I am currently on cardio prac in intensive care. Most of the patients are intubated and generally treatment is suctions, manual hyperinflation and vibes, but not in that order, or a combination of all 3. So far in the prac we had very few patients in the first few days and more supervision and now the patient case load has increased and the supervision has decreased as it is the final week this week. Today i had a different supervisor due to my normal one being busy and this supervisor kept reiterating the need for manual hyperinflation with patients to mobilise their secretions.
I wasn't aware, prior to today, that you would manually hyperinflation most patients as a general rule to mobilise secretions prior to suctioning and only on the patients where it was contraindicated would you not perform this.
I realise the reason why one would manually hyperinflate prior to suctioning an intubated patient. This being recruiting alveoli, potentially reducing areas of atelectasis and getting some inspired air behind the secretions and moving them into the larger airways to then allow suctioning of them. The problem i had with accepting what my supervisor said was that i reasoned in my head that if you can improve a patients chest (objectively measured via sats, chest expansion, auscultation and possible respirator rate) by simply suctioning and positioning techniques then only use manual hyperinflation in the patient where this is not working or perhaps a patient who has had an extensive stay in ICU and may need another treatment modality to mobilise secretions perhaps.
Because i was thinking a lot about this i decided to do a little research. I found that a lot of the time manual hyperinflation isn't done correctly. The patient it also at risk of barotrauma to the lungs and breath stacking when MHI'd. When it is done correctly it can recruit alveoli and help with movement of secretions however no evidence is substantial enough to always adopt this as a treatment modality.
So i understand the reasoning why you would and could MHI but at this stage in my career i would rather only resort the manual hyperinflation when the other modalities are not achieving desired expectoration of sputum. It just shows me that just because you can do something doesn't necessarily mean you should. If anyone has any thoughts on this one or any other information to back up routine MHI i would love it if you shared. Thanks!
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Good point Erin, i was under the impression that MHI was the intubated/ventilated version of DBing in ACBT's. I know for my prac VHI (ventilator hyper inflation) was done pretty routinely and had great results in, as you said, getting air behind secretions to allow clearance. This was possibly safer as airway pressures are closely monitored, as opposed to 'bagging'.
I think that MHI has another benefit for intubated pt's to prevent a permanant reduction in lung volume. If you think how often we take a spontaneous deep breath, these pt's if not contributing to their own ventilation, will never perform this. With this in mind, "routine" treatments are not always the best as their clearly not tailored to the pt, and clincal reasoning comes into play. You make some very good points and good hussle for hitting the books again!
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