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

Swingwood, E; Stilma, W; Tume, LN; Cramp, F; Paulus, F; Schultz, M; Scholte op Reimer, W; Rose, L

Abstract

Background: Critically ill patients receiving invasive ventilation are at risk of sputum retention. Mechanical insufflation-exsufflation (MI-E) is a technique used to mobilise sputum and optimise airway clearance. Recently, interest has increased in the use of mechanical insufflation-exsufflation for invasively ventilated critically ill adults, but evidence for the feasibility, safety and efficacy of this treatment is sparse. The aim of this scoping review is to map current and emerging evidence on the feasibility, safety and efficacy of MI-E for invasively ventilated adult patients with the aim of highlighting knowledge gaps and identifying areas for future research. Specific research questions aim to identify information informing indications and contraindications to the use of MI-E in the invasively ventilated adult, MI-E settings used, outcome measures reported within studies, adverse effects reported and perceived barriers and facilitators to using MI-E reported. Methods: We will search electronic databases MEDLINE, EMBASE, CINAHL using the OVID platform, PROSPERO, The Cochrane Library, ISI Web of Science and the International Clinical Trials Registry Platform. Two authors will independently screen citations, extract data and evaluate risk of bias using the Mixed Methods Appraisal Tool. Studies included will present original data and describe MI-E in invasively ventilated adult patients from 1990 onwards. Our exclusion criteria are studies in a paediatric population, editorial pieces or letters and animal or bench studies. Search results will be presented in a PRISMA study flow diagram. Descriptive statistics will be used to summarise quantitative data. For qualitative data relating to barriers and facilitators, we will use content analysis and the Theoretical Domains Framework (TDF) as a conceptual framework. Additional tables and relevant figures will present data addressing our research questions. Discussion: Our findings will enable us to map current and emerging evidence on the feasibility, safety and efficacy of MI-E for invasively ventilated critically ill adult patients. These data will provide description of how the technique is currently used, support healthcare professionals in their clinical decision making and highlight areas for future research in this important clinical area. Systematic review registration: Open Science Framework submitted on 9 July 2020. https://osf.io/mpksq/.

• Journal Article Type: Article
• Acceptance Date: Nov 26, 2020
• Publication Date: Dec 8, 2020
• Deposit Date: Dec 10, 2020
• Publicly Available Date: Dec 10, 2020
• Journal: Systematic Reviews
• Electronic ISSN: 2046-4053
• Publisher: Springer Verlag
• Volume: 9
• Issue: 1
• Pages: 287
• DOI: https://doi.org/10.1186/s13643-020-01547-8
• Publisher URL: https://doi.org/10.1186/s13643-020-01547-8
• Related Public URLs: https://systematicreviewsjournal.biomedcentral.com/
• Additional Information: Additional Information : ** From Springer Nature via Jisc Publications Router ** Licence for this article: http://creativecommons.org/licenses/by/4.0/ **Journal IDs: eissn 2046-4053 **Article IDs: publisher-id: s13643-020-01547-8; manuscript: 1547 **History: published 08-12-2020; online 08-12-2020; collection 12-2020; registration 26-11-2020; accepted 26-11-2020; submitted 15-07-2020; Funders : Nederlandse Organisatie voor Wetenschappelijk Onderzoek;National Institute for Health Research (NIHR);National Institute for Health Research; Projects : 023.011.016;NIHR300504; Grant Number: 023.011.016; Grant Number: NIHR300504