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      Manual and ventilator hyperinflation parameters used by intensive care physiotherapists in Sri Lanka: An online survey

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          Abstract

          Introduction

          Hyperinflation is a common procedure to clear secretion, increase lung compliance and enhance oxygenation in mechanically ventilated patients. Hyperinflation can be provided as manual hyperinflation (MHI) or ventilator hyperinflation (VHI), where outcomes depend upon the methods of application. Hence it is crucial to assess the application of techniques employed in Sri Lanka due to observed variations from recommended practices.

          Objective

          This study is aimed to evaluate the application and parameters used for MHI and VHI by physiotherapists in intensive care units (ICUs) in Sri Lanka.

          Methodology

          An online survey was conducted among physiotherapists who are working in ICUs in Sri Lanka using WhatsApp groups and other social media platforms.

          Results

          A total of 96 physiotherapists responded. The survey comprised of three sections to obtain information about socio-demographic data, MHI practices and VHI practices. Most of the respondents (47%) worked in general hospitals and 74% of participants had a bachelor’s degree in physiotherapy; 31.3% had 3–6 years of experience; 93.8% used hyperinflation, and 78.9% used MHI. MHI was performed routinely and as needed to treat low oxygen levels, abnormal breath sounds, and per physician orders while avoiding contraindications. Self-inflation bags are frequently used for MHI (40.6%). Only a few participants (26%) used a manometer or tracked PIP. In addition to the supine position, some participants (37.5%) used the side-lying position. Most physiotherapists followed the recommended MHI technique: slow squeeze (57.3%), inspiratory pause (45.8%), and quick release (70.8%). VHI was practised by 19.8%, with medical approval and it was frequently performed by medical staff compared to physiotherapists. Treatment time, number of breaths, and patient positioning varied, and parameters were not well-defined.

          Conclusion

          The study found that MHI was not applied with the recommended PIP, and VHI parameters were not identified. The study indicates a need to educate physiotherapists about current VHI and MHI practice guidelines.

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          Most cited references44

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          Improving the Quality of Web Surveys: The Checklist for Reporting Results of Internet E-Surveys (CHERRIES)

          Gunther Eysenbach (2004)
          Analogous to checklists of recommendations such as the CONSORT statement (for randomized trials), or the QUORUM statement (for systematic reviews), which are designed to ensure the quality of reports in the medical literature, a checklist of recommendations for authors is being presented by the Journal of Medical Internet Research (JMIR) in an effort to ensure complete descriptions of Web-based surveys. Papers on Web-based surveys reported according to the CHERRIES statement will give readers a better understanding of the sample (self-)selection and its possible differences from a “representative” sample. It is hoped that author adherence to the checklist will increase the usefulness of such reports.
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            An investigation of the early effects of manual lung hyperinflation in critically ill patients.

            G Ntoumenopoulos, Darin Carroll, G Ntoumenopoulos … (2000)
            This prospective within-group multicentre study was designed to assess the safety and short-term effectiveness of manual lung hyperinflation in mechanically ventilated patients. Eighteen patients from the intensive care units of two tertiary institutions were included and acted as their own control. Manual lung hyperinflation treatment involved patient positioning (side-lying), suctioning and manual lung hyperinflation. Side-lying treatment involved patient positioning and suctioning alone. Patients received both treatments on the day of data collection. Results demonstrated significant improvement for static respiratory system compliance (P = 0.001) with manual lung hyperinflation treatment compared to side-lying treatment. Manual lung hyperinflation treatment also cleared a significantly greater wet weight of sputum (P = 0.039). There were no differences between manual lung hyperinflation and side-lying treatment for gas exchange (PaO2/FIO2 and PaCO2), mean arterial pressure or heart rate. In conclusion, total static respiratory system compliance and sputum clearance were improved by the addition of manual hyperinflation to a physiotherapy treatment of positioning and suctioning in mechanically ventilated patients without compromise to cardiovascular stability or gas exchange.
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              Benefits and risks of manual hyperinflation in intubated and mechanically ventilated intensive care unit patients: a systematic review

              Frederique Paulus, Jan Binnekade, Margreeth B Vroom … (2012)
              Introduction Manual hyperinflation (MH), a frequently applied maneuver in critically ill intubated and mechanically ventilated patients, is suggested to mimic a cough so that airway secretions are mobilized toward the larger airways, where they can easily be removed. As such, MH could prevent plugging of the airways. Methods We performed a search in the databases of Medline, Embase, and the Cochrane Library from January 1990 to April 2012. We systematically reviewed the literature on evidence for postulated benefits and risks of MH in critically ill intubated and mechanically ventilated patients. Results The search identified 50 articles, of which 19 were considered relevant. We included 13 interventional studies and six 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. Conclusions Studies have failed to show that MH benefits critically ill intubated and mechanically ventilated patients. MH is infrequently associated with short-term side effects.
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                Author and article information

                Contributors
                Indrajith Liyanage:
                ORCID: https://orcid.org/0000-0002-8352-9182
                Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: Writing – original draftRole: Writing – review & editing
                D. A. R. K. Dassanayaka: Role: Data curationRole: Formal analysisRole: Writing – review & editing
                F. M. D. Chellapillai:
                ORCID: https://orcid.org/0000-0003-0970-551X
                Role: Writing – original draft
                E. Liyanage: Role: Writing – original draftRole: Writing – review & editing
                S. Rathnayake: Role: MethodologyRole: Writing – original draftRole: Writing – review & editing
                M. Rikas:
                ORCID: https://orcid.org/0000-0002-4591-9016
                Role: Writing – original draft
                S. Mayooran: Role: Writing – original draft
                Kalyana Chakravarthy Bairapareddy: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS One
                Journal ID (publisher-id): plos
                Title: PLOS ONE
                Publisher: Public Library of Science (San Francisco, CA USA )
                ISSN (Electronic): 1932-6203
                Publication date (Electronic): 20 May 2024
                Publication date Collection: 2024
                Volume: 19
                Issue: 5
                Electronic Location Identifier: e0297880
                Affiliations
                [1 ] Department of Physiotherapy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka
                [2 ] Department of Physiotherapy, Faculty of Allied Health Sciences, General Sir John Kotelawala Defence University, Dehiwala-Mount Lavinia, Sri Lanka
                [3 ] Department of Nursing, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka
                University of Sharjah, UNITED ARAB EMIRATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                https://orcid.org/0000-0002-8352-9182
                https://orcid.org/0000-0003-0970-551X
                https://orcid.org/0000-0002-4591-9016
                Article
                Publisher ID: PONE-D-23-32984
                DOI: 10.1371/journal.pone.0297880
                PMC ID: 11104683
                PubMed ID: 38768181
                SO-VID: 59270cf7-3bfb-4ced-8715-4a42a6453fb9
                Copyright © © 2024 Liyanage et al
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 10 October 2023
                Date accepted : 3 January 2024
                Page count
                Figures: 7, Tables: 4, Pages: 17
                Funding
                The authors did not receive any specific funding for this work.
                Categories
                Subject: Research Article
                Subject: Biology and Life Sciences
                Subject: Physiology
                Subject: Physiological Processes
                Subject: Secretion
                Subject: Engineering and Technology
                Subject: Equipment
                Subject: Laboratory Equipment
                Subject: Ventilators
                Subject: Medicine and Health Sciences
                Subject: Health Care
                Subject: Physiotherapy
                Subject: Medicine and Health Sciences
                Subject: Health Care
                Subject: Health Care Facilities
                Subject: Hospitals
                Subject: Intensive Care Units
                Subject: Research and Analysis Methods
                Subject: Research Design
                Subject: Survey Research
                Subject: Surveys
                Subject: Physical Sciences
                Subject: Physics
                Subject: Classical Mechanics
                Subject: Continuum Mechanics
                Subject: Fluid Mechanics
                Subject: Fluid Dynamics
                Subject: Flow Rate
                Subject: People and places
                Subject: Geographical locations
                Subject: Asia
                Subject: Sri Lanka
                Subject: Social Sciences
                Subject: Sociology
                Subject: Communications
                Subject: Social Communication
                Subject: Social Media
                Subject: Computer and Information Sciences
                Subject: Network Analysis
                Subject: Social Networks
                Subject: Social Media
                Subject: Social Sciences
                Subject: Sociology
                Subject: Social Networks
                Subject: Social Media
                Custom metadata
                Data Availability All relevant data are within the manuscript and its Supporting Information files.

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