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
License
All rights reserved
File Access Level
Controlled
Output statusPublished
Publication dates
Online26 Jul 2022
Publication process dates
Deposited18 Jul 2023
Permalink -

https://acuresearchbank.acu.edu.au/item/8z550/the-use-of-mechanical-insufflation-exsufflation-in-invasively-ventilated-critically-ill-adults

Restricted files

Publisher's version

  • 51
    total views
  • 0
    total downloads
  • 1
    views this month
  • 0
    downloads this month
These values are for the period from 19th October 2020, when this repository was created.

Export as

Related outputs

A conservative oxygenation strategy is feasible and appears to be safe compared with liberal oxygenation in mechanically ventilated patients
Ntoumenopoulos, George. (2015). A conservative oxygenation strategy is feasible and appears to be safe compared with liberal oxygenation in mechanically ventilated patients. Journal of Physiotherapy. 62(1), pp. 51 - 51. https://doi.org/10.1016/j.jphys.2015.10.005
Effects of manually-assisted cough combined with postural drainage, saline instillation and airway suctioning in critically-ill patients during high-frequency oscillatory ventilation : A prospective observational single centre trial
Ntoumenopoulos, George, Berry, Marc and Camporota, Luigi. (2014). Effects of manually-assisted cough combined with postural drainage, saline instillation and airway suctioning in critically-ill patients during high-frequency oscillatory ventilation : A prospective observational single centre trial. Physiotherapy Theory and Practice: an international journal of physical therapy. 30(5), pp. 306 - 311. https://doi.org/10.3109/09593985.2013.876694
Computerised lung sound monitoring to assess effectiveness of chest physiotherapy and secretion removal : a feasibility study
Ntoumenopoulos, George and Glickman, Y. (2012). Computerised lung sound monitoring to assess effectiveness of chest physiotherapy and secretion removal : a feasibility study. Physiotherapy. 98(3), pp. 250 - 255. https://doi.org/10.1016/j.physio.2011.12.003
Do commonly used ventilator settings for mechanically ventilated adults have the potential to embed secretions or promote clearance?
Ntoumenopoulos, George, Shannon, Harriet and Main, Eleanor. (2011). Do commonly used ventilator settings for mechanically ventilated adults have the potential to embed secretions or promote clearance? Respiratory Care. 56(12), pp. 1887 - 1892. https://doi.org/10.4187/respcare.01229
The validation of a clinical algorithm for the prevention and management of pulmonary dysfunction in intumbated adults :A synthesis of evidence and expert opinion
Hanekom, Susan, Berney, Sue, Morrow, Brenda, Ntoumenopoulos, George, Paratz, Jennifer, Patman, Shane and Louw, Quinette. (2011). The validation of a clinical algorithm for the prevention and management of pulmonary dysfunction in intumbated adults :A synthesis of evidence and expert opinion. Journal of Evaluation in Clinical Practice. 17(4), pp. 801 - 810. https://doi.org/10.1111/j.1365-2753.2010.01480.x
How do you safely mobilise your intubated and ventilated patient?
Ntoumenopoulos, George. (2009). How do you safely mobilise your intubated and ventilated patient? In In J.D. Chiche, R. Moreno and C. Putensen & A. Rhodes (Ed.). Patient safety and quality of care in intensive care medicine pp. 419 - 430 Medizinisch Wissenschaftliche Verlagsgesellschaft.
Managing secretions in the ventilated patient: The role of humidification, suction, physiotherapy, mucolytics and airway adjuncts
Ntoumenopoulos, George. (2009). Managing secretions in the ventilated patient: The role of humidification, suction, physiotherapy, mucolytics and airway adjuncts. In In A. McLuckie (Ed.). Respiratory disease and its management pp. 127 - 133 Springer.
An observational study of sitting out of bed in tracheostomised patients in the intensive care unit
Bahadur, Kristopher, Jones, Gareth and Ntoumenopoulos, George. (2008). An observational study of sitting out of bed in tracheostomised patients in the intensive care unit. Physiotherapy. 94(4), pp. 300 - 305. https://doi.org/10.1016/j.physio.2008.08.003
Intensive care for the critically ill adult
Jones, Alice Y.M., Ntoumenopoulos, George and Paratz, Jennifer D.. (2008). Intensive care for the critically ill adult. In In J.A. Pryor and S.A. Prasad (Ed.). Physiotherapy for respiratory and cardiac problems: Adults and paediatrics pp. 270 - 312 Churchill Livingstone.