Paulus Frederique, Binnekade Jan M, Vroom Margreeth B, Schultz Marcus J
Crit Care. 2012 Aug 3;16(4):R145. doi: 10.1186/cc11457.
Manual hyperinflation (MH), a frequently applied maneuver in critically ill intubated and mechanically ventilated patients, is suggested to mimic a cough so that airway secretions are mobilized toward the larger airways, where they can easily be removed. As such, MH could prevent plugging of the airways.
We performed a search in the databases of Medline, Embase, and the Cochrane Library from January 1990 to April 2012. We systematically reviewed the literature on evidence for postulated benefits and risks of MH in critically ill intubated and mechanically ventilated patients.
The search identified 50 articles, of which 19 were considered relevant. We included 13 interventional studies and six observational studies. The number of studies evaluating physiological effects of MH is limited. Trials differed too much to permit meta-analysis. It is uncertain whether MH was applied similarly in the retrieved studies. Finally, most studies are underpowered to show clinical benefit of MH. Use of MH is associated with short-term improvements in lung compliance, oxygenation, and secretion clearance, without changes in outcomes. MH has been reported to be associated with short-term and probably clinically insignificant side effects, including decreases in cardiac output, alterations of heart rates, and increased central venous pressures.
Studies have failed to show that MH benefits critically ill intubated and mechanically ventilated patients. MH is infrequently associated with short-term side effects.
手法肺膨胀（MH）是危重症插管并接受机械通气患者常用的操作，旨在模拟咳嗽，使气道分泌物向较大气道移动，以便于清除。因此，MH可预防气道堵塞。
我们检索了1990年1月至2012年4月期间的Medline、Embase和Cochrane图书馆数据库。我们系统回顾了关于危重症插管并接受机械通气患者中MH假定益处和风险的证据的文献。
检索到50篇文章，其中19篇被认为相关。我们纳入了13项干预性研究和6项观察性研究。评估MH生理效应的研究数量有限。各试验差异过大，无法进行荟萃分析。检索到的研究中MH的应用方式是否相似尚不确定。最后，大多数研究的样本量不足以显示MH的临床益处。使用MH与肺顺应性、氧合和分泌物清除的短期改善相关，但结局无变化。据报道，MH与短期且可能临床意义不大的副作用相关，包括心输出量降低、心率改变和中心静脉压升高。
研究未能表明MH对危重症插管并接受机械通气患者有益。MH很少与短期副作用相关。
