Effects of ventilator hyperinflation on pulmonary function and secretion clearance in adults receiving mechanical ventilation: A systematic review with meta-analysis

Bruno Prata Martinez; Layana Lisboa Lobo; Rodrigo Santos de Queiroz; Micheli Bernardone Saquetto; Luiz Alberto Forgiarini Júnior; Helena França Correia; Cássio Magalhães da Silva E Silva; Iura Gonzalez Nogueira Alves; Mansueto Gomes Neto

doi:10.1016/j.hrtlng.2022.05.011

Effects of ventilator hyperinflation on pulmonary function and secretion clearance in adults receiving mechanical ventilation: A systematic review with meta-analysis

Heart Lung. 2022 Nov-Dec:56:8-23. doi: 10.1016/j.hrtlng.2022.05.011. Epub 2022 May 29.

Authors

Bruno Prata Martinez¹, Layana Lisboa Lobo², Rodrigo Santos de Queiroz³, Micheli Bernardone Saquetto², Luiz Alberto Forgiarini Júnior⁴, Helena França Correia², Cássio Magalhães da Silva E Silva², Iura Gonzalez Nogueira Alves⁵, Mansueto Gomes Neto²

Affiliations

¹ Department of Physiotherapy, Federal University of Bahia, Salvador, Bahia, Brazil; Department of Physiotherapy, State University of Bahia, Salvador, Bahia, Brazil. Electronic address: brunopmartinez@hotmail.com.
² Department of Physiotherapy, Federal University of Bahia, Salvador, Bahia, Brazil.
³ Department of Physiotherapy, State University of Southwest Bahia, Jequié, Bahia, Brazil.
⁴ La Salle University Graduate Program, Porto Alegre, Rio Grande do Sul, Brazil.
⁵ Department of Medicine, Bahiana School of Medicine and Public Health(BSMPH), Salvador, Bahia, Brazil.

PMID: 35649308
DOI: 10.1016/j.hrtlng.2022.05.011

Abstract

Introduction: It is important to clarify the effect of ventilator hyperinflation(VHI) on pulmonary function and secretion clearance in adults receiving mechanical ventilation(MV). There is no published meta-analysis on the effects VHI on pulmonary function and secretion clearance in adults receiving MV. Objective Analyze the published randomized clinical trials(RCTs) that investigated the effects of VHI on pulmonary function and secretion clearance in adults receiving MV, comparing VHI with isolated aspiration, VHI with manual hyperinflation(MHI), VHI +vibrocompression(VB) versus VB and VHI+VB versus isolated aspiration.

Methods: The following databases PubMed, LILACS, EMBASE, SciELO, PEDro database and Cochrane Central Register of Controlled Trials (CENTRAL) were consulted up to December 2021. Secretion clearance, static and dynamic compliance of the respiratory system(Cstat and Cdyn), airway resistance(Raw) and oxygenation outcomes were evaluated.

Results: Thirteen studies met the study criteria, but only 12 studies were included on meta-analysis. There was no difference between VHI versus isolated aspiration for amount of secretions removed(0.41 SMD; 95% CI: -0.08 to 0.89; n=270), VHI versus MHI(0.51 grams; 95% CI: -0.08 to 1.11; n=256), VHI+VB versus VB(0.31 grams; 95% CI: -0.42 to 1.05; n=130) and VHI+VB versus isolated aspiration(0.54 grams; 95% CI: -0.06 to 1.14; n=132). There was difference for VHI versus isolated aspiration to Cstat (4.77 ml/cm H₂O; 95% CI: 2.41 to 7.14; n= 136).

Conclusion: Taking into account all studies included in meta-analysis, no evidences was found that VHI was effective in increasing the amount of secretions removed, Cdyn and oxygenation, but VHI seems to show a slight improvement in Cstat when compared to isolated aspiration. No evidence was found that VHI was effective in increasing the amount of secretions removed, Cdyn and oxygenation, but VHI seems to show a slight improvement in Cstat when compared to isolated aspiration.

Keywords: Mechanical ventilation; Mucociliary clearence; Systematic review; Ventilator hyperinflation.

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

Adult
Humans
Lung
Respiration, Artificial* / adverse effects
Ventilators, Mechanical*