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Selecting the best ventilator hyperinflation technique based on physiologic markers: A randomized controlled
Beatriz S Ribeiro1, Agnaldo J Lopes2, Sara L S Menezes3
1Rehabilitation Sciences Post Graduation Program, Augusto Motta University Center, Rio de Janeiro, RJ, Brazil.
Volume-controlled ventilation (VC-CMV20) and pressure support ventilation (PSV) are effective for ventilator hyperinflation (VHI). Careful consideration of ventilator settings is crucial to avoid overdistension and patient-ventilator asynchronies.
Area of Science:
- Critical Care Medicine
- Respiratory Physiology
- Mechanical Ventilation
Background:
- Ventilator hyperinflation (VHI) improves respiratory mechanics, secretion clearance, and gas exchange in mechanically ventilated patients.
- Optimal ventilator settings for performing VHI are not well-established, lacking specific recommendations.
Purpose of the Study:
- To compare six different modes of VHI.
- To evaluate physiological markers of efficacy and safety for selecting optimal VHI settings.
Main Methods:
- Thirty mechanically ventilated patients participated in the study.
- Six VHI modes were administered in a randomized order.
- Key assessments included delivered volume, expiratory flow bias, overdistension, patient-ventilator asynchronies, and hemodynamic variables.
Main Results:
- Volume-controlled ventilation with a 20 lpm inspiratory flow (VC-CMV20) and pressure support ventilation (PSV) demonstrated the highest effectiveness (P < 0.05).
- A target peak pressure of 40 cmH2O was linked to significant overdistension.
- PSV exhibited a reduced incidence of patient-ventilator asynchronies.
Conclusions:
- VC-CMV20 and PSV emerge as the most effective modes for VHI.
- Clinicians must carefully manage alveolar overdistension and patient-ventilator asynchronies during VHI application.
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