BACKGROUND: Clearing subglottic secretions has been proved to reduce ventilator-associated pneumonia. A manual method named the rapid flow expulsion maneuver was developed to clear subglottic secretions. This study evaluates its safety and effectiveness and analyzes the influential factors. METHODS: This study was composed of 2 parts. In an in vitro study, secretions were instilled directly to the area above the cuff in an intubated tracheal model. Secretions were expelled by the rapid flow expulsion maneuver with different volumes and peak flows in 3 tracheal positions (0, 15, and 30°). At each tracheal position, the maneuver was repeated twice, unless secretions above the cuff were <0.5 mL. In an in vivo study, subglottic secretions were suctioned via subglottic secretion drainage and then were cleared by the rapid flow expulsion maneuver. After the initial maneuver, methylene blue (2 mL) was instilled above the cuff, and the maneuver was performed again. The subject's sputum color was then recorded over 24 h. RESULTS: In the in vitro study, no aspiration was observed in the 277 maneuvers completed. Subglottic secretions were visibly expelled in 167 of 277 maneuvers (60.3%), and the median clearance efficiencies of the 3 consecutive maneuvers were 39.6, 6.3, and 0.4%. In the 108 first maneuvers, 93 (86.1%) produced visible secretions. Multiple linear regression models were used to identify predictors of clearance efficiency: tracheal position (P < .001), flow (P ‫؍‬ .041), and secretion viscosity (P ‫؍‬ .017). In the in vivo study, 77 rapid flow expulsion maneuvers were completed after suctioning via subglottic secretion drainage in 16 subjects, and the maneuvers collected 221.5 mL of secretions. No aspiration was observed over 24 h. CONCLUSIONS: The rapid flow expulsion maneuver was safe and effective to clear subglottic secretions. The first maneuver was the most effective to expel the majority of secretions. Supine position and high peak flow improved the clearance efficiency.

Background: Only limited data are available on the real-life clinical utilization of aerosolized medications in intensive care unit (ICU) patients. Exploring the utilization of aerosolized medications in the ICU may contribute to develop appropriate education and improve the quality of aerosol therapy. Methods: A 2-week, prospective, multicenter, observational, cohort study was conducted to record how the aerosolized medications were utilized in the Chinese ICUs, including indications, medications used in solo or combination, dosage, and side-effects in adult patients. Results: A total of 1006 patients from 28 ICUs were enrolled, of which 389 (38.7%) received aerosol therapy. The most common indications for aerosol therapy were difficulty in secretion management (23.1%) and chronic obstructive pulmonary disease exacerbation (18.5%). The combination of inhaled corticosteroids and shortacting muscarinic antagonist was the most commonly used medication (19.5%, 76/389). Ninety-two percent (358/389) of the patients did not have any side effects during aerosol therapy. More patients in the group with mechanical ventilation received bronchodilators than spontaneous breathing patients (81.3% vs. 55.5%, p < 0.001), and more patients who breathed spontaneously through a tracheostomy received mucus-regulating agents than other patients (70% vs. 37.9%, p ¼ 0.004).