert recommendations. In both conditions, three clinical scenarios were simulated: normal lung function, restrictive lung disease, and obstructive lung disease. RESULTS: Before instruction, it was common for an RT to compress the resuscitator bag two times, in rapid succession. Proximal pressure (Pprox) was higher before instruction than after. However, alveolar pressure (Palv) never exceeded 42.5 cmH2O (median, 16.1; interquartile range [IQR], 11.7-24.5), despite Pprox values as high as 96.6 cmH2O (median, 36.7; IQR, 22.9-49.4). The tidal volume (VT) generated was relatively low (median, 640 mL; IQR, 505-735), and peak inspiratory flow (PIF) often exceeded peak expiratory flow (PEF), the median values being 1.37 L/s (IQR, 0.99-1.90) and 1.01 L/s (IQR, 0.55-1.28), respectively. A PIF/PEF ratio < 0.9 (which theoretically favors mucus migration toward the central airways) was achieved in only 16.7% of the maneuvers. CONCLUSIONS: Under the conditions tested, MH produced safe Palv levels despite high Pprox. However, the MH maneuver was often performed in a way that did not favor secretion removal (PIF exceeding PEF), even after instruction. The unfavorable PIF/PEF ratio was attributable to overly rapid inflations and low VT. Physical therapy modalities Respiratory therapy Respiratory mechanics Positive-pressure respiration Diseases of the respiratory system Germano Forti verfasserin aut Márcia Souza Volpe verfasserin aut Carlos Roberto Ribeiro Carvalho verfasserin aut Marcelo Brito Passos Amato verfasserin aut Mauro Roberto Tucci verfasserin aut In Jornal Brasileiro de Pneumologia Sociedade Brasileira de Pneumologia e Tisiologia, 2005 39(2013), 2, Seite 205-213 (DE-627)508330513 (DE-600)2223157-2 18063756 nnns volume:39 year:2013 number:2 pages:205-213 https://doi.org/10.1590/S1806-37132013000200012 kostenfrei https://doaj.org/article/de3e70cd41e2471c8616a3bb87a9374e kostenfrei http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-37132013000200205&tlng=en kostenfrei http://www.scielo.br/pdf/jbpneu/v39n2/1806-3713-jbpneu-39-2-0205.pdf kostenfrei https://doaj.org/toc/1806-3756 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 39 2013 2 205-213
language	English Portuguese
source	In Jornal Brasileiro de Pneumologia 39(2013), 2, Seite 205-213 volume:39 year:2013 number:2 pages:205-213
sourceStr	In Jornal Brasileiro de Pneumologia 39(2013), 2, Seite 205-213 volume:39 year:2013 number:2 pages:205-213
format_phy_str_mv	Article
institution	findex.gbv.de
topic_facet	Physical therapy modalities Respiratory therapy Respiratory mechanics Positive-pressure respiration Diseases of the respiratory system
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container_title	Jornal Brasileiro de Pneumologia
authorswithroles_txt_mv	Tatiana de Arruda Ortiz @@aut@@ Germano Forti @@aut@@ Márcia Souza Volpe @@aut@@ Carlos Roberto Ribeiro Carvalho @@aut@@ Marcelo Brito Passos Amato @@aut@@ Mauro Roberto Tucci @@aut@@
publishDateDaySort_date	2013-01-01T00:00:00Z
hierarchy_top_id	508330513
id	DOAJ070372667
language_de	englisch portugiesisch
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callnumber-first	R - Medicine
author	Tatiana de Arruda Ortiz
spellingShingle	Tatiana de Arruda Ortiz misc RC705-779 misc Physical therapy modalities misc Respiratory therapy misc Respiratory mechanics misc Positive-pressure respiration misc Diseases of the respiratory system Experimental study on the efficiency and safety of the manual hyperinflation maneuver as a secretion clearance technique
authorStr	Tatiana de Arruda Ortiz
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topic_title	RC705-779 Experimental study on the efficiency and safety of the manual hyperinflation maneuver as a secretion clearance technique Physical therapy modalities Respiratory therapy Respiratory mechanics Positive-pressure respiration
topic	misc RC705-779 misc Physical therapy modalities misc Respiratory therapy misc Respiratory mechanics misc Positive-pressure respiration misc Diseases of the respiratory system
topic_unstemmed	misc RC705-779 misc Physical therapy modalities misc Respiratory therapy misc Respiratory mechanics misc Positive-pressure respiration misc Diseases of the respiratory system
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title	Experimental study on the efficiency and safety of the manual hyperinflation maneuver as a secretion clearance technique
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title_full	Experimental study on the efficiency and safety of the manual hyperinflation maneuver as a secretion clearance technique
author_sort	Tatiana de Arruda Ortiz
journal	Jornal Brasileiro de Pneumologia
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author_browse	Tatiana de Arruda Ortiz Germano Forti Márcia Souza Volpe Carlos Roberto Ribeiro Carvalho Marcelo Brito Passos Amato Mauro Roberto Tucci
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title_sort	experimental study on the efficiency and safety of the manual hyperinflation maneuver as a secretion clearance technique
callnumber	RC705-779
title_auth	Experimental study on the efficiency and safety of the manual hyperinflation maneuver as a secretion clearance technique
abstract	OBJECTIVE: To evaluate, in a lung model simulating a mechanically ventilated patient, the efficiency and safety of the manual hyperinflation (MH) maneuver as a means of removing pulmonary secretions. METHODS: Eight respiratory therapists (RTs) were asked to use a self-inflating manual resuscitator on a lung model to perform MH as if to remove secretions, under two conditions: as routinely applied during their clinical practice; and after receiving verbal instructions based on expert recommendations. In both conditions, three clinical scenarios were simulated: normal lung function, restrictive lung disease, and obstructive lung disease. RESULTS: Before instruction, it was common for an RT to compress the resuscitator bag two times, in rapid succession. Proximal pressure (Pprox) was higher before instruction than after. However, alveolar pressure (Palv) never exceeded 42.5 cmH2O (median, 16.1; interquartile range [IQR], 11.7-24.5), despite Pprox values as high as 96.6 cmH2O (median, 36.7; IQR, 22.9-49.4). The tidal volume (VT) generated was relatively low (median, 640 mL; IQR, 505-735), and peak inspiratory flow (PIF) often exceeded peak expiratory flow (PEF), the median values being 1.37 L/s (IQR, 0.99-1.90) and 1.01 L/s (IQR, 0.55-1.28), respectively. A PIF/PEF ratio < 0.9 (which theoretically favors mucus migration toward the central airways) was achieved in only 16.7% of the maneuvers. CONCLUSIONS: Under the conditions tested, MH produced safe Palv levels despite high Pprox. However, the MH maneuver was often performed in a way that did not favor secretion removal (PIF exceeding PEF), even after instruction. The unfavorable PIF/PEF ratio was attributable to overly rapid inflations and low VT.
abstractGer	OBJECTIVE: To evaluate, in a lung model simulating a mechanically ventilated patient, the efficiency and safety of the manual hyperinflation (MH) maneuver as a means of removing pulmonary secretions. METHODS: Eight respiratory therapists (RTs) were asked to use a self-inflating manual resuscitator on a lung model to perform MH as if to remove secretions, under two conditions: as routinely applied during their clinical practice; and after receiving verbal instructions based on expert recommendations. In both conditions, three clinical scenarios were simulated: normal lung function, restrictive lung disease, and obstructive lung disease. RESULTS: Before instruction, it was common for an RT to compress the resuscitator bag two times, in rapid succession. Proximal pressure (Pprox) was higher before instruction than after. However, alveolar pressure (Palv) never exceeded 42.5 cmH2O (median, 16.1; interquartile range [IQR], 11.7-24.5), despite Pprox values as high as 96.6 cmH2O (median, 36.7; IQR, 22.9-49.4). The tidal volume (VT) generated was relatively low (median, 640 mL; IQR, 505-735), and peak inspiratory flow (PIF) often exceeded peak expiratory flow (PEF), the median values being 1.37 L/s (IQR, 0.99-1.90) and 1.01 L/s (IQR, 0.55-1.28), respectively. A PIF/PEF ratio < 0.9 (which theoretically favors mucus migration toward the central airways) was achieved in only 16.7% of the maneuvers. CONCLUSIONS: Under the conditions tested, MH produced safe Palv levels despite high Pprox. However, the MH maneuver was often performed in a way that did not favor secretion removal (PIF exceeding PEF), even after instruction. The unfavorable PIF/PEF ratio was attributable to overly rapid inflations and low VT.
abstract_unstemmed	OBJECTIVE: To evaluate, in a lung model simulating a mechanically ventilated patient, the efficiency and safety of the manual hyperinflation (MH) maneuver as a means of removing pulmonary secretions. METHODS: Eight respiratory therapists (RTs) were asked to use a self-inflating manual resuscitator on a lung model to perform MH as if to remove secretions, under two conditions: as routinely applied during their clinical practice; and after receiving verbal instructions based on expert recommendations. In both conditions, three clinical scenarios were simulated: normal lung function, restrictive lung disease, and obstructive lung disease. RESULTS: Before instruction, it was common for an RT to compress the resuscitator bag two times, in rapid succession. Proximal pressure (Pprox) was higher before instruction than after. However, alveolar pressure (Palv) never exceeded 42.5 cmH2O (median, 16.1; interquartile range [IQR], 11.7-24.5), despite Pprox values as high as 96.6 cmH2O (median, 36.7; IQR, 22.9-49.4). The tidal volume (VT) generated was relatively low (median, 640 mL; IQR, 505-735), and peak inspiratory flow (PIF) often exceeded peak expiratory flow (PEF), the median values being 1.37 L/s (IQR, 0.99-1.90) and 1.01 L/s (IQR, 0.55-1.28), respectively. A PIF/PEF ratio < 0.9 (which theoretically favors mucus migration toward the central airways) was achieved in only 16.7% of the maneuvers. CONCLUSIONS: Under the conditions tested, MH produced safe Palv levels despite high Pprox. However, the MH maneuver was often performed in a way that did not favor secretion removal (PIF exceeding PEF), even after instruction. The unfavorable PIF/PEF ratio was attributable to overly rapid inflations and low VT.
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title_short	Experimental study on the efficiency and safety of the manual hyperinflation maneuver as a secretion clearance technique
url	https://doi.org/10.1590/S1806-37132013000200012 https://doaj.org/article/de3e70cd41e2471c8616a3bb87a9374e http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-37132013000200205&tlng=en http://www.scielo.br/pdf/jbpneu/v39n2/1806-3713-jbpneu-39-2-0205.pdf https://doaj.org/toc/1806-3756
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author2	Germano Forti Márcia Souza Volpe Carlos Roberto Ribeiro Carvalho Marcelo Brito Passos Amato Mauro Roberto Tucci
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up_date	2024-07-03T14:26:46.053Z
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