RT Journal Article
SR Electronic
T1 Comparison of Mechanical Insufflation-Exsufflation and Hypertonic Saline And Hyaluronic Acid With Conventional Open Catheter Suctioning in Intubated Patients
JF Respiratory Care
FD American Association for Respiratory Care
SP respcare.11566
DO 10.4187/respcare.11566
A1 Sánchez-García, Miguel
A1 Álvarez-González, Manuel
A1 Domingo-Marín, Sara
A1 del Pino-Ramírez, Ángela
A1 Martínez-Sagasti, Fernando
A1 González-Arenas, Paloma
A1 Cardenal-Sánchez, Carlos
A1 Velasco-López, Elena
A1 Núñez-Reiz, Antonio
YR 2024
UL http://rc.rcjournal.com/content/early/2024/04/09/respcare.11566.abstract
AB BACKGROUND: Open respiratory secretion suctioning with a catheter causes pain and tracheobronchial mucosal injury in intubated patients. The goal of mechanical insufflation-exsufflation (MI-E) is to move secretions proximally and noninvasively by generating a high peak expiratory air flow. Nebulized hypertonic saline with hyaluronic acid (HS-HA) may facilitate suctioning by hydration. We assessed the safety and tolerance of a single session of airway clearance with MI-E and HS-HA in critically ill intubated patients.METHODS: Adults with a cuffed artificial airway were randomized to (1) open suctioning, (2) open suctioning after HS-HA, (3) MI-E, or (4) MI-E with HS-HA. Adverse events, pain and sedation/agitation scores, and respiratory and hemodynamic variables were collected before, during, and 5-min and 60-min post intervention.RESULTS: One-hundred twenty subjects were enrolled and completed the study. Median (interquartile range [IQR]) Acute Physiology and Chronic Health Evaluation II (APACHE II) score was 22 (16–28); median (IQR) age was 69.0 (57.0–75.7) y, and 90 (75%) were male. Baseline respiratory and hemodynamic variables were comparable. Adverse events occurred in 30 subjects (25%), with no between-group differences. Behavioral pain equivalents and Richmond Agitation-Sedation Scale were higher during suctioning in groups 1 (P < .001) and 2 (P < .001). Independent predictive variables for higher pain and agitation/sedation scores were study groups 1 and 2 and simultaneous analgosedation, respectively. Noradrenaline infusion rates were lower at 60 min in groups 2 and 4. PaO2/FIO2 had decreased at 5 min after open suctioning in group 1 and increased at 60 min in group 3.CONCLUSIONS: We observed no difference in adverse events. MI-E avoids pain and agitation.