Ventilator versus manual hyperinflation in adults receiving mechanical ventilation: A systematic review

Introduction Manual hyperinflation (MHI) or with a mechanical ventilator (VHI) are alternatives in bronchial hygiene therapy, in recent years several studies have emerged with the objective of verifying the effectiveness and safety of the techniques. Objective Systematically review and analyze the most recent studies in the literature on MHI and VHI, compare both techniques and demonstrate their effectiveness in bronchial hygiene therapy in mechanically ventilated patients. Methods We conducted this systematic review based on the PICO strategy and used the databases Ovid, LILACS, CINAHL, Pubmed and CENTRAL. Search, selection and analysis of randomized controlled trials on MHI, VHI or comparing both techniques. We performed a comparison on secretion elimination, static and dynamic compliance, oxygenation and clinical outcomes. The studies were analyzed by two independent evaluators. Results Nine articles were selected comparing MHI with usual care, demonstrating improved compliance in the MHI group, but with no impact on secretion removal. Four studies compared VHI with usual care, with three showing increased secretion elimination and compliance in the HVM group. Another four articles compared MHI with VHI but none of the studies showed superiority in terms of elimination of secretion and three studies found improvement in static compliance. Conclusion Both techniques have proven to be effective alternatives to bronchial hygiene therapy.