Evidence - Mechanical Ventilation + HI

Question 1

What did Rothen et al, 1993 find about MHI

Answer 1

• During MHI, slow inspiratory breath of about 35-40 cmH2) effectively re-expands areas of atelectasis
• Clinical implications: Use MHI for lung collapse

Question 2

Describe what Maxwell & Ellis, 1998 discovered about MHI

Answer 2

• quick release during MHI increase expiratory flow rates
• mimics a cough and mobilise secretions from distal to proximal lung segments
• CI: try to include fast releases for best effects of MHI

Question 3

Hodgson et al 2007 compared Mepleson C circuit with Laerdal, what did they find?

Answer 3

• MC cleared 0.98g more secretions per treatment, but did not have an effect on O2 or compliance
• use MC for secretion clearance if available

Question 4

What did Berney et al, 2002 find when comparing MHI and VHI

Answer 4

MHI and WHI were equivalent in terms of:

• pulmonary compliance
• sputum clearance

Question 5

Chang et al, 2005 investigated risk of prolonged ventilation, describe

Answer 5

Risks included:
- ventilator associated pneumonia
- respiratory muscle weakness ( especially >7 days)
Clinical implications: wean from ventilator when possible and safe to do so

Question 6

what did Epstein et al, 1997 find in regards to extubation?

Answer 6

• Investigated risks of failed extubation and reintubation
  Risks included:
• increased mortality
• increased duration of ventilation
• increased LOS = $$
  Clinical implications: ensure that the benefits outweight the risks