Effects of Mechanical Insufflation-Exsufflation on Sputum Volume in Mechanically Ventilated Critically Ill Subjects.
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 tr...
| Publicado en: | Respiratory Care Vol. 66; no. 9; pp. 1371 - 1380 |
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| Autores principales: | , , , , , , , , , , , |
| Formato: | research tables/charts randomized controlled trial Journal Article |
| Publicado: |
Mary Ann Liebert, Inc.
Sep2021
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=152131910&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 152131910 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00201324 4GG jtl: Respiratory Care issn: 00201324 maglogo: N pubinfo: dt: Sep2021 vid: 66 iid: 9 pid: 1365 pub: Mary Ann Liebert, Inc. place: New Rochelle, New York artinfo: ui: 152131910 152131910 152131910 10.4187/respcare.08641 152131910 ppf: 1371 ppct: 9 formats: fmt: @attributes: type: P tig: atl: Effects of Mechanical Insufflation-Exsufflation on Sputum Volume in Mechanically Ventilated Critically Ill Subjects. aug: au: Martínez-Alejos, Roberto Martí, Joan-Daniel Bassi, Gianluigi Li Gonzalez-Anton, Daniel Pilar-Diaz, Xabier Reginault, Thomas Wibart, Philippe Ntoumenopoulos, George Tronstad, Oystein Gabarrus, Albert Quinart, Alice Torres, Antoni affil: Saint Eloi Department of Critical Care Medicine and Anesthesiology, Montpellier University Hospital and School of Medecine, Montpellier, France sug: subj: Insufflation Equipment and Supplies Respiration, Artificial Methods Respiratory Therapy Methods Critically Ill Patients Mucociliary Clearance Expiration Evaluation Noninvasive Procedures Cough Airway Management Methods Treatment Outcomes Patient Safety Chest Physical Therapy Sedation Intubation, Intratracheal Suctioning, Endotracheal Time Factors Respiratory Mechanics Hemodynamics P-Value Descriptive Statistics Lung Compliance Heart Rate Oxygenation Randomized Controlled Trials Prospective Studies Crossover Design Single-Blind Studies Data Analysis Software Human Male Female Adult Middle Age Aged Aged, 80 and Over Tidal Volume Peak Expiratory Flow Rate Airway Pressure Transducers Scales Body Mass Index Funding Source Adult: 19-44 years Middle Aged: 45-64 years Aged: 65+ years Aged, 80 & over Male Female ab: 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--1.39] mL vs 2.29 [1--4.67] mL, P < .001). The mean ± SD respiratory compliance improved in both groups immediately after the treatment, with the greater improvement in the ERCC+MI-E group (54.7 ± 24.1 mL/cm H2O vs 73.7 ± 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.) pubtype: Academic Journal doctype: research tables/charts randomized controlled trial Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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