Comparison of mechanical insufflation–Exsufflation and endotracheal suctioning in mechanically ventilated patients: Effects on respiratory mechanics, hemodynamics, and volume of secretions

Abstract

Context:Cough assist (CA) is a device to improve bronchial hygiene of patients with secretion in the airways and ineffective cough.Aims:To compare the physiological effects and the volume of secretion of mechanical insufflation–exsufflation (CA device) with isolated endotracheal suctioning in mechanically ventilated patients.Settings and Design:Randomized crossover trial.Materials and Methods:The patients were randomly allocated to the first technique, then the following technique was performed in the next day. We collected the variables related to oxygen saturation, hemodynamics (heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure [MAP]), and respiratory mechanics (tidal volume, minute volume, respiratory rate, and lung compliance and resistance), pre- and postimplementation (immediately and after 15 and 30 min), and the aspirated volume of secretion.Statistical Analysis Used:We used two-way analysis of variance followed by the Student–Newman–Keuls t-test to compare the variables at different time points. Student's t-test was used to compare secretion volumes. All data were stored and analyzed in SPSS for Windows Version 19.0. The significance level was set at 5%.Results:Forty-three patients were included in the study. When we compared the results before and after the application of the techniques, we observed no significant difference in lung compliance, pulmonary resistance, MAP, peripheral oxygen saturation, and secretion volume in both groups.Conclusions:The mechanical insufflation–exsufflation does not alter respiratory mechanics and hemodynamic stability, and it does not improve airway clearance in mechanically ventilated patients.

Effects Of Mechanical In-Exsufflation On Mucus Clearance In Critically Ill Patients On Invasive Mechanical Ventilation

“…In this randomized cross-over trial, when inspiratory/expiratory pressures of 50 cmH 2 O were applied, lung compliance improved immediately after the intervention, and 10 minutes thereafter. Despite these encouraging previous results, other publications have consistently failed to nd bene ts (15,16,18). In our study, compliance of the respiratory system increased immediately after CPT + MI-E intervention.…”

“…Nunes et al observed an improvement in SpO 2 after either endotracheal suctioning or MI-E (18), while other publications failed to corroborate these results (15,16). Sanchez-Garcia et al demonstrated an improvement in PaO 2 following MI-E (15).…”

“…Theoretically, the high PEF and NEP work alongside to drive mucus outward. To date, only a few studies have evaluated the e cacy and safety of MI-E in ventilated critically ill patients, reporting promising gures on the removal of airway secretions (15)(16)(17)(18), and safety (16)(17)(18). Encouraging results have also been reported in spontaneously-breathing patients with neuromuscular diseases, unable to produce an e cient cough (19).…”

Airway Clearance Techniques for Mechanically Ventilated Patients: Insights for Optimization

“…65,66 Only a few studies have investigated the effects of MI-E in critically ill mechanically ventilated subjects. [67][68][69][70][71] The first study was published in 2010 by Bach et al, 67 who reported successful extubation to continuous noninvasive ventilation and MI-E of 155 of 157 subjects with neuromuscular disease considered unweanable after multiple unsuccessful spontaneous breathing trials or extubations. In this first study, the subjects were submitted to MI-E every 20 min while intubated to maintain S pO 2 $ 95% in ambient air.…”

Physical Therapy and Rehabilitation in Chronic Obstructive Pulmonary Disease Patients Admitted to the Intensive Care Unit

“…Interestingly, although the study was underpowered for detection of subgroup effects, patients with COPD as comorbidity (i.e., 14 patients in each group) resulted in significantly less aspirated secretions. Finally, Coutinho et al75 performed a randomized crossover trial in 43 adult patients invasively ventilated for >48 hours to compare the volume of sputum retrieved during MI-E or conventional tracheal suctioning. No significant differences either in the primary outcome or secondary outcomes such as pulmonary mechanics were found between groups.…”