A literature review
This literature review will compare and contrast articles related to hyperinflation and hyperoxygenation and its’ relevance to practice. The author will look at a wide variety of recent, relevant research to find best practice to provide this care to patients in the intensive care setting. Originally, the research boundaries were articles from 2002 – 2007, however, due to the lack of research found, the author had to extend their search to earlier years. The author found much controversy in the research; and compares volume and pressures using a ventilator verses manual bag to hyperventilate to prevent barotrauma and the use of hyperventilating for the production of secretions. Also hyperoxygenation will be looked at in conjunction with hyperventilation and its effects on the intensive care patient.
Hyperventilation - barotrauma
Hyperinflation in the intensive care setting is advocated to mobilise secretions, prevent and treat atalectasis and improve oxygenation in the ventilated patient.
In practice, manual resuscitation bags are used to hyperinflate patients with large tidal volumes to open up alveoli, initiate a cough from the patient and improve gas exchange.
The literature surrounding optimum volumes to be delivered and pressures to be reached to improve oxygenation and move secretions at the least risk for barotrauma is limited and controversial. Mancinelle-Van Atta and Beck (1992) states hyperinflation involves lung inflation at a volume greater that the ventilator tidal volume. The author appreciates that whist this definition is technically true – a volume greater than the ventilator tidal volume could mean 200% increase in tidal volume and recognises that high airway pressures resulting from high lung volumes have been linked to developing barotrauma.
Singer et al (1994) suggests hyperinflation should be given at a volume 50% greater than that delivered by the ventilator. Glass and Grap... [continues]
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