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Manual hyperinflation causes norepinephrine release.

Jennifer Paratz1, Jeffrey Lipman

  • 1Department of Anaesthesiology and Critical Care, University of Queensland, Royal Brisbane Hospital, Brisbane, Australia.

Heart & Lung : the Journal of Critical Care
|July 26, 2006
PubMed
Summary
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Manual hyperinflation (MHI) in ventilated patients increased systemic vascular resistance index, diastolic arterial pressure, and plasma norepinephrine, indicating a sympathetic response. Cardiac index decreased, but oxygenation and mean arterial pressure remained stable.

Area of Science:

  • Critical Care Medicine
  • Respiratory Physiology
  • Hemodynamics

Background:

  • Mechanical ventilation is essential for critically ill patients.
  • Manual hyperinflation (MHI) is a technique used to augment lung volume and clear secretions.
  • The hemodynamic and neurohormonal effects of MHI in mechanically ventilated patients, particularly those in shock, are not well understood.

Purpose of the Study:

  • To investigate the hemodynamic and plasma catecholamine responses to MHI in mechanically ventilated patients with septic or cardiogenic shock.
  • To assess changes in arterial pressures, cardiac index, systemic vascular resistance, and oxygenation during MHI.

Main Methods:

  • Seven mechanically ventilated patients (6 septic shock, 1 cardiogenic shock) underwent MHI using a Mapleson

Related Experiment Videos

  • C
  • circuit.
  • Hemodynamic parameters (arterial pressures, cardiac index, pulmonary artery occlusion pressure), dynamic compliance, and plasma norepinephrine/epinephrine were measured.
  • Systemic vascular resistance index and oxygenation ratio were calculated.

    • Main Results:

    • MHI led to significant increases in systemic vascular resistance index (SVRI), diastolic arterial pressure (DAP), dynamic compliance, and plasma norepinephrine.
    • A significant decrease in cardiac index was observed post-MHI.
    • No significant changes were noted in mean arterial pressure, pulmonary artery occlusion pressure, or the PaO2/FiO2 ratio.

    Conclusions:

    • The observed increases in DAP, SVRI, and plasma norepinephrine suggest a sympathetic vasoconstrictive response during MHI application.
    • MHI may induce significant hemodynamic alterations in critically ill, ventilated patients.
    • Further research is needed to elucidate the clinical implications and optimal use of MHI in this population.