Ventilator hyperinflation determined by peak airway pressure delivered: A randomized crossover trial.

AIM: The aim of this study was to see if a more sophisticated ventilator hyperinflation protocol might result in more sputum clearance compared to manual hyperinflation. BACKGROUND: Hyperinflation has been used to mobilize lung secretions in mechanically ventilated patients in the intensive care unit setting for almost 50 years. In the past decade, rather than using a bag external to the ventilator circuit to deliver hyperinflation (known as "bagging" or "manual hyperinflation"), a new technique has evolved using existing ventilator circuitry (known as "ventilator hyperinflation"). One conservative ventilator hyperinflation protocol has demonstrated equivalence with manual hyperinflation in sputum clearance. DESIGN: A randomized crossover study. METHOD: Patients received manual hyperinflation and ventilator hyperinflation in two randomly ordered treatments on the same day by the same physiotherapist, using a ventilator hyperinflation protocol involving titration of hyperinflation according to airway pressure. RESULTS: Between 2013 and 2018, 48 patients were enrolled in the study. Physiotherapy treatment using ventilator hyperinflation yielded significantly more wet weight sputum (median 2.84 g, IQR 1.81, 4.22) than treatment using manual hyperinflation (median 1.5 g, IQR 0.73, 2.31, P < .001), without significant differences in secondary measures. CONCLUSIONS: A more sophisticated approach to the titration of the volume delivered using ventilator hyperinflation relative to the airway pressure resulted in greater wet weight sputum cleared during physiotherapy treatment. RELEVANCE TO CLINICAL PRACTICE: The results presented in this paper demonstrate that the application of ventilator hyperinflation using peak airway pressure rather than tidal volume may be superior in facilitating sputum clearance and improved oxygenation without patient harm.

The prevalence of back pain in patients in one Australian tertiary hospital population.

OBJECTIVES: The aims of the present study were to provide back pain (BP) point prevalence data from inpatients at an Australian tertiary hospital on one day, and compare this with Australian non-hospitalized population prevalence data; to collect data around the development of BP throughout hospital admission; and to analyse the association between BP and past history of BP, gender, age, admission specialty and hospital length of stay (LOS). METHODS: This was a single-site, prospective, observational study of hospitalized inpatients on one day during 2016, with a subsequent survey over the following 11 days (unless discharge or death occurred sooner). RESULTS: Data were collected from 343 patients (75% of the hospitalized cohort). A third of patients (n = 108) reported BP on admission, and almost a fifth (n = 63) developed new BP during their hospitalization. Patients who described BP at any time during their hospital stay had a higher chance of having had a history of BP, with odds increasing after adjustment for age and gender (odds ratio 5.89; 95% confidence interval (CI) 3.0 to 11.6; p < 0.001). After adjusting for age and gender, those experiencing BP had a significantly longer LOS (median 13 days; CI 10.8 to 15.3) than those who did not (median 10 days; CI 8.4 to 11.6; p = 0.034). CONCLUSIONS: Hospital LOS for patients who complained of BP at any time during their admission was 3 days longer than those who had no BP, and a history of BP predicted a higher likelihood of BP during admission. Screening of patients on admission to identify any history of BP, and application of a package of care including early mobilization and analgesia may prevent the onset of BP and reduce LOS.

How do Australian ICU survivors fare functionally 6 months after admission?

OBJECTIVES: To determine the extent to which physical function is restored 6 months after intensive care unit admission, and whether this is associated with short or long ICU length of stay (LOS). DESIGN, SETTING AND PARTICIPANTS: We conducted a prospective observational study between April and June 2010. All patients admitted for more than 48 hours to the general ICU at Sir Charles Gairdner Hospital, Perth, Western Australia, were eligible for inclusion. "Short" and "long" ICU LOS were defined as < 8 days and ≥ 8 days, respectively. Six months after ICU admission, an investigator (blinded to baseline data) contacted participants by telephone to administer a follow-up questionnaire based on the Functional Independence Measure (FIM). OUTCOME MEASURES: The primary measure was FIM score; secondary measures were rehabilitation requirement, readmission rate, and whether or not patients had returned to work and driving. RESULTS: 77 patients consented to take part in the study, and 71 were followed up. Median total FIM score (124) and motor (89) and cognitive (35) subscores suggested high-level functional independence at follow-up. Fifty per cent of patients who were workers at baseline had returned to work, and 76% of drivers had returned to driving at follow-up. Paired t tests of the changes in total FIM and its subscales showed that only the motor subscore showed a significant deterioration (mean change, -3.7; P=0.04). Changes for the total FIM did not appear to be correlated with any demographic or baseline data. Furthermore, there appeared to be no difference in FIM between patients with short or long ICU LOS. CONCLUSIONS: Our study showed that patients who survive treatment for life-threatening illness in an Australian ICU for more than 48 hours and are subsequently able to communicate are likely to return to their premorbid functional level (as defined by FIM score) within 6 months.