Graduate Program of Child and Adolescent Health, Department of Pediatrics, Faculty of Medical Sciences, Universidade Estadual de Campinas, Campinas, São Paulo, Brazil.
Respir Care. 2012 Nov;57(11):1908-13. doi: 10.4187/respcare.01511. Epub 2012 Jun 15.
Manual hyperinflation (MH) is used to improve mucociliary clearance and alveolar expansion in mechanically ventilated patients. Despite the popularity of MH, studies with adults have shown considerable variability in the results from its use. This study assessed if professional training on the application of MH influences its performance.
An experimental study was conducted with physiotherapists, including 11 with previous professional experience (experienced) and 11 without previous experience (inexperienced). They applied MH in a test lung model using self-inflating bags in 2 sizes (infant and pediatric) from 3 manufacturers (Hudson, Laerdal, and JG Moriya). The test lung simulated the lung mechanics of a newborn and a pediatric patient in 2 different clinical situations: at normal and reduced compliance. The professionals were instructed to perform MH as described in the literature. Measurements of inspiratory volume, peak inspiratory pressure, peak inspiratory flow, and peak expiratory flow were recorded using a pneumotachograph in each condition.
The delivered peak inspiratory flow was higher in the experienced group (P = .03) than in the inexperienced group. This result was observed in both neonatal and pediatric self-inflating bags. There was no difference in the parameters delivered between the experienced and inexperienced groups.
The experienced and inexperienced groups were similar in their overall MH performance; the only difference was the observation of the highest PIF in the results from the experienced group.
手动通气（MH）用于改善机械通气患者的黏液纤毛清除和肺泡扩张。尽管 MH 应用广泛，但对成人的研究表明，其使用结果存在相当大的差异。本研究评估了对 MH 应用的专业培训是否会影响其性能。
对理疗师进行了一项实验研究，包括 11 名有既往专业经验的理疗师（经验组）和 11 名无既往经验的理疗师（无经验组）。他们使用来自 3 个制造商（Hudson、Laerdal 和 JG Moriya）的 2 种尺寸（婴儿和小儿）的自充气球囊在测试肺模型中应用 MH。测试肺模拟了新生儿和小儿患者在 2 种不同临床情况下的肺力学：正常和顺应性降低。专业人员按照文献中的描述进行 MH。在每种情况下，使用气动流量计记录吸气量、吸气峰压、吸气峰流速和呼气峰流速的测量值。
在经验组中，传递的吸气峰流速（P =.03）高于无经验组。这一结果在新生儿和小儿自充气球囊中均观察到。在经验组和无经验组之间，传递的参数没有差异。
在 MH 的整体性能方面，经验组和无经验组相似；唯一的区别是在经验组的结果中观察到最高的吸气峰流速。
