Hemodynamic effects of intermittent manual lung hyperinflation in patients with septic shock

Abstract Objective: The purposes of this study were to investigate the hemodynamic changes induced by intermittent manual lung hyperinflation (MHI) and to assess if these changes are adverse enough to warrant prohibition of MHI as a routine procedure in the care of patients with septic shock. Design: The study’s design was experimental prospective. Setting: The settings were university hospital intensive care units. Patients: Subjects included 13 consecutive mechanically ventilated patients with septic shock who met the inclusion criteria. Measurements And Results: Phasic MHI-related increments in mean inspiratory airway pressure were concordant to changes in mean pulmonary artery pressure (MPAP) (r 2 = 0.67) with a 0.6 mm Hg rise in MPAP per cm H 2 O airway pressure. The magnitude of MPAP changes was not reflected in magnitude of stroke volume index (SVI) (r 2 = 0.06). On average, MHI did not induce statistically significant hemodynamic changes and mean values returned to baseline level within 15 minutes. SVI during MHI increased slightly in 9 patients, from 37 ± 15 (mean ± SD) to 41 ± 17 mL/m 2 ( P 2 (not significant). Patients with an increase in SVI had lower baseline values for SVI, cardiac index, and left ventricular stroke work index ( P P P P Conclusion: The hemodynamic effects of intermittent MHI in patients with septic shock are relatively small and insignificant and seem to be related to the cardiovascular state before the procedure. The risk of inducing hemodynamic changes with MHI should not be considered as a contraindication in patients with septic shock who are mechanically ventilated. (Heart Lung® 2000;29:356-66.)