Benefits of interventions for respiratory secretion management in adult palliative care patients—a systematic review

Abstract

BackgroundRespiratory secretions impact negatively on palliative patients. Unfortunately, a gold standard therapy is not yet available. The purpose of this study was to identify which interventions are in use to control respiratory secretions in patients with chronic disease with a poor prognosis and verify their effects on outcomes relevant for palliative care patients.MethodsA systematic review of the literature with narrative summary was conducted. We searched eight electronic databases in April 6th, 2016. Citation-tracking and reference list searches were conducted. We included randomized controlled trials, crossover trials, observational and qualitative studies regarding interventions for respiratory secretion management in adult patients with chronic diseases that met inclusion criteria indicating short prognosis.ResultsSix randomized controlled trials, 11 observational studies, ten crossover trials and one qualitative study were found. Interventions included mechanical insufflation-exsufflation (MIE), expiratory muscle training, manually-assisted cough, tracheotomy, chest physiotherapy, suctioning, air stacking, electrical stimulation of abdominal muscles, nebulized saline, positive expiratory pressure masks, percussive ventilation, high frequency chest wall oscillations. The interventions with most promising benefits to patients in palliative care were manually-assisted cough and mechanical insufflation-exsufflation to promote expectoration and percussive ventilation to improve mucous clearance.ConclusionTherapies, such as manually assisted cough, mechanical insufflation-exsufflation and percussive ventilation, which aim to deal with respiratory secretion, were the most promising treatment for use in palliative care for specific diseases. Nevertheless, the evidence still needs to improve in order to identify which treatment is the best.Electronic supplementary materialThe online version of this article (doi:10.1186/s12904-016-0147-y) contains supplementary material, which is available to authorized users.

Effects of Mechanical Insufflation-Exsufflation on Airway Mucus Clearance Among Mechanically Ventilated ICU Subjects

“…Cough augmentation techniques, such as lung volume recruitment or manually and mechanically assisted cough, are used to prevent and manage respiratory complications associated with chronic conditions, in particular, neuromuscular disease, 17 patients with tracheal devices, 15 and patients who receive palliative care, 4 and possibly may improve the short-and long-term outcomes for patients with acute respiratory failure. 10,[22][23][24] Nevertheless, a Canadian survey reported that there is a moderate adoption of cough augmentation techniques, and a lack of expertise and knowledge are the potentially modifiable barriers addressed with educational interventions.…”

“…2 Therefore, the standard care of ICU patients on mechanical ventilation includes respiratory physiotherapy combined with direct suction through the endotracheal tube, which aims to prevent the complications associated with mucus retention, such as pulmonary atelectasis, bronchospasm, tracheobronchitis, and pneu-monia. [3][4][5][6] However, endotracheal tube suctioning is effective in clearing only a small portion of the proximal airway, and this procedure may be insufficient to fully prevent the complications associated with the airway mucus retention. 7…”

Soins de fin de vie pour les patients atteints d’un virus respiratoire extrêmement transmissible : implications pour la COVID-19

“…The mainstay of pharmacologic management of secretions is anti-muscarinic drugs such as glycopyrrolate (0.4 mg sc/iv every four hours, as needed), and/or octreotide (300 lg sc q8h, as needed). 67…”

Estrategias actuales en el manejo de las secreciones traqueobronquiales

“…No obstante, hasta el momento no existen estudios que demuestren que tenga la misma eficacia en pacientes con enfermedades respiratorias. 18,19 Mucocinéticos Comúnmente referidos como fármacos que mejoran el aclaramiento de la tos al actuar de forma directa en el latido ciliar. Es importante mencionar que no se ha demostrado un efecto consistente sobre el aclaramiento mucociliar en pacientes con historia de enfermedad pulmonar crónica.…”