%0 Journal Article %A Anne H. Nielsen %A Dan S. Karbing %A Christoffer G. Sølling %A Robert R. Winding %A Stephen E. Rees %A Nilanjan Dey %T Efficacy of an automated secretion removal technology at different inspiratory pressures %D 2023 %R 10.4187/respcare.10850 %J Respiratory Care %P respcare.10850 %X BACKGROUND: Endotracheal suctioning is resource demanding, causes patient discomfort and is associated with side-effects. A new artificial cough method has been developed for automated secretion removal using rapid deflation and inflation of the endotracheal tube cuff during the inspiratory phase of mechanical ventilation. This method has been evaluated in a bench model and in animals, but not in subjects. The aim of this study is to investigate whether this method can remove the need for endotracheal suctioning in subjects and whether this is dependent on ventilator settings.METHODS: This prospective, non-controlled study recruited 20 mechanically ventilated, intubated, subjects. On clinical need for endotracheal suctioning, the automatic cough procedure was applied 3 times over 30 seconds, with this repeated at higher ventilatory pressure and lower respiratory frequency if considered unsuccessful. Success was determined by removal of clinical need for suctioning. Subject safety and comfort was measured by the Critical-care Pain Observation Tool (CPOT) before and after the procedure, and negative effects recorded. To assess intra-subject variability, the above procedure was performed on three different occasions for each subject.RESULTS: The procedure was successful in 18 of 20 subjects (90%), with mean subject success rates of 53% at low settings (Peak inspiratory pressure 21.8 ± 3.8 cmH2O) and 83% at high settings (Peak inspiratory pressure 25.6 ± 3.6 cmH2O). CPOT category remained unchanged in 30 (77%) procedures, improved in 7 (18%) and deteriorated in 2 (5%).CONCLUSIONS: This study has illustrated the potential for significant reduction in the clinical need for endotracheal suctioning following use of an automated artificial cough procedure at both low and high peak inspiratory pressures, and which was well tolerated. %U https://rc.rcjournal.com/content/respcare/early/2023/04/28/respcare.10850.full.pdf