PMID- 21068707
OWN - NLM
STAT- MEDLINE
DCOM- 20110414
LR  - 20101223
IS  - 1827-1596 (Electronic)
IS  - 0375-9393 (Linking)
VI  - 76
IP  - 12
DP  - 2010 Dec
TI  - Manual hyperinflation is associated with a low rate of adverse events when 
      performed by experienced and trained nurses in stable critically ill patients--a 
      prospective observational study.
PG  - 1036-42
AB  - BACKGROUND: Manual hyperinflation (MH) can be performed as part of airway 
      management in intubated and mechanically ventilated patients to mobilize airway 
      secretions. Although previous studies demonstrated MH to be associated with 
      hemodynamic and respiratory instability, we hypothesized MH to cause fewer 
      adverse events (AEs) when performed by experienced and trained nurses in stable 
      critically ill patients. METHODS: The incidence and type of AEs associated with 
      MH were studied in a 28-bed mixed medical-surgical Intensive Care Unit. A 
      difference in mean arterial pressure (MAP) or heart rate (HR) >15%, a decrease in 
      peripheral oxygen saturation (SpO2) >5%, and a change in end-tidal (et)-CO2 >20% 
      were considered AEs. A decrease of MAP to </=60 mmHg, any new arrhythmia, and a 
      decrease of SpO2 </=90% were all considered severe AEs. Also, all changes in 
      medication were considered severe AEs. RESULTS: A total of 107 MH maneuvers in 74 
      patients, performed by 57 nurses, were observed and analyzed. A total of 17 MH 
      maneuvers (16%) were associated with any AE; 7 maneuvers (6%) were associated 
      with a severe AE. Overall, MH did not affect MAP. MH caused a statistically 
      significant but clinically irrelevant increase of HR (from 87+/-24 to 89+/-22 bpm). 
      In one patient the MAP dropped from 70 mmHg to 60 mmHg, requiring adjustment of 
      vasopressor therapy; one patient developed ventricular tachycardia requiring 
      electric cardioversion. In general, MH did not affect SpO2. In one patient SpO2 
      dropped below 90%, requiring additional oxygen supply for 10 minutes. MH caused a 
      statistically significant but clinically irrelevant increase of et-CO2 levels 
      (from 4.4+/-0.9 to 4.5+/-1.0 kPa). Five patients developed anxiety/agitation during 
      or shortly after MH, mandating additional sedation in four patients. Occurrence 
      of (severe) AEs was not associated with any specific patient or MH 
      characteristic. CONCLUSION: The rate of hemodynamic and respiratory AEs with MH 
      is low when performed by experienced and trained nurses in stable, critically ill 
      patients. MH, however, may induce or increase anxiety/agitation. We consider MH a 
      safe maneuver in stable ICU patients in our setting.
FAU - Paulus, F
AU  - Paulus F
AD  - Department of Intensive Care Medicine, Academic Medical Center, University of 
      Amsterdam, Amsterdam, the Netherlands. f.paulus@amc.uva.nl
FAU - Binnekade, J M
AU  - Binnekade JM
FAU - Vermeulen, M
AU  - Vermeulen M
FAU - Vroom, M B
AU  - Vroom MB
FAU - Schultz, M J
AU  - Schultz MJ
LA  - eng
PT  - Journal Article
DEP - 20101110
PL  - Italy
TA  - Minerva Anestesiol
JT  - Minerva anestesiologica
JID - 0375272
SB  - IM
MH  - Aged
MH  - Airway Management/*adverse effects/*methods
MH  - Clinical Competence
MH  - Critical Care/*methods
MH  - Critical Illness
MH  - Female
MH  - Hemodynamics/physiology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - *Nurses
MH  - Respiratory Mechanics/physiology
EDAT- 2010/11/12 06:00
MHDA- 2011/04/16 06:00
CRDT- 2010/11/12 06:00
PHST- 2010/11/12 06:00 [entrez]
PHST- 2010/11/12 06:00 [pubmed]
PHST- 2011/04/16 06:00 [medline]
AID - R02105966 [pii]
PST - ppublish
SO  - Minerva Anestesiol. 2010 Dec;76(12):1036-42. Epub 2010 Nov 10.