Paulus Frederique, Binnekade Jan M, Middelhoek Pauline, Vroom Margreeth B, Schultz Marcus J
Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Med Sci Monit. 2009 Aug;15(8):CR418-22.
The aim of manual hyperinflation (MH) is to mobilize airway secretions and prevent sputum plugging in intubated and mechanically ventilated patients. With MH, the nurse applies a larger than normal breath with a slow inspiratory flow and, after an inspiratory pause, a high expiratory flow is created by completely releasing the resuscitation bag.
MATERIAL/METHODS: This was a prospective observational study in a skills lab of a university hospital. Intensive care unit nurses performed MH procedures for an imaginary patient in three different compliance settings. Data were collected via direct video recordings and an air-flow analyzer.
One hundred nurses participated. Video recordings demonstrated inappropriate performance of MH, reflected by the appearance of inspirations which were too rapid (53% of cases), absence of holds (60%), and absence of complete release of the resuscitation bag (78%). In the majority of cases the applied volumes were too large according to what was advised in the local guideline (80%). Peak inspiratory flow was 70 (range: 55-89) l/min for all compliance settings and peak expiratory flows were low: for over-compliant (46, range: 42-51), normal (51, range: 45-57), and noncompliant lungs (58, range: 52-64 l/min).
Performance of MH by certified ICU nurses is far from appropriate. These results emphasize the necessity for clearer guidelines with explicit directions for this frequently applied procedure, if it is decided to practice it in the daily care of intubated and mechanically ventilated patients.
手法肺膨胀（MH）的目的是促进气道分泌物排出，防止气管插管和机械通气患者出现痰栓。进行MH时，护士以慢吸气流量给予大于正常的呼吸，在吸气暂停后，通过完全松开复苏袋产生高呼气流量。
材料/方法：这是一项在大学医院技能实验室进行的前瞻性观察研究。重症监护病房护士在三种不同的顺应性设置下对一名虚拟患者进行MH操作。通过直接视频记录和气流分析仪收集数据。
100名护士参与。视频记录显示MH操作不当，表现为吸气过快（53%的病例）、无屏气（60%）和未完全松开复苏袋（78%）。根据当地指南建议，大多数情况下应用的气量过大（80%）。所有顺应性设置下的吸气峰流量均为70（范围：55 - 89）升/分钟，呼气峰流量较低：顺应性过高（46，范围：42 - 51）、正常（�1，范围：45 - 57）和顺应性过低的肺（58，范围：52 - 64升/分钟）。
认证的重症监护病房护士进行的MH操作远不恰当。如果决定在气管插管和机械通气患者的日常护理中实施该操作，这些结果强调了制定更清晰指南并明确该常用操作指导的必要性。
