Archives of Critical Care Medicine

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.