The use of mechanical insufflation-exsufflation in invasively ventilated critically ill adults : a scoping review

Swingwood, E; Stilma, W; Tume, LN; Cramp, F; Voss, S; Bewley, J; Ntoumenopoulos, G; Schultz, M; op Reimer, W; Paulus, F; Rose, L

Abstract

Mechanical insufflation-exsufflation (MI-E) is traditionally used in the neuromuscular population. There is growing interest of MI-E use in invasively ventilated critically ill adults. We aimed to map current evidence on MI-E use in invasively ventilated criticall ill adults.Two authors independently searched electronic databases MEDLINE, EMBASE and CINAHL via the OVID platform, PROSPERO, The Cochrane Library, ISI Web of Science and International Clinical Trials Registry Platform between January 1990 and April 2021. Inclusion criteria were (1) adult critically ill invasively ventilated patients, (2) use of MI-E, (3) study design with original data, (4) published from 1990 onwards. Data were extracted by two authors independently using a bespoke extraction form. We used Mixed Methods Assessment Tool to appraise risk of bias. Theoretical Domains Framework was used to interpret qualitative data. Of 3090 citations identified, 28 citations were taken forward for data extraction. Main indications for MI-E use during invasive mechanical ventilation were presence of secretions and mucus plugging (13/28 46%). Perceived
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contraindications related to use of high levels of positive pressure (19/28 68%). Protocolised MI-E settings with a pressure of +/- 40 cmH2O were most commonly used with detail on timing, flow and frequency of prescription infrequently reported. Various outcomes were reintubation rate, wet sputum weight, and pulmonary mechanics. Only 3 studies reported the occurrence of adverse events. From qualitative data, the main barrier to MI-E use in this patient group was lack of knowledge and skills. We conclude that there is little consistency in how MI-E is used and reported and therefore recommendations about best practices are not possible.

Citation

Swingwood, E., Stilma, W., Tume, L., Cramp, F., Voss, S., Bewley, J., …Rose, L. (2022). The use of mechanical insufflation-exsufflation in invasively ventilated critically ill adults : a scoping review. Respiratory care, 67(8), 1043-1057. https://doi.org/10.4187/respcare.09704

• Journal Article Type: Article
• Acceptance Date: Feb 10, 2022
• Publication Date: 2022-08
• Deposit Date: Feb 18, 2022
• Journal: Respiratory Care
• Print ISSN: 0020-1324
• Electronic ISSN: 1943-3654
• Peer Reviewed: Peer Reviewed
• Volume: 67
• Issue: 8
• Pages: 1043-1057
• DOI: https://doi.org/10.4187/respcare.09704
• Publisher URL: http://rc.rcjournal.com/
• Additional Information: Projects : NIHR Doctoral Fellowship; Grant Number: 023.011.016