Monitoring Cough Effectiveness and Use of Airway Clearance Strategies: A Canadian and UK Survey

Rose, Louise; McKim, Douglas; Leasa, David; Nonoyama, Mika; Tandon, Anu; Kamińska, Marta; O’Connell, Colleen; Loewen, Andrea; Connolly, Bronwen; Murphy, Patrick B.; Hart, Nicholas; Road, Jeremy

doi:10.4187/respcare.06321

Cited by 16 publications

(20 citation statements)

References 17 publications

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“…Only 12 children reported measurement of Peak Cough Flow, the most common assessment of cough capacity 18 . However, a high proportion of participants were <6 years, limiting the possibility of performing voluntary measurements.…”

Section: Discussionmentioning

confidence: 99%

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Prevalence of long‐term mechanical insufflation‐exsufflation in children with neurological conditions: a population‐based study

Hov

Andersen

Toussaint

et al. 2021

Develop Med Child Neuro

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Long-term mechanical ventilation MI-E Mechanical insufflationexsufflation NMD Neuromuscular disorder SMA Spinal muscular atrophy AIM To determine the prevalence of long-term mechanical insufflation-exsufflation (MI-E) and concomitant mechanical ventilation in children with neurological conditions, with reported reasons behind the initiation of treatment. METHOD This was a population-based, cross-sectional study using Norwegian national registries and a questionnaire. RESULTS In total, 114 of 19 264 children with a neurological condition had an MI-E device. Seventy-three of 103 eligible children (31 females, 42 males), median (min-max) age of 10 years 1 month (1y 5mo-17y 10mo), reported their MI-E treatment initiation. Overall, 76% reported airway clearance as the main reason to start long-term MI-E. A prophylactic use was mainly reported by children with neuromuscular disorders (NMDs). Prevalence and age at initiation differed by diagnosis. In spinal muscular atrophy and muscular dystrophies, MI-E use was reported in 34% and 7% of children, of whom 83% and 57% respectively received ventilator support. One-third of the MI-E users were children with central nervous system (CNS) conditions, such as cerebral palsy and degenerative disorders, and ventilator support was provided in 31%. The overall use of concomitant ventilatory support among the longterm MI-E users was 56%. INTERPRETATION The prevalence of MI-E in a neuropaediatric population was 6 per 1000, with two-thirds having NMDs and one-third having conditions of the CNS. The decision to initiate MI-E in children with neurological conditions relies on clinical judgment.

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Section: Discussionmentioning

confidence: 99%

“…To help decide if MI‐E is indicated, Peak Cough Flow is the preferred measurement of cough capacity 18 . However, being effort dependent, it has major limitations in children.…”

mentioning

confidence: 99%

Prevalence of long‐term mechanical insufflation‐exsufflation in children with neurological conditions: a population‐based study

Hov

Andersen

Toussaint

et al. 2021

Develop Med Child Neuro

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“…11 Department of Cardiology, Amsterdam University Medical Centers, location 'AMC', Amsterdam, the Netherlands. 12 Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK. 13 Lane Fox Respiratory Unit, Guy's and Thomas' Foundation NHS Hospital Trust, London, UK.…”

Section: Resultsmentioning

confidence: 99%

“…There is growing interest in the role of MI-E for invasively ventilated critically ill adults but to date adoption and application of this technique is variable [11][12][13]. The primary aim of this scoping review is to map emerging and current evidence, on MI-E in an ICU setting, thus adding to previous Cochrane Review findings [15].…”

Section: Discussionmentioning

confidence: 99%

“…Our group has conducted practice surveys of cough augmentation techniques in ICUs in Canada [11,12], the United Kingdom (UK) [13] and the Netherlands [14]. Results from all surveys illustrated that MI-E was predominantly used for sputum management in non-intubated patients to prevent intubation or reintubation [11][12][13]. Across all three countries, MI-E was not commonly used in invasively ventilated patients.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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/.

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Airway Clearance Techniques in Neuromuscular Disorders

Oliveira

Gomes

2020

Noninvasive Ventilation in Sleep Medicine and Pulmonary Critical Care

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Monitoring Cough Effectiveness and Use of Airway Clearance Strategies: A Canadian and UK Survey

Abstract: The somewhat variable cough effectiveness monitoring and airway clearance practices identified in this survey confirm the need for further work on knowledge translation related to guideline recommendations and the need to address common constraints to optimal service delivery.

Cited by 16 publications

References 17 publications

Prevalence of long‐term mechanical insufflation‐exsufflation in children with neurological conditions: a population‐based study

Prevalence of long‐term mechanical insufflation‐exsufflation in children with neurological conditions: a population‐based study

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

Airway Clearance Techniques in Neuromuscular Disorders

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