Effects of Mechanical Insufflation-Exsufflation on Airway Mucus Clearance Among Mechanically Ventilated ICU Subjects

Márcio Luiz Ferreira de Camillis, Augusto Savi, Regis Goulart Rosa, Mariana Figueiredo, Ricardo Wickert, Luis Guilherme Alegretti Borges, Lucas Galant, Cassiano Teixeira
2018 Respiratory care  
BACKGROUND: Few studies have evaluated the effects of mechanical insufflation-exsufflation (MI-E) in subjects on mechanical ventilation. Therefore, this study aimed to evaluate the effectiveness of MI-E on airway mucus clearance among mechanically ventilated ICU subjects. METHODS: A randomized, parallel-group, open-label trial was conducted between June and November 2017 in a single, mixed ICU. Adult ICU subjects receiving mechanical ventilation for > 24 h with stable ventilatory and
more » ... tory and hemodynamic status were randomized to receive either standard respiratory physiotherapy alone (control group) or respiratory physiotherapy by using an MI-E device (intervention group). The primary outcome was the weight of aspirated airway mucus after study interventions. Secondary outcomes included variation in static lung compliance (⌬C L ), airway resistance (⌬R aw ), work of breathing (⌬WOB) in relation to the pre-intervention period, and hemodynamic and ventilator complications during the procedures. RESULTS: There were 90 subjects in each group. The mean ؎ SD weight of the aspirated airway mucus was higher in the intervention group than in the control group (2.42 ؎ 2.32 g vs 1.35 ؎ 1.56 g, P < .001). The ⌬C L values in the intervention group were higher than those in the control group (1.76 ؎ 4.90 mL/cm H 2 O vs ؊0.57 ؎ 4.85 mL/cm H 2 O, P ‫؍‬ .001). The ⌬R aw and ⌬WOB values were similar between the groups. No hemodynamic or ventilatory complications were observed. CONCLUSIONS: Among the general ICU subjects receiving mechanical ventilation, use of an MI-E device during respiratory physiotherapy resulted in a larger amount of airway mucus clearance than respiratory physiotherapy alone. (ClinicalTrials.gov registration NCT03178565.)
doi:10.4187/respcare.06253 pmid:30018175 fatcat:nenyrq2qfjfbtky4pkptvqvn3y