Manual hyperinflation, known as manual ventilation or ‘bagging’, is a technique that is used by respiratory physiotherapists in the management of ventilated patients or patients self-ventilating through a tracheostomy. Manual hyperinflation is used to increase lung volumes and facilitate secretion clearance when used in combination with suctioning. Manual hyperinflation involves the use of a manual resuscitator bag connected to oxygen for providing a slow, deep inspiratory breath that is followed by an inspiratory pause of 1-2 seconds with a rapid release of the resuscitation bag. It is not indicated in patients with Undrained pneumothorax Severe bronchospasm Head injury with intracranial pressure > 25mmHg Severe arterial hypotension High peak end-inspiratory pressure (PEEP) ventilation and PEEP dependency Nitric Oxide ventilation Brief of case study: An ICU patient was critically ill and was pre-oxygenated. Treatment given: After adequate pre-oxygenation, the patient was intubated. He was manually bagged i.e., hyperinflated with a 1.5 liters Ambu bag at a respiratory rate of 15. The attending consultant remarked not to do manual hyperinflation and placed the patient on a ventilator with a tidal volume of 400 ml. Discussion: Manual hyperinflation is a common practice in Asia and many European countries. It involves a prolonged large tidal volume breath followed by an inspiratory hold and a sudden release of pressure (the intention is of simulating a cough and thus move mucus upwards).1 The hyperinflation technique is used intentionally by doctors involved in active intubations and resuscitation of the patients. This technique is also used in critically ill ventilated patients by physiotherapists etc. to enhance recruitment, mitigate atelectasis and mobilise secretions. In normal noncritically ill patients there may or may not be any change in the heart rate and mean arterial pressure. But, in critically ill patients, hyperinflation might cause an increase in pulmonary vascular resistance and can…
Case study of Manual hyperinflation in an ICU patientOctober 13, 2021 | 0 Comment
Dr. Sanjith Saseedharan
MBBS, Diploma in Anesthesiology
Head, Department of Intensive Care Unit, S.L. Raheja Hospital (A Fortis Associate), Mumbai, Maharashtra, India.