Effects of ventilator hyperinflation on pulmonary function and secretion clearance in adults receiving mechanical ventilation: A systematic review with meta-analysis

Introduction: It is important to clarify the effect of ventilator hyperinflation(VHI) on pulmonary function and secretion clearance in adults receiving mechanical ventilation(MV). There is no published meta-analysis on the effects VHI on pulmonary function and secretion clearance in adults receiving MV. Objective Analyze the published randomized clinical trials(RCTs) that investigated the effects of VHI on pulmonary function and secretion clearance in adults receiving MV, comparing VHI with isolated aspiration, VHI with manual hyperinflation(MHI), VHI +vibrocompression(VB) versus VB and VHI+VB versus isolated aspiration. Methods: The following databases PubMed, LILACS, EMBASE, SciELO, PEDro database and Cochrane Central Register of Controlled Trials (CENTRAL) were consulted up to December 2021. Secretion clearance, static and dynamic compliance of the respiratory system(Cstat and Cdyn), airway resistance(Raw) and oxygenation outcomes were evaluated. Results: Thirteen studies met the study criteria, but only 12 studies were included on meta-analysis. There was no difference between VHI versus isolated aspiration for amount of secretions removed(0.41 SMD; 95% CI: -0.08 to 0.89; n=270), VHI versus MHI(0.51 grams; 95% CI: -0.08 to 1.11; n=256), VHI+VB versus VB(0.31 grams; 95% CI: -0.42 to 1.05; n=130) and VHI+VB versus isolated aspiration(0.54 grams; 95% CI: -0.06 to 1.14; n=132). There was difference for VHI versus isolated aspiration to Cstat (4.77 ml/cm H2O; 95% CI: 2.41 to 7.14; n= 136). Conclusion: No evidence was found that VHI was effective in increasing the amount of secretions removed, Cdyn and oxygenation, but VHI seems to show a slight improvement in Cstat when compared to isolated aspiration. (C) 2022 Elsevier Inc. All rights reserved.

Automated summary

This study analyzed the effects of ventilator hyperinflation (VHI) on pulmonary function and secretion clearance in adults receiving mechanical ventilation (MV). The results showed that VHI did not have a significant impact on the amount of secretions removed, dynamic compliance (Cdyn), and oxygenation. However, there was a slight improvement in static compliance (Cstat) compared to isolated aspiration.