Ventilator Hyperinflation Versus Manual Chest Compression and Airway Clearance in Mechanically Ventilated Patients.

Abstract

Background: Secretion accumulation in patients undergoing mechanical ventilation impairs ventilatory mechanics and gas exchange, which may prolong hospital stay and increase the risk of respiratory infections. Manual chest compression (MCC) and ventilator hyperinflation (VHI) are techniques used for airway clearance, but there are no studies comparing the effect of these two techniques. The aim of this study was to compare the effects of VHI and MCC on secretion clearance in mechanically ventilated patients. Method: This randomized crossover clinical trial enrolled 44 adult ICU subjects on mechanical ventilation. Each participant received both interventions in random order, separated by a 4-hour washout period. The primary outcome was the amount of sputum removed. Secondary outcomes included peak expiratory flow (PEF), flow bias, dynamic lung compliance, and hemodynamic parameters. Results: The results showed that although VHI significantly increased PEF (P = .007) and expiratory flow bias (P < .001) compared with MCC, there was no statistically significant difference in the amount of sputum removed between the two methods (P = .51). Furthermore, there was no difference in the effects on blood pressure, heart rate, peripheral O₂ saturation, and compliance between the two maneuvers. Conclusions: VHI was noninferior to MCC in promoting airway clearance and offers additional advantages, including enhanced flow dynamics and reduced physical strain on physiotherapists. These findings suggest that VHI may be a practical, safe, and efficient alternative for airway clearance therapy in critically ill, mechanically ventilated patients.