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Patients who require invasive ventilatory support are subject to the deleterious effects of this, mainly ventilator-associated pneumonia (VAP). The physiotherapist, a member of the multiprofessional team, assists the patient with the purpose of promoting the recovery and preservation of the functionality, being able to minimize / avoid secondary complications. This study aims to identify the repercussions of mechanical ventilation hyperinflation (MVH) in the flow bias concept in respiratory mechanics. This study is a narrative review. MVH is an important resource commonly used in clinical practice that involves the manipulation of mechanical ventilator configurations to provide larger pulmonary volumes, and the generated airflow gradient may play a relevant role in mucus transport, with the concept of flow bias the main factor responsible for its direction. For the mobilization of the mucus towards the cephalic direction to occur, there must be a predominant expiratory flow, guaranteeing the peak ratio of expiratory flow / inspiratory flow peak (EFP / IFP) greater than 1.11. Maintenance of mechanical ventilation assures the patient to maintain the positive end expiratory pressure (PEEP) and the oxygen inspired fraction, avoiding the deleterious effects of the mechanical ventilator disconnection. MVH is able to improve lung compliance without, however, increasing airway resistance. MVH in the cephalic flow bias concept is effective for the mucus mobilization in the central direction, being able to improve pulmonary compliance and peripheral oxygen saturation.Keywords: Respiration, Artificial. Intensive Care Units. Physical Therapy Department, Hospital.ResumoOs pacientes internados que necessitam de suporte ventilatorio invasivo estao sujeitos aos efeitos deleterios deste, principalmente a pneumonia associada a ventilacao mecânica (PAV). O fisioterapeuta, integrante da equipe multiprofissional, assiste o paciente com a finalidade de promover a recuperacao e preservacao da funcionalidade, podendo minimizar/evitar complicacoes secundarias. Este estudo consiste em identificar as repercussoes da hiperinsuflacao com ventilador mecânico (HVM) no conceito flow bias na mecânica respiratoria. O presente estudo trata-se de uma revisao narrativa. A HVM e um importante recurso comumente utilizado na pratica clinica que envolve a manipulacao das configuracoes do ventilador mecânico para fornecer maiores volumes pulmonares, e o gradiente de fluxo de ar gerado pode desempenhar um papel relevante no transporte do muco, sendo o conceito de flow bias cefalico o principal fator responsavel pelo direcionamento deste. Para que a mobilizacao do muco em direcao cefalica ocorra, deve existir um fluxo expiratorio predominante, garantindo a razao pico de fluxo expiratorio/pico de fluxo inspiratorio (PFE/PFI) maior do que 1,11. A manutencao da assistencia ventilatoria mecânica assegura ao paciente a manutencao da pressao positiva ao final da expiracao (PEEP) e a fracao inspirada de oxigenio (FiO2), evitando os efeitos deleterios da desconexao do ventilador mecânico. A HVM e capaz de melhorar a complacencia pulmonar sem, no entanto, aumentar a resistencia das vias aereas. A HVM no conceito flow bias cefalico e eficaz para a mobilizacao do muco em direcao central, sendo capaz de melhorar a complacencia pulmonar e saturacao periferica de oxigenio (SpO2).Palavras-chave: Respiracao Artificial. Unidades de Terapia Intensiva. Servico Hospitalar de Fisioterapia.

Impacts in the Respiratory Mechanics of the Ventilator Hyperinsuflation in the Flow Bias Concept: a Narrative Review