Review ArticleNarrative Review

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

Ema L Swingwood, Willemke Stilma, Lyvonne N Tume, Fiona Cramp, Sarah Voss, Jeremy Bewley, George Ntoumenopoulos, Marcus J Schultz, Wilma Scholte Op Reimer, Frederique Paulus and Louise Rose
Respiratory Care August 2022, 67 (8) 1043-1057; DOI: https://doi.org/10.4187/respcare.09704

References

  1. 1.↵
    1. McCool FD
    . Global physiology and pathophysiology of cough: ACCP evidence-based clinical practice guidelines. Chest 2006;129(1 Suppl):48S-53S.
    OpenUrlCrossRefPubMedWeb of Science
  2. 2.↵
    1. Nakagawa NK,
    2. Franchini ML,
    3. Driusso P,
    4. de Oliveira LR,
    5. Saldiva PH,
    6. Lorenzi-Filho G
    . Mucociliary clearance is impaired in acutely ill patients. Chest 2005;128(4):2772-2777.
    OpenUrlCrossRefPubMed
  3. 3.↵
    1. Fahy JV,
    2. Dickey BF
    . Airway mucus function and dysfunction. N Engl J Med 2010;363(23):2233-2247.
    OpenUrlCrossRefPubMedWeb of Science
  4. 4.↵
    1. Sole ML,
    2. Bennett M,
    3. Ashworth S
    . Clinical indicators for endotracheal suctioning in adult patients receiving mechanical ventilation. Am J Crit Care 2015;24(4):318-324.
    OpenUrlAbstract/FREE Full Text
  5. 5.↵
    1. Auger C,
    2. Hernando V,
    3. Galmiche H
    . Use of mechanical insufflation-exsufflation devices for airway clearance in subjects with neuromuscular disease. Respir Care 2017;62(2):236-245.
    OpenUrlAbstract/FREE Full Text
  6. 6.↵
    1. Chatwin M,
    2. Toussaint M,
    3. Goncalves MR,
    4. Sheers N,
    5. Mellies U,
    6. Gonzales-Bermejo J,
    7. et al
    . Airway clearance techniques in neuromuscular disorders: a state of the art review. Respir Med 2018;136:98-110.
    OpenUrlCrossRefPubMed
  7. 7.↵
    1. Toussaint M
    . The use of mechanical insufflation-exsufflation via artificial airways (editorial). Respir Care 2011;56(8):1217-1219.
    OpenUrlFREE Full Text
  8. 8.↵
    1. Rose L,
    2. Adhikari NK,
    3. Poon J,
    4. Leasa D,
    5. McKim DA
    . Cough augmentation techniques in the critically ill: a Canadian national survey. Respir Care 2016;61(10):1360-1368.
    OpenUrlAbstract/FREE Full Text
  9. 9.↵
    1. Rose L,
    2. McKim D,
    3. Leasa D,
    4. Nonoyama M,
    5. Tandon A,
    6. Kaminska M,
    7. et al
    . Monitoring cough effectiveness and use of airway clearance strategies: a Canadian and UK survey. Respir Care 2018;63(12):1506-1513.
    OpenUrlAbstract/FREE Full Text
  10. 10.↵
    1. Stilma W,
    2. van der Hoeven SM,
    3. Scholte Op Reimer WJM,
    4. Schultz MJ,
    5. Rose L,
    6. Paulus F
    . Airway care interventions for invasively ventilated critically ill adults—a Dutch national survey. JCM 2021;10(15):3381.
    OpenUrl
  11. 11.↵
    1. Swingwood E,
    2. Tume L,
    3. Cramp F
    . A survey examining the use of mechanical insufflation-exsufflation on adult intensive care units across the UK. J Intensive Care Soc 2019.
  12. 12.↵
    1. Rose L,
    2. Adhikari NK,
    3. Leasa D,
    4. Fergusson DA,
    5. McKim D
    . Cough augmentation techniques for extubation or weaning critically ill patients from mechanical ventilation. Cochrane Database Syst Rev 2017;1:Cd011833.
  13. 13.↵
    1. Arksey H,
    2. O'Malley L
    . Scoping studies: toward a methodological framework. Int J Soc Res Methodol 2005;8(1):19-32.
    OpenUrlCrossRef
  14. 14.
    1. Levac D,
    2. Colquhoun H,
    3. O'Brien KK
    . Scoping studies: advancing the methodology. Implement Sci 2010;5(69).
  15. 15.↵
    1. Tricco AC,
    2. Lillie E,
    3. Zarin W,
    4. O'Brien KK,
    5. Colquhoun H,
    6. Levac D,
    7. et al
    . PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med 2018;169(7):467-473.
    OpenUrlCrossRefPubMed
  16. 16.↵
    1. Swingwood E,
    2. Stilma W,
    3. Tume L,
    4. Cramp F,
    5. Paulus F,
    6. Schultz M,
    7. et al
    . The use of mechanical insufflation-exsufflation in invasively ventilated critically ill adults: a scoping review protocol. Syst Rev 2020;9(1):287.
    OpenUrl
  17. 17.↵
    1. Pace R,
    2. Pluye P,
    3. Bartlett G,
    4. Macaulay AC,
    5. Salsberg J,
    6. Jagosh J,
    7. et al
    . Testing the reliability and efficiency of the pilot mixed methods appraisal tool (MMAT) for systematic mixed studies review. Int J Nurs Stud 2012;49(1):47-53.
    OpenUrlCrossRefPubMed
  18. 18.↵
    1. Atkins L,
    2. Francis J,
    3. Islam R,
    4. O'Connor D,
    5. Patey A,
    6. Ivers N,
    7. et al
    . A guide to using the theoretical domains framework of behavior change to investigate implementation problems. Implement Sci 2017;12(1):77.
    OpenUrlCrossRefPubMed
  19. 19.↵
    1. Cane J,
    2. O'Connor D,
    3. Michie S
    . Validation of the theoretical domains framework for use in behavior change and implementation research. Implement Sci 2012;7:37.
    OpenUrlCrossRefPubMed
  20. 20.↵
    1. Campos JFR,
    2. Godoy MDP,
    3. Cordeiro de Souza L,
    4. Coutinho WM,
    5. Forgiarini Junior LA
    . Insuflador-exsuflador mecânico versus manobra PEEP-ZEEP em pacientes em ventilação mecânica prolongada. Fisioter Bras 2019;20(4):462-467.
    OpenUrl
  21. 21.↵
    1. Coutinho WM,
    2. Vieira PJC,
    3. Kutchak FM,
    4. Dias AS,
    5. Rieder MM,
    6. Forgiarini LA Jr.
    Comparison of mechanical insufflation-exsufflation and endotracheal suctioning in mechanically ventilated patients: effects on respiratory mechanics, hemodynamics, and volume of secretions. Indian J Crit Care Med 2018;22(7):485-490.
    OpenUrl
  22. 22.↵
    1. Goncalves MR,
    2. Honrado T,
    3. Winck JC,
    4. Paiva JA
    . Effects of mechanical insufflation-exsufflation in preventing respiratory failure after extubation: a randomized controlled trial. Crit Care 2012;16(2):R48.
    OpenUrlCrossRefPubMed
  23. 23.↵
    1. Ferreira de Camillis ML,
    2. Savi A,
    3. Goulart Rosa R,
    4. Figueiredo M,
    5. Wickert R,
    6. Borges LGA,
    7. et al
    . Effects of mechanical insufflation-exsufflation on airway mucus clearance among mechanically ventilated ICU subjects. Respir Care 2018;63(12):1471-1477.
    OpenUrlAbstract/FREE Full Text
  24. 24.↵
    1. Martínez-Alejos R,
    2. Martí J-D,
    3. Li Bassi G,
    4. Gonzalez-Anton D,
    5. Pilar-Diaz X,
    6. Reginault T,
    7. et al
    . Effects of mechanical insufflation-exsufflation on sputum volume in mechanically ventilated critically ill subjects. Respir Care 2021;66(9):1371-1379.
    OpenUrlAbstract/FREE Full Text
  25. 25.↵
    In-exsufflation mechanics in intubated patients. https://ww-w.cochranelibrary.com/central/doi/10.1002/central/CN-01816206/full Accessed, May 2021.
  26. 26.↵
    Effect of mechanical sputum assistance for ventilated patients in intensive care unit. Available at: https://www.cochranelibrary.com/central/doi/10.1002/central/CN-01911097/full. Accessed, May 2021.
  27. 27.↵
    Effectness of Treatment With Mechanical Insufflation-Exsufflation. Available at: https://clinicaltrials.gov/show/NCT04149873 2019.
  28. 28.↵
    1. Sanchez Garcia M,
    2. Alvarez M,
    3. Domingo S,
    4. Pino D,
    5. Martinez A,
    6. Gonzalez FP,
    7. et al
    . Safety and tolerability of mechanical insufflation-exsufflation (MIE) and hypertonic saline with hyaluronic acid (HS-HA) for respiratory secretion suctioning (RSS) in intubated patients (abstract). Intensive Care Med 2019;7.
  29. 29.↵
    1. Bach JR,
    2. Goncalves MR,
    3. Hamdani I,
    4. Winck JC
    . Extubation of patients with neuromuscular weakness: a new management paradigm. Chest 2010;137(5):1033-1039.
    OpenUrlCrossRefPubMedWeb of Science
  30. 30.↵
    1. Kikuchi K,
    2. Satake M,
    3. Terui Y,
    4. Kimoto Y,
    5. Iwasawa S,
    6. Furukawa Y
    . Cough peak flow with different mechanically assisted coughing approaches under different conditions in patients with neuromuscular disorders. Phys Ther Res 2019;22(2):58-65.
    OpenUrl
  31. 31.↵
    1. Sanchez-Garcia M,
    2. Santos P,
    3. Rodriguez-Trigo G,
    4. Martinez-Sagasti F,
    5. Farina-Gonzalez T,
    6. Del Pino-Ramirez A,
    7. et al
    . Preliminary experience on the safety and tolerability of mechanical “insufflation-exsufflation” in subjects with artificial airway. Intensive Care Med Exp 2018;6(1):8.
    OpenUrl
  32. 32.↵
    1. Bach JR,
    2. Sinquee DM,
    3. Saporito LR,
    4. Botticello AL
    . Efficacy of mechanical insufflation-exsufflation in extubating unweanable subjects with restrictive pulmonary disorders. Respir Care 2015;60(4):477-483.
    OpenUrlAbstract/FREE Full Text
  33. 33.↵
    1. Farina T,
    2. Del Pino A,
    3. Santos P,
    4. Rodriguez G,
    5. Martinez F.,
    6. Sanchez GM
    . Pilot study on the safety of mechanical 'Insufflation-Exsufflation' in patients with artificial airway (abstract). Intensive Care Med 2017;5:2 (Supplement 1).
    OpenUrl
  34. 34.↵
    1. Kuroiwa R,
    2. Tateishi Y,
    3. Oshima T,
    4. Inagaki T,
    5. Furukawa S,
    6. Takemura R,
    7. et al
    . Mechanical insufflation-exsufflation for the prevention of ventilator-associated pneumonia in intensive care units: a retrospective cohort study. Indian J Crit Care Med 2021;25(1):62-66.
    OpenUrl
  35. 35.↵
    1. Soares ML,
    2. Goncalves M,
    3. Gazola N,
    4. Bach JR
    . Mechanical insufflation-exsufflation in neuromuscular disease: What is the best combination of pressures? (abstract). Eur Respir J 2014;44:Suppl 58).
  36. 36.↵
    1. Schmitt JK,
    2. Stiens S,
    3. Trincher R,
    4. Lam M,
    5. Sarkarati M,
    6. Linder S,
    7. et al
    . Survey of use of the insufflator-exsufflator in patients with spinal cord injury. J Spinal Cord Med 2007;30(2):127-130.
    OpenUrlPubMed
  37. 37.
    1. Prevost S,
    2. Brooks D,
    3. Bwititi PT
    . Mechanical insufflation-exsufflation: practice patterns among respiratory therapists in Ontario. Can J Respir Ther 2015;51(2):33-38.
    OpenUrl
  38. 38.↵
    1. Garstang SV,
    2. Kirshblum SC,
    3. Wood KE
    . Patient preference for in-exsufflation for secretion management with spinal cord injury. J Spinal Cord Med 2000;23(2):80-85.
    OpenUrlPubMed
  39. 39.↵
    1. Bialais É,
    2. Coppens T,
    3. Roeseler J
    . Atelectasis of the right lung: interest of CoughAssist? About a case. Kinesitherapie Revue; 2010(104-105):19-22.
  40. 40.↵
    1. Tan JH,
    2. Fauzi AA,
    3. Hasnan N
    . Pulmonary rehabilitation using mechanical insufflation-exsufflation therapy for spinal cord injury - two case studies in the University Malaya Medical Center. JUMMEC 2017;20(2):31-33.
    OpenUrl
  41. 41.↵
    1. Vokes R,
    2. Van Willigen Z
    . A case study describing the use of mechanical insufflation: exsufflation (MI: E) in an intubated and ventilated patient with high-oxygen and positive end-expiratory pressure (PEEP) (abstract). J Intensive Care Soc 2020;21(2):47 Suppl).
    OpenUrl
  42. 42.↵
    1. Khan AM,
    2. Kantrow S,
    3. Guiterrez A
    . Extubation after acute respiratory failure in amyotrophic lateral sclerosis (abstract). Am J Respir Crit Care Med 2015;191.
  43. 43.↵
    1. Guarnieri M,
    2. Fossi F,
    3. Pozzi F,
    4. Curto F,
    5. Chieregato A
    . A safe strategy for early weaning and tracheostomy avoidance in cervical spinal cord injury: a single-center experience (abstract). Intensive Care Med 2020;8:Suppl 2.
  44. 44.↵
    1. Sancho J,
    2. Servera E,
    3. Vergara P,
    4. Marín J
    . Mechanical insufflation-exsufflation vs tracheal suctioning via tracheostomy tubes for patients with amyotrophic lateral sclerosis: a pilot study. Am J Phys Med Rehabil 2003;82(10):750-753.
    OpenUrlCrossRefPubMedWeb of Science
  45. 45.↵
    1. Brower RG,
    2. Matthay MA,
    3. Morris A,
    4. Schoenfeld D,
    5. Thompson BT,
    6. Wheeler A
    . Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 2000;342(18):1301-1308.
    OpenUrlCrossRefPubMedWeb of Science
  46. 46.↵
    1. Park HY,
    2. Ha SY,
    3. Lee SH,
    4. Kim S,
    5. Chang KS,
    6. Jeon K,
    7. et al
    . Repeated de-recruitments accentuate lung injury during mechanical ventilation. Crit Care Med 2013;41(12):e423-430.
    OpenUrl
  47. 47.↵
    1. Chatwin M,
    2. Simonds AK
    . Long-term mechanical insufflation-exsufflation cough assistance in neuromuscular disease: patterns of use and lessons for application. Respir Care 2020;65(2):135-143.
    OpenUrlAbstract/FREE Full Text
  48. 48.↵
    1. Guerin C,
    2. Bourdin G,
    3. Leray V,
    4. Delannoy B,
    5. Bayle F,
    6. Germ-ain M,
    7. et al
    . Performance of the CoughAssist insufflation-exsufflation device in the presence of an endotracheal tube or tracheostomy tube: a bench study. Respir Care 2011;56(8):1108-1114.
    OpenUrlAbstract/FREE Full Text
  49. 49.↵
    1. Berney S,
    2. Denehy L
    . A comparison of the effects of manual and ventilator hyperinflation on static lung compliance and sputum production in intubated and ventilated intensive care patients. Physiother Res Int 2002;7(2):100-108.
    OpenUrlPubMed
  50. 50.↵
    1. Allen JE,
    2. O'Leary EL
    . Considerations for chest clearance and cough augmentation in severe bulbar dysfunction: a case study. Can J Respir Ther 2018;54(3):66-70.
    OpenUrl
  51. 51.↵
    1. Suri P,
    2. Burns SP,
    3. Bach JR
    . Pneumothorax associated with mechanical insufflation-exsufflation and related factors. Am J Phys Med Rehabil 2008;87(11):951-955.
    OpenUrlCrossRefPubMedWeb of Science
  52. 52.
    1. McDonald LA,
    2. Berlowitz DJ,
    3. Howard ME,
    4. Rautela L,
    5. Chao C,
    6. Sheers N
    . Pneumothorax in neuromuscular disease associated with lung volume recruitment and mechanical insufflation-exsufflation. Respirol Case Rep 2019;7(6):e00447.
    OpenUrl
  53. 53.↵
    1. Yasokawa N,
    2. Tanaka H,
    3. Kurose K,
    4. Abe M,
    5. Oga T
    . Mechanical insufflation-exsufflation–related bilateral pneumothorax. Respir Med Case Rep 2020;29:101017.
    OpenUrl
  54. 54.↵
    1. Fulbrook P,
    2. Albarran JW,
    3. Baktoft B,
    4. Sidebottom B
    . A survey of European intensive care nurses' knowledge levels. Int J Nurs Stud 2012;49(2):191-200.
    OpenUrlCrossRefPubMed
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