Mechanical Insufflation-exsufflation for the Prevention of Ventilator-associated Pneumonia in Intensive Care Units: A Retrospective Cohort Study

Kuroiwa, Ryota; Tateishi, Yohei; Oshima, Taku; Inagaki, Takeshi; Furukawa, Seiichiro; Takemura, Ryo; Kawasaki, Yohei; Murata, Astushi

doi:10.5005/jp-journals-10071-23508

Cited by 9 publications

(13 citation statements)

References 22 publications

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“…¼ 19) including observational cohort studies (no. ¼ 7), [29][30][31][32][33][34][35] surveys (no. ¼ 6), 8,10,11,[36][37][38] and case study/series reports (no.…”

Section: Resultsmentioning

confidence: 99%

“…[21][22][23][24]26,[28][29][30]39,44 Time settings were reported in 11/20 (55%) studies. [21][22][23][24]29,30,34,[39][40][41]44 Most commonly used time settings were inspiratory time 3 s, expiratory time 2 s, and 1 s pause. A pause duration was reported in 8/20 (40%) studies.…”

Section: Clinical Studiesmentioning

confidence: 99%

“…A pause duration was reported in 8/20 (40%) studies. [20][21][22][23][24]30,34,44 Five studies (25%) reported use of one insufflation prior to an exsufflation breath (not reported in the remaining studies). Flow profile was specified in only 3 (15%) studies and was set at medium (no.…”

Section: Clinical Studiesmentioning

confidence: 99%

“…One study applied an oscillation amplitude of 10 and frequency of 20 Hz, 20 whereas only oscillation frequency was reported in the remaining 2 studies as high 33 regimens varied across studies, with MI-E cycles being repeated up to every 20 min, 29 hourly, 32 1-2 times per day, 34 3 times a day, 22 4 times a day, 43 and most commonly up to once per day. 20,21,23,24,30,31,33,39,44 Five studies (25%) reported the inclusion of other treatment adjuncts alongside MI-E including side positioning, 43 manual assisted cough, 34 and suction. 24,41,44 Table 3 provides an overview of described settings of MI-E use in invasively ventilated critically ill participants.…”

Section: Clinical Studiesmentioning

confidence: 99%

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The Use of Mechanical Insufflation-Exsufflation in Invasively Ventilated Critically Ill Adults

et al. 2022

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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 640 cm H 2 O 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.

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“…¼ 19) including observational cohort studies (no. ¼ 7), [29][30][31][32][33][34][35] surveys (no. ¼ 6), 8,10,11,[36][37][38] and case study/series reports (no.…”

Section: Resultsmentioning

confidence: 99%

Section: Clinical Studiesmentioning

confidence: 99%

Section: Clinical Studiesmentioning

confidence: 99%

Section: Clinical Studiesmentioning

confidence: 99%

See 2 more Smart Citations

The Use of Mechanical Insufflation-Exsufflation in Invasively Ventilated Critically Ill Adults

et al. 2022

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“…Además, se ha comprobado en otro ECA 72 , que el volumen de secreciones aspirado es significativamente superior al que se consigue con la sonda estéril de aspiración convencional. Asimismo, un estudio retrospectivo 73 sugiere que la aplicación de la IEM en pacientes intubados reduce la incidencia de la NAVM.…”

Section: Medidas Mecánicas ( Tabla 3 )unclassified

Actualización de las recomendaciones del proyecto Neumonía Zero

Arias-Rivera

Jam-Gatell²,

Nuvials-Casals³

et al. 2022

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Effect of mechanical insufflation-exsufflation for ineffective cough on weaning duration in diseases of the peripheral or central nervous system (MEDINE): study protocol for a randomised controlled trial in a neurological weaning centre

et al. 2023

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IntroductionPatients with neurological or neurosurgical disease can suffer from impaired cough, which may result in life-threatening retention of tracheobronchial secretions, atelectasis, pneumonia and finally death. Due to a lack of alternatives and pathophysiological plausibility, the application of mechanical insufflation-exsufflation (MI-E) has already become international standard care in neuromuscular disease and spinal cord injury although a lack of evidence for efficacy. High-quality studies to support the use of MI-E in neurological and neurosurgical patients during weaning from mechanical ventilation are missing. The goal of this exploratory study is to display the effect size of MI-E intervention on the duration of mechanical ventilation and additional outcomes.Methods and analysisOne hundred adult patients with a cough deficiency or retention of secretion admitted to a neurological intensive care unit (ICU) are planned to be recruited for this randomised controlled trial. Patients are randomised 1:1 to receive either MI-E or best standard care. Observation will take place until discharge from the hospital, death or end of the study period. The primary endpoint of this trial is the duration of mechanical ventilation from randomisation until successful weaning. The outcome will be analysed with Kaplan-Meier estimation and competing risks analyses. Secondary endpoint is the proportion of patients with successful weaning. Further outcomes will include the incidence of hospital-acquired pneumonia, mortality, decannulation rate, length of stay on the ICU and the total score of the Glasgow Coma Scale.Ethics and disseminationThe study was approved by the Medical Ethics Committee of the University of Oldenburg. The findings of this study will be submitted for publication in a peer-reviewed journal.Trial registration numberDRKS00020981.

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Mechanical Insufflation-exsufflation for the Prevention of Ventilator-associated Pneumonia in Intensive Care Units: A Retrospective Cohort Study

Cited by 9 publications

References 22 publications

The Use of Mechanical Insufflation-Exsufflation in Invasively Ventilated Critically Ill Adults

The Use of Mechanical Insufflation-Exsufflation in Invasively Ventilated Critically Ill Adults

Actualización de las recomendaciones del proyecto Neumonía Zero

Effect of mechanical insufflation-exsufflation for ineffective cough on weaning duration in diseases of the peripheral or central nervous system (MEDINE): study protocol for a randomised controlled trial in a neurological weaning centre

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