• Matthew P Linnane, Lawrence R Caruana, Oystein Tronstad, Amanda Corley, Amy J Spooner, Adrian G Barnett, Peter J Thomas, and James R Walsh.
• Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Brisbane, QLD 4032, Australia; Physiotherapy Department, The Prince Charles Hospital, Brisbane, QLD 4032, Australia. Electronic address: matthew.linnane@health.qld.gov.au.
• J Crit Care. 2019 Feb 1; 49: 77-83.

PurposeEndotracheal suctioning (ES) of mechanically ventilated patients decreases end-expiratory lung volume (EELV). Manual hyperinflation (MHI) and ventilator hyperinflation (VHI) may restore EELV post-ES but it remains unknown which method is most effective. The primary aim was to compare the efficacy of MHI and VHI in restoring EELV post-ES.Materials And MethodsES was performed on mechanically ventilated intensive care patients, followed by MHI or VHI, in a randomised crossover design. The washout period between interventions was 1 h. End-expiratory lung impedance (EELI), measured by electrical impedance tomography, was recorded at baseline, during ES, during hyperinflation and 1, 5, 15 and 30 min post-hyperinflation.ResultsNine participants were studied. ES decreased EELI by 1672z (95% CI, 1204 to 2140) from baseline. From baseline, MHI increased EELI by 1154z (95% CI, 977 to 1330) while VHI increased EELI by 769z (95% CI, 457 to 1080). Five minutes post-VHI, EELI remained 528z (95% CI, 4 to 1053) above baseline. Fifteen minutes post-MHI, EELI remained 351z (95% CI, 111 to 592) above baseline. At subsequent time-points, EELI returned to baseline.ConclusionsMHI and VHI effectively restore EELV above baseline post-ES and should be considered post suctioning.Copyright © 2018 Elsevier Inc. All rights reserved.

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