Abstract
Objectives
Patients requiring mechanical ventilation in the intensive care unit (ICU) have diminished
respiratory defences and are at high risk of respiratory compromise, leading to an
increased risk of pulmonary infection and prolonged ventilation. Ventilator hyperinflation
(VHI) is an airway clearance technique used by physiotherapists and is suggested to
improve respiratory mechanics. The objective of this study was to review the evidence
for the benefits and risks of VHI in intubated and mechanically ventilated patients
in the ICU.
Review method used
We conducted a systematic review.
Data sources
We searched PubMed, Embase, CINAHL, CENTRAL, and Scopus from inception to 31st May
2022 for all randomised control trials evaluating VHI in intubated and mechanically
ventilated adults in the ICU.
Review methods
Two authors independently performed study selection and data extraction. Individual
study risk of bias was assessed using the Physiotherapy Evidence Database scale, and
certainty in outcomes was assessed using the Grading of Recommendations, Assessment,
Development and Evaluations framework.
Results
We included 10 studies enrolling 394 patients. Compared to standard care, VHI had
significant effects on sputum clearance (Standardise mean difference: 0.36, 95% confidence
interval [CI]: 0.12 to 0.61; very low certainty), static pulmonary compliance (mean
difference [MD]: 4.77, 95% CI: 2.40 to 7.14; low certainty), dynamic pulmonary compliance
(MD: 1.59, 95% CI: 0.82 to 2.36; low certainty) and oxygenation (MD: 0.28, 95% CI:
0.01 to 0.55; low certainty). No significant adverse events or immediate side effects
relating to VHI were reported. There is a paucity of data available on the effects
of VHI on clinical outcomes including mechanical ventilation duration, ICU length
of stay, and mortality.
Conclusions
Our findings suggest VHI has potential short-term respiratory benefits including increased
secretion clearance, pulmonary compliance, and oxygenation, with no immediate adverse
effects in intubated and mechanically ventilated ICU patients. However, there remains
limited data on the longer term influence of VHI on clinical outcomes, and further
research to inform clinical practice is needed.
Registration
This study is registered with the International Prospective Register of Systematic
Reviews (PROSPERO; CRD42022341421).
Keywords
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Article info
Publication history
Published online: February 21, 2023
Accepted:
January 8,
2023
Received in revised form:
December 14,
2022
Received:
August 11,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.
