Manual hyperinflation is a respiratory therapy technique that helps patients on mechanical ventilation improve lung function and clear mucus. Here’s what you need to know:
- Purpose: Clears secretions, reopens collapsed alveoli, and improves lung flexibility.
- Common Uses: Post-surgery recovery, mechanical ventilation support, and critical care for conditions like ARDS or pneumonia.
- Equipment Needed: Manual resuscitation bag, pressure manometer, HEPA filter, oxygen supply, tubing, and PPE.
- Procedure Highlights:
- Preoxygenate with 100% oxygen.
- Deliver slow, controlled breaths (6–8 per minute) while monitoring pressures.
- Reassess the patient and document outcomes after the procedure.
- Safety Tips: Stop if SpO2 drops below 90%, heart rate changes by 20%, or signs of distress appear. Keep pressures below 40 cmH2O.
This technique is a critical tool for respiratory care, but it requires proper setup, execution, and monitoring to ensure patient safety and effectiveness.
Respiratory Physiotherapy – Manual Hyperinflation
Required Equipment
Choosing and setting up the right equipment is crucial for successful manual hyperinflation.
Basic Tools You’ll Need
Here’s what you’ll need to get started:
- Manual Resuscitation Bag: A self-inflating bag with a 1.5–2L capacity and a non-rebreathing valve.
- Pressure Manometer: Monitors delivered pressures, typically in the 0–40 cmH2O range.
- HEPA Filter: A bacterial/viral filter to ensure clean airflow.
- Oxygen Supply: Either a wall-mounted or portable oxygen source with a flowmeter.
- Oxygen Tubing: Medical-grade tubing, usually 6–7 ft long.
- Personal Protective Equipment (PPE):
- N95 respirator or surgical mask
- Eye protection
- Clean gloves
- Isolation gown (if needed)
Setting Up the Equipment
1. Assemble the System
Follow these steps to connect everything properly:
- Attach the pressure manometer to the bag’s port.
- Connect the HEPA filter to the patient end of the system.
- Secure the oxygen tubing to the oxygen inlet port.
- Double-check that all connections are tight and secure.
2. Check the Equipment
- Set the oxygen flow to 15 L/min.
- Compress the resuscitation bag to ensure it inflates correctly.
- Verify the manometer readings (should not exceed 40 cmH2O).
- Inspect the valve for smooth movement and confirm there are no leaks.
3. Ensure Safety
- Confirm the oxygen flow is consistent.
- Test the pressure relief valve to ensure it’s functioning.
- Recheck all connection points for stability.
- Keep backup equipment nearby in case of emergencies.
These steps help ensure the equipment is ready to deliver controlled, safe breaths during manual hyperinflation. Proper setup minimizes risks and supports patient safety.
sbb-itb-b787f78
Manual Hyperinflation Steps
Pre-Procedure Checks
-
Patient Assessment
- Record the current ventilator settings.
- Check vital signs, including heart rate, blood pressure, and SpO2.
- Evaluate breath sounds and chest movement.
- Review imaging to ensure there are no contraindications.
-
Safety Preparation
- Wear proper PPE: gloves, gown, and eye protection.
- Perform hand hygiene according to CDC guidelines.
- Position the patient at a 30–45-degree angle unless contraindicated.
- Ensure suction equipment is available and functional.
- Adjust the bed to a comfortable working height.
Once these steps are completed, you can move on to the manual hyperinflation procedure.
Performing the Technique
After confirming the patient is stable, follow these steps for manual hyperinflation:
-
Initial Setup
- Position yourself at the head of the bed with all equipment within easy reach.
-
Preparation
- Preoxygenate the patient with 100% FiO2 for 2–3 minutes.
-
Ventilator Disconnection
- Take note of the ventilator settings.
- Disconnect the patient from the ventilator.
- Attach them to the manual resuscitation circuit.
-
Delivery Technique
- Deliver a slow inhalation over 3 seconds.
- Hold the inspiration for 2–3 seconds.
- Allow passive exhalation for 4–6 seconds.
- Continuously monitor the pressure gauge.
- Keep peak pressures below 40 cmH2O.
- Administer 6–8 breaths per minute.
After-Procedure Care
-
Immediate Post-Procedure
- Reconnect the patient to the ventilator, using the previous settings.
- Reassess breath sounds and chest movement.
- Monitor vital signs for 5–10 minutes after the procedure.
-
Documentation
- Record the duration of the procedure.
- Note the peak pressures used.
- Document the patient’s response and tolerance.
- Report any complications encountered.
- Include an assessment of secretion clearance.
-
Follow-up Monitoring
- Check arterial blood gases if ordered.
- Monitor SpO2 and end-tidal CO2 levels.
- Observe the patient’s work of breathing.
- Watch for any signs of respiratory distress.
- Plan the timing of the next treatment as needed.
Safety Guidelines
Risk Management
Stop the procedure immediately if you notice any of the following:
- SpO2 falls below 90%
- Heart rate changes by more than 20% from baseline
- Patient becomes agitated
- New arrhythmias are detected
- Increased respiratory effort is observed
Pressure Management Guidelines
- Begin with lower pressures (20-25 cmH2O) and increase gradually based on patient tolerance.
- Continuously monitor the pressure gauge during inflation.
- Release pressure right away if resistance is detected.
- Maintain PEEP at the prescribed levels throughout the procedure.
Use the patient safety checklist below to ensure critical monitoring steps are followed.
Patient Safety Checklist
This checklist is designed to support risk management efforts during the procedure:
| Safety Component | Required Actions | Monitoring Parameters |
|---|---|---|
| Equipment Check | Confirm equipment is functioning properly | Pressure readings Circuit connections Valve function |
| Patient Status | Assess hemodynamic stability Verify ventilator settings Review contraindications |
Vital signs SpO2 Work of breathing |
| Monitoring Setup | Connect to a cardiac monitor Set alarm limits appropriately Ensure pressure gauge is clearly visible |
Heart rate Blood pressure Respiratory rate |
Critical Safety Points
- Maintain consistent patient positioning throughout the procedure.
- Keep suction equipment nearby and ready to use.
- Ensure backup ventilation equipment is accessible at all times.
- Record baseline parameters before starting the procedure.
- Have emergency medications on hand in case they are needed.
Technique Modifications
- Deliver reduced volume for patients with acute lung injury.
- Adjust inspiratory time based on patient compliance.
- Shorten treatment duration for unstable patients.
- Monitor chest wall movement to ensure symmetry.
- Frequently check breath sounds during the procedure.
Summary
This guide pulls together essential clinical uses and practical tools to master manual hyperinflation techniques.
Clinical Applications
Manual hyperinflation plays a key role in improving lung function for ventilated patients. Its effectiveness relies on proper technique and close monitoring. Healthcare professionals should tailor pressure settings to each patient and address safety concerns as they arise. This approach supports better secretion clearance and helps reopen the lungs effectively.
For more skill-building opportunities, check out the educational resources listed below.
Learning Resources
Respiratory Cram provides a variety of tools to help sharpen manual hyperinflation skills. The platform includes video tutorials, practice questions, and detailed articles focused on techniques and safety measures.
Available resources include:
- Step-by-step instructions
- Clinical case study reviews
- Safety protocol overviews
- Equipment usage tutorials
- Guidelines for adapting procedures
These resources are regularly updated to align with the latest practices in respiratory care. Visit Respiratory Cram to explore these specialized materials and expand your clinical knowledge.
