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Critical Care
Published in: Critical Care 4/2011

Open Access 01-08-2011 | Research

Manual hyperinflation partly prevents reductions of functional residual capacity in cardiac surgical patients - a randomized controlled trial

Authors: Frederique Paulus, Denise P Veelo, Selma B de Nijs, Ludo FM Beenen, Paul Bresser, Bas AJM de Mol, Jan M Binnekade, Marcus J Schultz

Published in: Critical Care | Issue 4/2011

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Abstract

Introduction

Cardiac surgery is associated with post-operative reductions of functional residual capacity (FRC). Manual hyperinflation (MH) aims to prevent airway plugging, and as such could prevent the reduction of FRC after surgery. The main purpose of this study was to determine the effect of MH on post-operative FRC of cardiac surgical patients.

Methods

This was a randomized controlled trial of patients after elective coronary artery bypass graft and/or valve surgery admitted to the intensive care unit (ICU) of a university hospital. Patients were randomly assigned to a "routine MH group" (MH was performed within 30 minutes after admission to the ICU and every 6 hours thereafter, and before tracheal extubation), or a "control group" (MH was performed only if perceptible (audible) sputum was present in the larger airways causing problems with mechanical ventilation, or if oxygen saturation (SpO2) dropped below 92%). The primary endpoint was the reduction of FRC from the day before cardiac surgery to one, three, and five days after tracheal extubation. Secondary endpoints were SpO2 (at similar time points) and chest radiograph abnormalities, including atelectasis (at three days after tracheal extubation).

Results

A total of 100 patients were enrolled. Patients in the routine MH group showed a decrease of FRC on the first post-operative day to 71% of the pre-operative value, versus 57% in the control group (P = 0.002). Differences in FRC became less prominent over time; differences between the two study groups were no longer statistically significant at Day 5. There were no differences in SpO2 between the study groups. Chest radiographs showed more abnormalities (merely atelectasis) in the control group compared to patients in the routine MH group (P = 0.002).

Conclusions

MH partly prevents the reduction of FRC in the first post-operative days after cardiac surgery.

Trial registration

Netherlands Trial Register (NTR): NTR1384. http://​www.​trialregister.​nl
Appendix
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Metadata
Title
Manual hyperinflation partly prevents reductions of functional residual capacity in cardiac surgical patients - a randomized controlled trial
Authors
Frederique Paulus
Denise P Veelo
Selma B de Nijs
Ludo FM Beenen
Paul Bresser
Bas AJM de Mol
Jan M Binnekade
Marcus J Schultz
Publication date
01-08-2011
Publisher
BioMed Central
Published in
Critical Care / Issue 4/2011
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc10340

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