The Effect of Manual Hyperinflation and Postural Drainage on Respiratory Indices in Patients under Mechanical Ventilation in Intensive Care Units.

Autor: Khodayari, Sajjad, Seylani, Khatereh, Sharifi, Farshad, Navab, Elham
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Zdroj: Journal of Critical Care Nursing; Jun2022, Vol. 15 Issue 2, p1-11, 11p
Abstrakt: Background & Aim: Accumulation of secretions is one of the serious complications in patients under mechanical ventilation. The management of airway secretions in these patients includes using the usual methods like fluid therapy as well as techniques such as changing the patient's position and manual hyperinflation. Tracheal suction, which is performed with the aim of secretion removal, can be effective in improving airway clearance along with manual hyperinflation techniques and postural drainage. This randomized clinical trial was conducted to compare the effect of manual hyperinflation (MH) and postural drainage (PD) on respiratory parameters of patients under mechanical ventilation. Materials: This crossover clinical trial study was conducted in the intensive care units of Imam Khomeini Hospital, Ilam in 2018. Sample size was 50 patients under mechanical ventilation who were included in the study according to the inclusion criteria through convenience sampling. After the first 24 hours, patients received routine respiratory care in ICU, each patient was randomly assigned to one of the two intervention groups, manual dilatation (MH) or postural drainage (PD) for 24 hours, and then the patient was transferred to the next intervention group. Data collection tool was a demographic questionnaire and a form for recording respiratory variables (including dynamic compliance, arterial blood oxygen saturation percentage, tidal volume, Peak Inspiratory Pressure and Positive End Expiratory Pressure). On the first day, after selecting the patient and recording the demographic information, when the patient needed suction, the patient's respiratory variables were recorded at three times including before suction, 5 and 25 minutes after suction, and the results were recorded as the basic information (control). During the second day, in addition to receiving routine respiratory care, before each suction, depending on the intervention group, the patients were subjected to MH or PD and respiratory variables were recorded before suctioning as well as 5 and 25 minutes after suction. On the third day, the patient was assigned to the next intervention group (crossover design) and the evaluation of respiratory variables was repeated and the results were recorded. Results: Based on the repeated measure ANOVA, atrial blood oxygen saturation (P value=0.001), tidal volume (P value=0.001) and dynamic compliance (P value=0.038) in the intervention groups at 25 minutes after suction were more than the control group, in favor of MH intervention comparing to PD intervention. Regarding the peak inspiratory pressure, the intervention of MH in 25 minutes after suction created a significant decrease compared to the PD (P value=0.001). There was no significant difference in the PEEP between any of the study phases and the investigated times. Conclusion: The findings reconfirmed the necessity of nursing interventions in order to manage airway secretions, and also showed that MH intervention is more effective than PD in improving the respiratory indicators. Therefore, while emphasizing the necessity of training HCWs for respiratory care and management of airway clearance in patients under mechanical ventilation, it is suggested to prepare evidence-based clinical guidelines emphasizing the superiority of MH intervention in order to improve the respiratory indicators of patients. [ABSTRACT FROM AUTHOR]
Databáze: Complementary Index
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