The Effect Of Manual Hyperinflationimprove Respiratory Function In MV Patients: A Systematic Review

?Objectives?1.Evaluating the effect of MHI intervention on respiratory function in MV patients.2.Summarizing the current situation of MHI intervention in MV patients.3.Discussing the problems of MHI in MV patients,to provide the basis for clinical nursing practice of MHI,and to point out the direction and train of thought for clinical nursing research of MHI in the future.?Methods?Chinese Biomedical Literature Database?CBM?,China knowledge Network Database?CNKI?,Weip Database?VIP?,Wanfang Database?Cochrane Library?and JBI database were searched.Medline of Science database.ScienceDirect database and other databases published in mechanical ventilation patients with pulmonary inflation related to the literature.According to the PICO principle,the inclusion and exclusion criteria were established.The evaluation criteria of the final literature reference Cochrane guide manual were evaluated with methodological quality and then the data were extracted.Review Manager5.3 software was used to analyze the data by Meta.?Results?Through a comprehensive and systematic literature retrieval,we have selected out a preliminary study of 188 articles by removing repeated literature,reading titles and abstracts.It is found that the number of studies on nursing care of MV patients with MHI has increased year by year since 2001year.In the last ten years,172 papers were published,accounting for 91.5%of the total number of such studies.After strict selection of inclusion and exclusion criteria,24 articles were included.The total number of patients included in the study was 1633.In the aspect of intervention,7 articles of routine nursing combined with MHI routine comparative experimental study,17 articles of routine nursing and MHI control study.Included in the study of common measurement PaO₂/FiO₂,Crs,PaO₂,SaO₂,PaCO₂,etc.Using the Cochrane bias risk assessment criteria,the methodological quality was mostly moderate,of which 3 articles were of grade A and 16 articles were of grade B and 5 articles were of grade C.The results of Meta analysis showed that the effect of MHIintervention on respiratory function of MV patients was statistically significant,PaO₂[WMD=5.46,95%CI?3.38,7.53?,p<0.00001],SaO₂[WMD=3.59,95%CI?2.46,4.72?,p<0.00001],PaCO₂[WMD=-3.57,95%CI?-4.89,-2.26?,p<0.0001];PaO₂/FiO₂[WMD=42.26,95%CI?18.56,65.95?,p=0.0005],C rs:[WMD=12.52,95%CI?6.30,18.74?,p<0.0001],R_AW[WMD=-2.49,95%CI?-2.83,-2.14?,p<0.00001].The effect MHI intervention on the pulmonary complications of patients with the MV,the incidence of atelectasis[RR=0.26,95%CI?0.15,0.15?,p<0.0001],VAP[(RR=0.33,95%CI?0.20,0.20?,p<0.0001],R[WMD=7.84,95%CI?10.61,5.07?,p<0.00001],The effect MHI intervention on sputum clearance[WMD=0.98,95%CI?0.72,0.72?,p<0.00001];The effect MHI intervention on the heart rate and average arterial pressure in MV patients,HR[WMD=-1.53,95%CI?-4.52,1.46?,p=0.32],MAP[WMD=-0.61,95%CI?-2.42,1.20?,p=0.51];The effect hyperinflation care intervention on the prognosis of patients with MV,Time to extubating of patients[WMD=2.06,95%CI?2.40,1.72?,p<0.00001],hospital stays[WMD=2.63,95%CI?3.24,2.01?,p<0.00001].?Conclusions?MHI can help improve the respiratory function of MV patients,improve PaO₂,SaO₂ and Crs,improve PaO₂/FiO₂,and reduce PaCO₂ and Crs.Reduce the incidence of pulmonary insufficiency and VAP complications;Shortening the time of tube drawing and hospital stay.However,MHI intervention in patients with MV is not obvious in the HR and MAP.Because,in the study of clinical cases are less,and research into the HR and MAP measurement reports is less,the results of the analysis it is concluded that there may be a potential risk of bias.In conclusion,MHI has beneficial effects on MV patients,and it is worthy to be popularized and applied in MV patients.At present,MHI has not formed the operation flow of the system,and the evaluation index is not unified.The nursing staff should explore the MHI optimal nursing scheme based on the current domestic and international situation.