Comparison of Manual Hyperinflation in Supine versus Lateral Decubitus Position on Arterial Blood Gases in Patients with Ventilator-Associated Pneumonia

Abstract

Background: Ventilator-associated pneumonia (VAP) is a significant concern in critically ill patients, often leading to prolonged hospital stays and increased mortality. Manual Hyperinflation (MHI) is a physiotherapeutic intervention used to improve alveolar recruitment and secretion clearance in mechanically ventilated patients. However, there is limited data comparing the efficacy of MHI in different positions. Objective: The study aims to compare the effects of MHI on arterial blood gases (ABG) in ventilated patients with pneumonia in supine versus lateral decubitus positions. Methods: A total of 30 mechanically ventilated patients diagnosed with VAP were randomly assigned into two groups: Group A (n=15) received MHI in a supine position, while Group B (n=15) received MHI in a lateral decubitus position. MHI sessions were administered twice daily for six days. Pre- and post-intervention ABG parameters, including PaO2, PaCO2, SaO2, and PaO2/FiO2, were recorded and analysed using paired and unpaired t-tests. Results: In the supine position, MHI resulted in minor, statistically non-significant improvements in PaO2 and SaO2 (p>0.05). In the lateral decubitus position, significant improvements were observed in PaO2 (p<0.05) and PaCO2 (p<0.001). When comparing post-intervention ABG values between groups, PaO2 and PaCO2 were significantly better in the lateral decubitus position (p<0.05), while SaO2 and PaO2/FiO2 showed non-significant improvements.