The Effectiveness of Mechanical Insufflator/Exsufflator in Sputum Discharge Among Intensive Care Unit Admitted Patients
Archives of Critical Care Medicine,
Vol. 3 No. 1 (2017),
31 October 2023
Abstract
Background: Mechanical insufflator/exsufflator has been introduced in relevant fields during the recent decades and provides intermittent negative and positive pressures to simulate an effective cough in patients. The current study attempted to assess the effectiveness of mechanical insufflator/exsufflator in secretion evacuation from patients’ airways in an ICU setting.
Methods: Through a randomized clinical trial study at a university referral center for pulmonary diseases, patients with neuro[1]muscular disorders causing face sputum discharge problems, were recruited. Patients with chest tube and positive cases for human immunodeficiency virus (HIV) in addition to people with predisposing problems, who confounded the study, were excluded. Physical examination and the consequent findings, such as chest auscultation, peak cough flow, the color of sputum, and patient’s general condition were recorded before dividing the participants to two groups of cases and controls. The control group only experienced traditional techniques of physiotherapy, such as respiratory exercises, chest massage and percussion against the other group, who used mechanical insufflator/exsufflator under the brand “Cough Assist ®” in coping mode (SYNC) beside the mentioned traditional methods, available for the controls. Visual analog scale (VAS) was used for the two former items with scores between 0 and 10, considering higher scores for more critical or worse conditions.
Results: In total, the 40 cases enrolled in the trial were divided to 20 cases and 20 controls. The mean age ± standard deviation was 32.3 ± 4 years in controls and 31.8 ± 3.4 years in others. The results showed statistically significant differences between the groups. Heart rate, O2 saturation, and Ptcco2 (transcutaneous carbon dioxide tension) were the only parameters, which were not different comparing cases and controls. Chest auscultation and sputum growth had the most improvement in cases. Concerning the peak cough flow, an absolute rise was found in mechanical insufflator/exsufflator when compared with traditional methods (43 cmH2O in cases versus 8 cmH2O in controls). Sputum transparence was the other parameter, which differed absolutely after using the machine in the case group (56% versus 44% in controls).
Conclusions: To conclude, MIE deserves greater focus in a wide area to assist patients with impaired cough expectorate and their secretions using a device with no serious complications like barotrauma, pneumothorax, cardiovascular consequences or even post[1]operative wound dehiscence in relevant surgery cases.
- Intensive Care Units
- Sputum
- Heart Rate
How to Cite
References
Gormley MC. Respiratory management of spinal muscular atrophy type 2. J Neurosci Nurs. 2014;46(6):E33–41. doi:
1097/JNN.0000000000000080. [PubMed: 25365058].
Bosch A, Winterholler M. [Technical aspects of mechanical insufflatorexsufflators. Construction and function of the Emerson CoughAssist].
Pneumologie. 2008;62 Suppl 1:S49–54. doi: 10.1055/s-2007-1016441.
[PubMed: 18317985].
Leith DE. The development of cough.Am Rev Respir Dis. 1985;131(5):S39–
doi: 10.1164/arrd.1985.131.S5.S39. [PubMed: 4003907].
Polkey MI, Lyall RA, Green M, Nigel Leigh P, Moxham J. Expiratory
muscle function in amyotrophic lateral sclerosis. Am J Respir Crit Care
Med. 1998;158(3):734–41. doi: 10.1164/ajrccm.158.3.9710072. [PubMed:
.
Kang SW, Kang YS, Sohn HS, Park JH, Moon JH. Respiratory muscle strength and cough capacity in patients with Duchenne
muscular dystrophy. Yonsei Med J. 2006;47(2):184–90. doi:
3349/ymj.2006.47.2.184. [PubMed: 16642546]. [PubMed Central:
PMC2687626].
Carter GT, Abresch RT, Fowler WJ, Johnson ER, Kilmer DD, McDonald
CM. Profiles of neuromuscular diseases. Spinal muscular atrophy. Am
J Phys Med Rehabil. 1995;74(5 Suppl):S150–9. [PubMed: 7576422].
Bach JR, Ishikawa Y, Kim H. Prevention of pulmonary morbidity for
patients with Duchenne muscular dystrophy. Chest. 1997;112(4):1024–
[PubMed: 9377912].
Chatwin M, Simonds AK. The addition of mechanical insufflation/exsufflation shortens airway-clearance sessions in neuromuscular patients with chest infection. Respir Care. 2009;54(11):1473–9.
[PubMed: 19863831].
Bradley J, Moran F. Physical training for cystic fibrosis. Cochrane Database Syst Rev. 2002;(2). CD002768. doi:
1002/14651858.CD002768. [PubMed: 12076449].
Thomas J, Cook DJ, Brooks D. Chest physical therapy management of
patients with cystic fibrosis. A meta-analysis. Am J Respir Crit Care Med.
;151(3 Pt 1):846–50. doi: 10.1164/ajrccm/151.3_Pt_1.846. [PubMed:
.
Warnock L, Gates A, van der Schans CP. Chest physiotherapy compared to no chest physiotherapy for cystic fibrosis. Cochrane Database
Syst Rev. 2013;(9). CD001401. doi: 10.1002/14651858.CD001401.pub2.
[PubMed: 24006212].
Bach JR, Niranjan V, Weaver B. Spinal muscular atrophy type 1: A noninvasive respiratory management approach. Chest. 2000;117(4):1100–
[PubMed: 10767247].
Bach JR, Alba AS. Noninvasive options for ventilatory support of the
traumatic high level quadriplegic patient. Chest. 1990;98(3):613–9.
[PubMed: 2203616].
Chatwin M. How to use a mechanical insufflator–exsufflator “cough
assist machine”. Breathe. 2008;4(4):320–9.
Daniels T. Physiotherapeutic management strategies for the treatment of cystic fibrosis in adults. J Multidiscip Healthc. 2010;3:201–
doi: 10.2147/JMDH.S8878. [PubMed: 21289861]. [PubMed Central:
PMC3024890].
Kendrick AH. Airway clearance techniques in cystic fibrosis: physiology, devices and the future. J R Soc Med. 2007;100 Suppl 47:3–23.
[PubMed: 17926724].
Bach JR, Sinquee DM, Saporito LR, Botticello AL. Efficacy of mechanical insufflation-exsufflation in extubating unweanable subjects with
restrictive pulmonary disorders. Respir Care. 2015;60(4):477–83. doi:
4187/respcare.03584. [PubMed: 25492956].
Beck GJ, Barach AL. Value of mechanical aids in the management
of a patient with poliomyelitis. Ann Intern Med. 1954;40(6):1081–94.
[PubMed: 13159080].
Beck GJ, Graham GC, Barach AL. Effect of physical methods on the mechanics of breathing in poliomyelitis. Ann Intern Med. 1955;43(3):549–
[PubMed: 13249237].
Neumannova K. [Use of pulmonary rehabilitation in the treatment of
decreased respiratory muscle strength].Cas Lek Cesk. 2015;154(2):72–8.
[PubMed: 25994909].
Miske LJ, McDonough JM, Weiner DJ, Panitch HB. Changes in gastric
pressure and volume during mechanical in-exsufflation. Pediatr Pulmonol. 2013;48(8):824–9. doi: 10.1002/ppul.22671. [PubMed: 22949331].
Rafiq MK, Bradburn M, Proctor AR, Billings CG, Bianchi S, McDermott CJ, et al. A preliminary randomized trial of the mechanical
insufflator-exsufflator versus breath-stacking technique in patients
with amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener. 2015;16(7-8):448–55. doi: 10.3109/21678421.2015.1051992.
[PubMed: 26140500].
Prevost S, Brooks D, Bwititi PT. Mechanical insufflation-exsufflation:
Practice patterns among respiratory therapists in Ontario. Can J
Respir Ther. 2015;51(2):33–8. [PubMed: 26089736]. [PubMed Central:
PMC4467476].
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