Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
Minerva Anestesiol. 2010 Dec;76(12):1036-42. Epub 2010 Nov 10.
Manual hyperinflation (MH) can be performed as part of airway management in intubated and mechanically ventilated patients to mobilize airway secretions. Although previous studies demonstrated MH to be associated with hemodynamic and respiratory instability, we hypothesized MH to cause fewer adverse events (AEs) when performed by experienced and trained nurses in stable critically ill patients.
The incidence and type of AEs associated with MH were studied in a 28-bed mixed medical-surgical Intensive Care Unit. A difference in mean arterial pressure (MAP) or heart rate (HR) >15%, a decrease in peripheral oxygen saturation (SpO2) >5%, and a change in end-tidal (et)-CO2 >20% were considered AEs. A decrease of MAP to ≤60 mmHg, any new arrhythmia, and a decrease of SpO2 ≤90% were all considered severe AEs. Also, all changes in medication were considered severe AEs.
A total of 107 MH maneuvers in 74 patients, performed by 57 nurses, were observed and analyzed. A total of 17 MH maneuvers (16%) were associated with any AE; 7 maneuvers (6%) were associated with a severe AE. Overall, MH did not affect MAP. MH caused a statistically significant but clinically irrelevant increase of HR (from 87±24 to 89±22 bpm). In one patient the MAP dropped from 70 mmHg to 60 mmHg, requiring adjustment of vasopressor therapy; one patient developed ventricular tachycardia requiring electric cardioversion. In general, MH did not affect SpO2. In one patient SpO2 dropped below 90%, requiring additional oxygen supply for 10 minutes. MH caused a statistically significant but clinically irrelevant increase of et-CO2 levels (from 4.4±0.9 to 4.5±1.0 kPa). Five patients developed anxiety/agitation during or shortly after MH, mandating additional sedation in four patients. Occurrence of (severe) AEs was not associated with any specific patient or MH characteristic.
The rate of hemodynamic and respiratory AEs with MH is low when performed by experienced and trained nurses in stable, critically ill patients. MH, however, may induce or increase anxiety/agitation. We consider MH a safe maneuver in stable ICU patients in our setting.
手动过度充气（MH）可以作为气管内插管和机械通气患者气道管理的一部分，以移动气道分泌物。尽管以前的研究表明 MH 与血流动力学和呼吸不稳定有关，但我们假设在稳定的重症患者中，由经验丰富且经过培训的护士进行 MH 会导致更少的不良事件（AE）。
在 28 张混合内科-外科重症监护病房中，研究了与 MH 相关的 AE 的发生率和类型。MAP 或 HR 增加> 15%，外周血氧饱和度（SpO2）降低> 5%，呼气末（et）-CO2 改变> 20%被认为是 AE。MAP 降至≤60mmHg、任何新的心律失常以及 SpO2 降至≤90%均被认为是严重 AE。此外，所有药物变化均被视为严重 AE。
共观察和分析了 74 名患者 57 名护士进行的 107 次 MH 操作。共有 17 次 MH 操作（16%）与任何 AE 相关；7 次 MH 操作（6%）与严重 AE 相关。总体而言，MH 不会影响 MAP。MH 导致 HR 出现统计学上显著但临床上无关紧要的增加（从 87±24 增加到 89±22 bpm）。在一名患者中，MAP 从 70mmHg 降至 60mmHg，需要调整血管加压治疗；一名患者出现室性心动过速，需要电复律。一般来说，MH 不会影响 SpO2。在一名患者中，SpO2 降至 90%以下，需要额外供氧 10 分钟。MH 导致 et-CO2 水平出现统计学上显著但临床上无关紧要的增加（从 4.4±0.9 增加到 4.5±1.0 kPa）。5 名患者在 MH 期间或之后不久出现焦虑/躁动，需要在 4 名患者中额外镇静。AE（严重）的发生与任何特定患者或 MH 特征均无关。
在稳定的重症患者中，由经验丰富且经过培训的护士进行 MH 时，与血流动力学和呼吸相关的 AE 发生率较低。然而，MH 可能会引起或增加焦虑/躁动。在我们的环境中，我们认为 MH 是稳定 ICU 患者的一种安全操作。
