The use of manual and ventilator hyperinflation by physiotherapists in New Zealand intensive care units
Reeve, JC; Munn, L; Quinn, L; Eagle, E; Jenson, L
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Manual hyperinflation (MHI) and ventilator hyperinflation (VHI) are techniques performed by physiotherapists in intubated, ventilated patients which deliver larger than baseline volume breaths to enhance secretion removal, improve oxygenation and re-expand atelectatic lung tissue. Studies have demonstrated these techniques to be widely used by physiotherapists in other countries. This study aimed to determine current practice of MHI and VHI by physiotherapists in New Zealand, investigating differences in the use of these techniques both nationally and internationally. A purpose-designed postal survey was distributed to the senior physiotherapist of each intensive care unit throughout New Zealand (n = 25). The response rate was 76% (n = 19). Twelve (63.2%) respondents reported using MHI, with only one (5.3%) respondent using VHI. The specific techniques and dosages used in applying MHI varied widely amongst respondents as did the equipment used to implement the technique. In those respondents using MHI, the incorporation of recommended safety equipment varied, with six (50%) respondents reporting never including airway pressure manometry. The majority of respondents using MHI always included a positive end expiratory pressure valve in the circuit (n = 8, 66.7%) and used 100% oxygen whilst undertaking the procedure (n = 7, 58.3%). Availability of equipment was the key factor in determining the specific methods used in delivering MHI. This survey has highlighted differences between New Zealand physiotherapists in the administration of MHI. It has also shown differences from those practices and recommendations emerging from overseas. Reasons for these differences should be further investigated.