A survey examining the use of mechanical insufflation-exsufflation on adult intensive care units across the UK

Abstract

Introduction Despite potential benefits, it is not known how widely physiotherapists use mechanical insufflation-exsufflation devices on UK adult intensive care units. This survey aimed to describe mechanical insufflation-exsufflation use in UK adult intensive care units. Methods Cross-sectional electronic survey of physiotherapists working in a permanent post on adult intensive care units. Results One hundred and sixty-six complete surveys were available for analysis, reflecting a diverse geographical spread. Nearly all (98%; 163/166) clinicians had access to mechanical insufflation-exsufflation. The estimated frequency of use varied, with the majority reporting weekly or monthly use (52/163, 32%; 50/163, 31%, respectively). Nearly all clinicians (99%) used mechanical insufflation-exsufflation with extubated patients. In contrast, around half of respondents (86/163, 53%) used mechanical insufflation-exsufflation with intubated patients, with a range of perceived barriers reported. Conclusions Mechanical insufflation-exsufflation devices are widely available on UK adult intensive care units, with use more common in extubated patients. Barriers to mechanical insufflation-exsufflation use in the intubated population warrant further investigation

Airway Care Interventions for Invasively Ventilated Critically Ill Adults—A Dutch National Survey

“…We found use of MI-E in invasively ventilated patients uncommon in the Netherlands (21%) compared to Canada (64% of the ICUs) [ 17 ] and the United Kingdom (98% of the ICUs) [ 27 ]. These surveys report MI-E to be used for invasively ventilated patients during weaning from invasive ventilation [ 17 , 27 ].…”

The use of mechanical insufflation-exsufflation in invasively ventilated critically ill adults: a scoping review protocol

“…12 Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK. 13 Lane Fox Respiratory Unit, Guy's and Thomas' Foundation NHS Hospital Trust, London, UK.…”

“…There is growing interest in the role of MI-E for invasively ventilated critically ill adults but to date adoption and application of this technique is variable [11][12][13]. The primary aim of this scoping review is to map emerging and current evidence, on MI-E in an ICU setting, thus adding to previous Cochrane Review findings [15].…”

“…Our group has conducted practice surveys of cough augmentation techniques in ICUs in Canada [11,12], the United Kingdom (UK) [13] and the Netherlands [14]. Results from all surveys illustrated that MI-E was predominantly used for sputum management in non-intubated patients to prevent intubation or reintubation [11][12][13]. Across all three countries, MI-E was not commonly used in invasively ventilated patients.…”

ERS International Congress, Madrid, 2019: highlights from the Respiratory Intensive Care Assembly

“…The authors concluded that the role of cough augmentation techniques in prevention of extubation failure is unclear and additional robust research, including understanding intervention safety and intensity, is essential. Furthermore, despite emerging evidence in the intubated population a recent UK survey has highlighted limited adoption of this device in the intubated population [128]. Analgo-sedation and NIV Lara Pisani provided a clear overview of the available medications and the role they should play to facilitate NIV.…”