Mechanical insufflation/exsufflation improves respiratory mechanics in critical care: Randomized crossover trial

Laís de Cássia Nunes; Danize Aparecida Rizzetti; Douglas Neves; Fernando Nataniel Vieira; Fernanda Machado Kutchak; Giulia Alessandra Wiggers; Franck Maciel Peçanha

doi:10.1016/j.resp.2019.05.008

Mechanical insufflation/exsufflation improves respiratory mechanics in critical care: Randomized crossover trial

Respir Physiol Neurobiol. 2019 Aug:266:115-120. doi: 10.1016/j.resp.2019.05.008. Epub 2019 May 13.

Authors

Laís de Cássia Nunes¹, Danize Aparecida Rizzetti², Douglas Neves³, Fernando Nataniel Vieira⁴, Fernanda Machado Kutchak⁵, Giulia Alessandra Wiggers⁶, Franck Maciel Peçanha⁷

Affiliations

¹ Health Integrated Residency Program, Grupo Hospitalar Conceição. Av. Francisco Trein, 596, Cristo Redentor, Porto Alegre, Rio Grande do Sul, 91350-200, Brazil. Electronic address: [email protected].
² Physiotherapy Department, Universidade Federal do Pampa. BR 472 - Km 585 - Postal Code 118, Rio Grande do Sul, 97501-970, Brazil. Electronic address: [email protected].
³ Health Integrated Residency Program, Grupo Hospitalar Conceição. Av. Francisco Trein, 596, Cristo Redentor, Porto Alegre, Rio Grande do Sul, 91350-200, Brazil. Electronic address: [email protected].
⁴ Physiotherapy Outpatient Clinic, Grupo Hospitalar Conceição. Av. Francisco Trein, 596, Cristo Redentor, Porto Alegre, Rio Grande do Sul, 91350-200, Brazil. Electronic address: [email protected].
⁵ Physiotherapy Outpatient Clinic, Grupo Hospitalar Conceição. Av. Francisco Trein, 596, Cristo Redentor, Porto Alegre, Rio Grande do Sul, 91350-200, Brazil. Electronic address: [email protected].
⁶ Physiotherapy Department, Universidade Federal do Pampa. BR 472 - Km 585 - Postal Code 118, Rio Grande do Sul, 97501-970, Brazil. Electronic address: [email protected].
⁷ Physiotherapy Department, Universidade Federal do Pampa. BR 472 - Km 585 - Postal Code 118, Rio Grande do Sul, 97501-970, Brazil. Electronic address: [email protected].

PMID: 31096012
DOI: 10.1016/j.resp.2019.05.008

Abstract

This study evaluated the ventilatory and haemodynamic effects of the mechanical insufflator-exsufflator (MI-E) in critically ill patients. Sixteen mechanically ventilated patients performed three protocols: MI-E (-30/+30 cmH₂O) plus endotracheal suctioning; 50S: MI-E (-50/+50 cmH2O) plus endotracheal suctioning; and isolated endotracheal suctioning (IES). The protocols were applied randomly in all subjects, with 3 -h intervals in between. Peak airway pressure (Ppeak), plateau pressure (Pplat), airway resistance (Raw), static compliance (Cst), heart rate (HR), systolic (SBP) and diastolic (DBP) blood pressure, peripheral oxygen saturation (SpO₂) and amount of removed secretions were evaluated before (PRE), immediately after (POST) and 10 min after (10' POST) each protocol. The 50S protocol reduced Ppeak and Raw and increased Cst immediately after its application. Moreover, this protocol provided the largest amount of removed secretions and held SBP, DBP and SpO₂ at basal values. The MI-E at high pressures promotes benefits to respiratory mechanics, is more effective in removing pulmonary secretions and it does not lead to hemodynamic repercussions.

Keywords: Cough; Critical care; Endotracheal suctioning; Hemodynamic; Mechanical insufflation/exsufflation.

Publication types

Randomized Controlled Trial

MeSH terms

Adult
Aged
Aged, 80 and over
Clinical Protocols
Critical Care*
Cross-Over Studies
Female
Hemodynamics*
Humans
Insufflation / instrumentation
Insufflation / methods*
Male
Middle Aged
Outcome and Process Assessment, Health Care*
Respiration, Artificial*
Respiratory Physiological Phenomena*
Sputum