The use of mechanical insufflation-exsufflation in invasively ventilated critically ill adults

Journal article


Swingwood, Ema L., Stilma, Willemke, Tume, Lyvonne N., Cramp, Fiona, Voss, Sarah, Bewley, Jeremy, Ntoumenopoulos, George, Schultz, Marcus J., Scholte Op Reimer, Wilma, Paulus, Frederique and Rose, Louise. (2022). The use of mechanical insufflation-exsufflation in invasively ventilated critically ill adults. Respiratory Care. 67(8), pp. 1043-1057. https://doi.org/10.4187/respcare.09704
AuthorsSwingwood, Ema L., Stilma, Willemke, Tume, Lyvonne N., Cramp, Fiona, Voss, Sarah, Bewley, Jeremy, Ntoumenopoulos, George, Schultz, Marcus J., Scholte Op Reimer, Wilma, Paulus, Frederique and Rose, Louise
Abstract

Mechanical insufflation-exsufflation (MI-E) is traditionally used in the neuromuscular population. There is growing interest of MI-E use in invasively ventilated critically ill adults. We aimed to map current evidence on MI-E use in invasively ventilated critically ill adults. Two authors independently searched electronic databases MEDLINE, Embase, and CINAHL via the Ovid platform; PROSPERO; Cochrane Library; ISI Web of Science; and International Clinical Trials Registry Platform between January 1990–April 2021. Inclusion criteria were (1) adult critically ill invasively ventilated subjects, (2) use of MI-E, (3) study design with original data, and (4) published from 1990 onward. Data were extracted by 2 authors independently using a bespoke extraction form. We used Mixed Methods Appraisal Tool to appraise risk of bias. Theoretical Domains Framework was used to interpret qualitative data. Of 3,090 citations identified, 28 citations were taken forward for data extraction. Main indications for MI-E use during invasive ventilation were presence of secretions and mucus plugging (13/28, 46%). Perceived contraindications related to use of high levels of positive pressure (18/28, 68%). Protocolized MI-E settings with a pressure of ±40 cm H2O were most commonly used, with detail on timing, flow, and frequency of prescription infrequently reported. Various outcomes were re-intubation rate, wet sputum weight, and pulmonary mechanics. Only 3 studies reported the occurrence of adverse events. From qualitative data, the main barrier to MI-E use in this subject group was lack of knowledge and skills. We concluded that there is little consistency in how MI-E is used and reported, and therefore, recommendations about best practices are not possible.

Keywordsmechanical insufflation-exsufflation; CoughAssist; ICU; extubation; airway clearance; physiotherapy; weaning
Year2022
JournalRespiratory Care
Journal citation67 (8), pp. 1043-1057
PublisherDaedalus Enterprises, Inc.
ISSN0020-1324
1943-3654
Digital Object Identifier (DOI)https://doi.org/10.4187/respcare.09704
PubMed ID35610033
Scopus EID2-s2.0-85134739979
Page range1043-1057
Publisher's version
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All rights reserved
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Controlled
Output statusPublished
Publication dates
Online26 Jul 2022
Publication process dates
Deposited18 Jul 2023
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