Please cite this article in press as: Anderson A, et al. Effects of ventilator vs manual hyperinflation in adults receiving mechanical ventilation: a systematic review of randomised clinical trials. Physiotherapy (2014), http://dx.doi.org/10.1016/j.physio.2014.07.006 ARTICLE IN PRESS PHYST-786; No. of Pages 8 Physiotherapy xxx (2014) xxx–xxx Systematic review Effects of ventilator vs manual hyperinflation in adults receiving mechanical ventilation: a systematic review of randomised clinical trials A. Anderson a,∗ , J. Alexanders b , C. Sinani c , S. Hayes b , M. Fogarty b a Physiotherapy Department, Faculty of Health and Social Sciences, Leeds Metropolitan University, Leeds, UK b Sport, Health and Sciences Department, The University of Hull, Hull, UK c Faculty of Health and Life Sciences, York St. John University, York, UK Abstract Background Ventilator hyperinflation (VHI) and manual hyperinflation (MHI) are thought to improve secretion clearance, atelectasis and oxygenation in adults receiving mechanical ventilation. However, to the authors’ knowledge, a systematic review of their relative effectiveness has not been undertaken previously. Objective To determine whether VHI is more effective than MHI for the improvement of clinical outcomes in adults receiving mechanical ventilation. Data sources The electronic databases PubMed, Cochrane Library, CINHAL Plus, Wiley Online Library, ScienceDirect and PEDro were searched from January 1993 until August 2013. OpenGrey, the metaRegister of Controlled Trials (mRCT) and the reference lists of all potentially relevant studies were also searched. Study eligibility criteria Full English reports of randomised clinical trials comparing at least one effect of VHI and MHI in adults receiving mechanical ventilation. Study synthesis and appraisal Included studies were appraised using the Cochrane risk of bias tool. The findings were synthesised using a purely qualitative approach. Results All four included studies reported no significant differences in sputum wet weight, dynamic and static pulmonary compliance, oxygenation and cardiovascular stability between VHI and MHI. Limitations All of the included studies had considerable limitations related to the protocols, equipment, participants and outcome measures. Furthermore, the overall risk of bias was judged to be high for three studies and unclear for one study. Conclusion Only four studies, all of which had a high or unclear risk of bias and significant additional limitations, have compared the effects of VHI and MHI in adults receiving mechanical ventilation. As such, further research in this area is clearly warranted. © 2014 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved. Keywords: Manual hyperinflation; Ventilator hyperinflation; Adults; Mechanical ventilation; Systematic review Introduction Investigating physiotherapeutic interventions that may benefit patients with critical illnesses is of paramount ∗ Corresponding author. Address: Leeds Teaching Hospitals, Beckett Street, Leeds LS9 7TF. Tel.: +44 0113 206 7590; fax: +44 0113 206 7704. E-mail address: ama48@cantab.net (A. Anderson). importance, and currently ranked sixth in the Chartered Society of Physiotherapy’s list of cardiorespiratory and medical rehabilitation research priorities [1]. One such intervention is hyperinflation, a procedure in which larger volumes of gas than normal are delivered to a patient’s lungs with the aims of aiding secretion clearance, reversing atelectasis and improving oxygenation [2]. In adults receiv- ing mechanical ventilation, this may be achieved through http://dx.doi.org/10.1016/j.physio.2014.07.006 0031-9406/© 2014 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.