Manual hyperinflation of intubated and mechanically ventilated patients in Dutch intensive care units—A survey into current practice and knowledge

Paulus, Frederique; Binnekade, Jan M.; Middelhoek, Pauline; SchuItz, Marcus J.; Vroom, Margreeth B.

doi:10.1016/j.iccn.2009.04.003

« Previous Next »Intensive and Critical Care Nursing
Volume 25, Issue 4 , Pages 199-207, August 2009

Manual hyperinflation of intubated and mechanically ventilated patients in Dutch intensive care units—A survey into current practice and knowledge

Frederique Paulus
- Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Corresponding author at: Department of Intensive Care, C3-323, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DE Amsterdam, The Netherlands. Tel.: +31 20 5662509; fax: +31 20 5669568.
Jan M. Binnekade
- Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
Pauline Middelhoek
- Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
Marcus J. SchuItz
- Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Laboratory for Experimental Intensive Care and Anesthesiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
Margreeth B. Vroom
- Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

Accepted 10 April 2009.

Summary

Background

In the daily bedside routine of the intensive care, potentially hazardous interventions that lack evidence need critical consideration. Therefore we examined current practice and knowledge of basic principles of manual hyperinflation (MH) in intubated and mechanically ventilated patients among intensive care unit nurses in the Netherlands.

Methods

A written survey method was used, questionnaires were sent to ICU nurses specialised in mechanical ventilation in 115 Dutch hospitals. The questions related to following domains: (1) demographics; (2) use of MH; (3) presumed benefits; (4) essential elements of the MH procedure; (5) equipment and safety.

Results

The response rate was 77%. From responding ICUs the majority (96%) stated they performed MH; 27% as a daily routine procedure, 69% performed MH on indication only. MH was mainly performed by ICU nurses. Half of ICUs reported to have a MH guideline available. Improved oxygenation and better removal of sputum were presumed benefits of MH. While slow inspiration and rapid expiration are considered to be essential elements of MH procedures, the majority of respondents stated to use rapid inspiration and slow expiration.

Conclusions

This survey indicates that MH is widely used as an important item of airway management. Importantly, there is no uniformity in the performance of the procedure. Before definitive research can be developed, standards for the MH procedure should be established.

Keywords: Manual hyperinflation, Respiratory care, Practice variation