Mechanical insufflation-exsufflation for invasively ventilated critically ill patients—A focus group study
Issued Date
2022-01-01
Resource Type
ISSN
13621017
eISSN
14785153
Scopus ID
2-s2.0-85143242321
Journal Title
Nursing in Critical Care
Rights Holder(s)
SCOPUS
Bibliographic Citation
Nursing in Critical Care (2022)
Suggested Citation
Stilma W., Verweij L., Spek B., Scholte op Reimer W.J.M., Schultz M.J., Paulus F., Rose L. Mechanical insufflation-exsufflation for invasively ventilated critically ill patients—A focus group study. Nursing in Critical Care (2022). doi:10.1111/nicc.12858 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/87569
Title
Mechanical insufflation-exsufflation for invasively ventilated critically ill patients—A focus group study
Other Contributor(s)
Abstract
Introduction: Mechanical Insufflation-Exsufflation (MI-E) is used as an airway clearance intervention in primary care (home ventilation), long-term care (prolonged rehabilitation after intensive care, neuromuscular diseases, and spinal cord injury), and increasingly in acute care in intensive care units (ICU). Aim: We sought to develop in-depth understanding of factors influencing decision-making processes of health care professionals regarding initiation, escalation, de-escalation, and discontinuation of MI-E for invasively ventilated patients including perceived barriers and facilitators to use. Methods: We conducted focus groups (3 in the Netherlands; 1 with participants from four European countries) with clinicians representing the ICU interprofessional team and with variable experience of MI-E. The semi-structured interview guide was informed by the Theoretical Domains Framework (TDF). Two researchers independently coded data for directed content analysis using codes developed from the TDF. Results: A purposive sample of 35 health care professionals participated. Experience varied from infrequent to several years of frequent MI-E use in different patient populations. We identified four main themes: (1) knowledge; (2) beliefs; (3) clinical decision-making; and (4) future adoption. Conclusion: Interprofessional knowledge and expertise of MI-E in invasively ventilated patients is limited due to minimal available evidence and adoption. Participants believed MI-E a potentially useful intervention for airway clearance and inclusion in weaning protocols when more evidence is available. Relevance to Clinical Practice: This focus group study provides an overview of current practice, knowledge and expertise, and barriers and facilitators to using MI-E in mechanically ventilated patients. From these data, it is evident there is a need to develop further clinical expertise and evidence of efficacy to further understand the role of MI-E as an airway clearance technique for ventilated patients.