The Use of Mechanical Insufflation-Exsufflation in Invasively Ventilated Critically Ill Adults
Issued Date
2022-08-01
Resource Type
ISSN
00201324
eISSN
19433654
Scopus ID
2-s2.0-85134739979
Pubmed ID
35610033
Journal Title
Respiratory Care
Volume
67
Issue
8
Start Page
1043
End Page
1057
Rights Holder(s)
SCOPUS
Bibliographic Citation
Respiratory Care Vol.67 No.8 (2022) , 1043-1057
Suggested Citation
Swingwood E.L., Stilma W., Tume L.N., Cramp F., Voss S., Bewley J., Ntoumenopoulos G., Schultz M.J., Scholte Op Reimer W., Paulus F., Rose L. The Use of Mechanical Insufflation-Exsufflation in Invasively Ventilated Critically Ill Adults. Respiratory Care Vol.67 No.8 (2022) , 1043-1057. 1057. doi:10.4187/respcare.09704 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/85671
Title
The Use of Mechanical Insufflation-Exsufflation in Invasively Ventilated Critically Ill Adults
Author's Affiliation
University Hospitals Bristol and Weston NHS Foundation Trust
Hogeschool van Amsterdam, University of Applied Sciences
Alder Hey Children's NHS Foundation Trust
University of the West of England
Mahidol University
King's College London
Australian Catholic University
Nuffield Department of Medicine
University of Salford
Guy's and St Thomas' NHS Foundation Trust
Amsterdam UMC - University of Amsterdam
Hogeschool van Amsterdam, University of Applied Sciences
Alder Hey Children's NHS Foundation Trust
University of the West of England
Mahidol University
King's College London
Australian Catholic University
Nuffield Department of Medicine
University of Salford
Guy's and St Thomas' NHS Foundation Trust
Amsterdam UMC - University of Amsterdam
Other Contributor(s)
Abstract
Mechanical insufflation-exsufflation (MI-E) is traditionally used in the neuromuscular popula-tion. 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 identi-fied, 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 ±40 cm H2O 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.
