Mucus Clearance Strategies in Mechanically Ventilated Patients

Abstract

The use of airway clearance strategies as supplementary treatment in respiratory disease has been best investigated in patients with cystic fibrosis (CF) and non-cystic fibrosis bronchiectasis (NCFBE), conditions which are traditionally characterized by excessive mucus stasis and mucociliary dysfunction. A variety of airway clearance therapies both pharmacological and non-pharmacological have been shown to ameliorate disease progression in this population and have hence been assimilated into routine respiratory care. This self-propagating cycle of mucus retention and airway damage leading to chronic inflammation and infections can also be applied to patients with respiratory failure requiring mechanical ventilation. Furthermore, excessive trachea-bronchial secretions have been associated with extubation failure presenting an opportunity for intervention. Evidence for the use of adjunctive mucoactive agents and other therapies to facilitate secretion clearance in these patients are not well defined, and this subgroup still remains largely underrepresented in clinical trials. In this review, we discuss the role of mucus clearance techniques with a proven benefit in patients with CF and NCFBE, and their potential role in patients requiring mechanical ventilation while highlighting the need for standardization and adoption of mucus clearance strategies in these patient populations.

The level of discomfort during the use of different circuits of the mechanical ventilator

“…Pharmacological interventions, including the use of nonsteroidal anti-inflammatory drugs or acetaminophen to alleviate pain, sedative agents to alleviate anxiety, and mucolytic agents to facilitate easier coughing, can be employed to address specific symptoms and enhance overall patient comfort [ 18 19 20 ]. Nonpharmacological approaches, such as physical therapy, relaxation techniques, and breathing exercises, contribute to the overall relief of discomfort [ 21 22 ]. Careful patient positioning during interventions can minimize physical strain [ 23 24 ].…”

Respiratory physiotherapy as a tool to allow and optimize lung donation

“…Pathologic discussion: As referred in the case presentation, mucus plugs are a common complication in ventilated patients. Respiratory physiotherapy is a multimodal intervention that has proved to be effective in its management in viable patients that should be continued in donors [ 3 ].…”

“…In viable ventilated patients, respiratory physiotherapy is usually applied to avoid mucus retention and its complications, being terminated when there is evidence of subject's non-viability [ [1] , [2] , [3] , [4] ].…”

Octreotide as a novel agent for the management of bronchorrhea in mechanically ventilated patients: A case series and review of literature

“…The removal of foreign particles and bacteria from the lungs is a function of the mucociliary system and the cough reflex [ 5 ]. There are various reasons for the retention of secretions in the ICU setting which include: epithelial damage from the endotracheal tube, lack of humidification, direct cough impairment, use of anesthetic agents, and consequences of critical illness like: inflammation, immobility, and atelectasis [ [5] , [6] , [7] , [8] ].…”