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If peak inspiratory flow (PIF) exceeds peak expirtory flow the secretions might migrate deeper into the lung (PEF).
It is suggested that the effectiveness of MHI on sputum clearance is dependent on the difference between the peak inspiratory flow (PIF) and peak expiratory (PEF)(PEF rate needs to exceed the inspiratory flow rate by at least 10%) [5]. Achieved by a slow inspiration and a rapid release technique.
Peak expiratory flow rate
A technique that provides a tidal volume greater than the baseline volume. It produces a turbulent flow which aims to improves static lung compliance, increase oxygenation, mobilise secretions toward central airways and recruit collapsed lung (Maa et al, 2005)
Inspiratory Pause
Maintains the pressure gradient for an appropriate length of time to overcome the opening pressure of the alveoli and allow distribution of the air among ventilated areas.
Increased tidal volumes
Commonly used treatment by physiotherapist in intubated and mechanically ventilated patients.
Larger than normal tidal volumes up to 150% of that delivered by the ventilator to increase alveoli recruitment and open up collateral channels [2]
1. Paulus et al (2012); Benefits and risks of manual hyperinflation in intubated and mechanically ventilated intensive care unit patients: a systematic review; Crictical Care, 16:R14
2. Blattner et al (2008); Oxygenation and static compliance is improved immediately after manual hyperinflation follwoing myocardial revascularisation: a randomised controlled trial; Australian JOurnal of Physiotherapy Vol 54 pp173-178
3. Maa et al (2005); Manual hyperinflation improves alveolar recruitment in difficult-to wean patients. Chest 128: 2714-2721
4. Ortiz et al (2013) Experimental study on effiency and safety of the manual hyperinflation maneuver as a secretion clearance technique, Journal of Brazilian medicine 39 (2), 205-213
5. Ntoumenopoulos.G (2005) Indications for manual lung hyperinflation (MHI) in the mechanically ventilated patient with chronic obstructive pulmonary disease, Chronic Respiratory Disease, 2 ,199-207
6. Savian et al (2005) The effect of positive end-expiratory pressure level on peak expiratory flow during manual hyperinflation, Critical Care and Trauma 100, 1112-6.
7. Paulus et al (2011) Manual hyperinflation partly prevents reductions of functional residial capacity in cardiac surgucal patients - a randomized conrtolled trial, Critical Care 15, R187