The hyperinflation ventilator was performed in different modalities and ventilatory adjustments, with total pressure of 40cmH2O. The inspiratory volume, inspiratory time, mean airway pressure, inspiratory and expiratory flow, and bias flow were evaluated.
PURPOSE: To compare different ways of applying ventilator hyperinflation. METHODS: A randomized crossover clinical trial was performed with 30 patients (66.5 ± 17.3 years) with hypersecretion. The ventilator hyperinflation was performed in five ventilatory modalities for five minutes, with an interval of 2 hours, the order being determined by randomization: controlled ventilation at volume (VCV) with constant flow of 20 (VCV20) Lpm and 40 Lpm (VCV40), controlled ventilation pressure ventilation (PCV), controlled pressure ventilation associated with inspiratory time adjustment (PCV + Tins) and support pressure ventilation (PSV). In VCV mode, the volume was increased every 50mL, until reaching a maximum pressure of 40cmH2O. In the pressure controlled modes, the inspiratory pressure was increased every 5 cmH2O until the total pressure reached 40 cmH2O. The inspiratory time was adjusted so that the inspiratory flow reached the baseline. The following variables were evaluated: tidal volume, inspiratory time (Tins), mean airway pressure (Pmean), peak inspiratory flow (PIFR) and expiratory flow (PEFR), PIFR / PEFR and Bias Flow (PEFR-PIFR).
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
NONE
Enrollment
30
controlled volume ventilation mode under constant flow of 20 Lpm. The inspired volume was progressively increased until the Pmax reached 40cmH2O.
volume controlled ventilation mode under constant flow of 40 Lpm. The inspired volume was progressively increased until the Pmax reached 40cmH2O.
controlled ventilation mode, 1 second inspiratory time. The inspiratory pressure was increased every 5 cmH2O, until reaching the maximum pressure of 40 cmH2O.
Luciano M Chicayban
Campos dos Goytacazes, Rio de Janeiro, Brazil
Inspiratory Volume
Inspiratory volume reached in each mode of ventilator hyperinflation, under a maximum pressure of 40cmH2O
Time frame: Five minutes after the onset of intervention
Inspiratory time
inspiratory time necessary for the inspiratory flow to reach the baseline or according to the settings of each modality
Time frame: Five minutes after the onset of intervention
Mean Pressure
airway mean pressure measured on the mechanical ventilator in 2 cycles
Time frame: Five minutes after the onset of intervention
Peak Expiratory Flow
maximal expiratory flow in 2 cycles
Time frame: Five minutes after the onset of intervention
Peak Inspiratory Flow
Maximal inspiratory flow in 2 cycles
Time frame: Five minutes after the onset of intervention
PIFR/PEFR
Peak inspiratory to expiratory flow ratio
Time frame: Five minutes after the onset of intervention
Bias Flow
Difference between peak inspiratory and expiratory flows
Time frame: Five minutes after the onset of intervention
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controlled ventilation and inspiratory pressure was increased every 5 cmH2O until the maximum pressure was 40 cmH2O. The inspiratory time was gradually increased until the inspiratory flow reached the baseline. Concomitantly, the respiratory rate was decreased to allow the expiratory flow also to reach the baseline, to avoid self-PEEP.
ventilatory mode with pressure support, with progressive increases of 5 cmH2O at inspiratory pressure, until reaching Pmax of 40 cmH2O. The expiratory sensitivity was adjusted by 25% for all patients.