@article {Mart{\'\i}nez-Alejos1371, author = {Roberto Mart{\'\i}nez-Alejos and Joan-Daniel Mart{\'\i} and Gianluigi Li Bassi and Daniel Gonzalez-Anton and Xabier Pilar-Diaz and Thomas Reginault and Philippe Wibart and George Ntoumenopoulos and Oystein Tronstad and Albert Gabarrus and Alice Quinart and Antoni Torres}, title = {Effects of Mechanical Insufflation-Exsufflation on Sputum Volume in Mechanically Ventilated Critically Ill Subjects}, volume = {66}, number = {9}, pages = {1371--1379}, year = {2021}, doi = {10.4187/respcare.08641}, publisher = {Respiratory Care}, abstract = {BACKGROUND: Mechanical insufflation-exsufflation (MI-E) is a noninvasive technique performed to simulate cough and remove sputum from proximal airways. To date, the effects of MI-E on critically ill patients on invasive mechanical ventilation are not fully elucidated. In this randomized crossover trial, we evaluated the efficacy and safety of MI-E combined to expiratory rib cage compressions (ERCC).METHODS: Twenty-six consecutive subjects who were sedated, intubated, and on mechanical ventilation \> 48 h were randomized to perform 2 sessions of ERCC with or without additional MI-E before tracheal suctioning in a 24-h period. The primary outcome was sputum volume following each procedure. Secondary end points included effects on respiratory mechanics, hemodynamics, and safety.RESULTS: In comparison to ERCC alone, median (interquartile range) sputum volume cleared was significantly higher during ERCC+MI-E (0.42 [0{\textendash}1.39] mL vs 2.29 [1{\textendash}4.67] mL, P \< .001). The mean {\textpm} SD respiratory compliance improved in both groups immediately after the treatment, with the greater improvement in the ERCC+MI-E group (54.7 {\textpm} 24.1 mL/cm H2O vs 73.7 {\textpm} 35.8~mL/cm H2O, P \< .001). Differences between the groups were not significant (P = .057). Heart rate increased significantly in both groups immediately after each intervention (P \< .05). Additionally, a significant increase in oxygenation was observed from baseline to 1 h post-intervention in the ERCC+MI-E group (P \< .05). Finally, several transitory hemodynamic variations occurred during both interventions, but these were nonsignificant and were considered clinically irrelevant.CONCLUSIONS: In mechanically ventilated subjects, MI-E combined with ERCC increased the sputum volume cleared without causing clinically important hemodynamic changes or adverse events. (ClinicalTrials.gov registration: NCT03316079.)}, issn = {0020-1324}, URL = {https://rc.rcjournal.com/content/66/9/1371}, eprint = {https://rc.rcjournal.com/content/66/9/1371.full.pdf}, journal = {Respiratory Care} }