| Summary: | 碩士 === 長庚大學 === 護理學研究所 === 90 === Use of mechanical ventilator support through tracheostomy or intubation has been one of extremely important medical intervention to help support life for ICU patients. However, as the result of using current medical intervention for patients with lung collapse during mechanical ventilation is limited, manual hyperinflation helps alveolar recruitment that results in secretion clearance, ventilation improvement, lung collapse prevention, lung collapse re-inflation, dynamic compliance improvement, artery oxygenation improvement and work of breathing reduction according to certain clinic reports from foreign sources. This study seeks to verify success of sputum clearance and ventilation in giving manual hyperinflation to patients suffering from lung collapse who has been using mechanical ventilation for more than one week. The study takes the assumption that through manual hyperinflation to recruit alveolar, it will help patients sputum clearance and ventilation.
A controlled, randomized, single blind, experimental design was used. Each patient was assigned a random number upon entering the research project, which allowed randomly allocation to two groups: experimental group and control group. The samples were collected in the ICU of a Medical Center in northern Taiwan and the Chronic Respiratory Treatment Center of the Regional Hospital under the cooperation program. A total of 28 patients joined the study in two groups, i.e., experimental group and control group, 14 patients in each group. Cases from the experimental group were treated with ventilation support and additional manual hyperinflation while cases from the control group were only treated with ventilation support. Patients in experimental group received the manual hyperinflation once of 20 minutes in 3 times per day for 5 days.
Outcome measurement was evaluated by noting changes in the patient’s score in dry/wet ratio of sputum, sputum viscosity, tidal volume, maximal respiratory pressure, PaO2/FiO2, upper chest X-ray film, dynamic lung compliance and the index of rapid shallow breathing.
Outcome measurements were assessed 3 times for all patients: at the day admitted to this study, the 3rd day, and 6th day. Upon giving the conclusions are as follows:
(1)For the sputum clearance, patients from the experiment group indicate significant improvement than those from control group does depending on the time-point in terms of sputum viscosity (p=0.002); while patients from both group indicate no significant variance in dry/wet ratio of sputum;
(2)For the ventilation, patients from the experimental group indicate significant improvement than those from control group does depending on the time-point in terms of improved tidal volume (p=0.033), maximal respiratory pressure (p=0.05), PaO2/FiO2 (p=0.016), upper chest X-ray film (p=0.069), the index of rapid shallow breathing (p=0.008); and while patients from both groups indicate no significant variance in terms of dynamic compliance.
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