Hemodynamic effects of manual hyperinflation in critically ill mechanically ventilated patients

To assess the hemodynamic effects of manual lung hyperinflation in mechanically ventilated patients and to measure the different inspiratory pressures and tidal volumes generated by different operators.

Measurements of aortic blood flow (by esophageal Doppler ultrasonography), systemic blood pressure, tidal volumes (by respirometry), and inspiratory pressures in the ventilator circuit were measured on the ventilator, during six intended manual hyperinflations (tidal volume > 150% that delivered by ventilator) using a 2-L rebreathing bag, and at 1, 5, 10, and 15 min after reconnection to the ventilator.

Intensive care unit.

Eighteen mechanically ventilated patients with normovolemia and stable circulatory status were assessed on a total of 20 occasions.

Patients were disconnected from the ventilator to enable six manual hyperinflations to be given. Measurements were made before and at 5-min intervals until no further hemodynamic changes were seen.

Hyperinflation (50% increase in tidal volume) was achieved only in 10 of 20 studies. Large variations were seen in percentage change in peak inspiratory pressure (-30% to +250%) and tidal volume (-33% to +127%) generated. Falls in cardiac output correlated to the increase in tidal volume but not to the increase in peak inspiratory pressure and took up to 15 min to recover to baseline values. Changes in cardiac output were independent of lung compliance and concurrent vasoactive drug support. No consistent change was noted in either blood pressure or heart rate.

Lung hyperinflation is frequently not achieved by the manual technique. Significant changes in cardiac output can occur and appear to be related to the tidal volume rather than pressure generated.