Insuflador-exsuflador mecânico versus manobra PEEP-ZEEP em pacientes em ventilação mecânica prolongada

Campos, Josué Felipe R.; Godoy, M.; Souza, Leonardo Cordeiro de; Coutinho, William Maia; Forgiarini, Luiz Alberto

doi:10.33233/fb.v20i4.2299

Cited by 2 publications

(6 citation statements)

References 25 publications

(33 reference statements)

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“…Most studies (no. ¼ 9) were randomized controlled trials (5 full-text publications, [20][21][22][23][24] 3 trial registrations, [25][26][27] and one abstract 28 ) or descriptive studies (no. ¼ 19) including observational cohort studies (no.…”

Section: Resultsmentioning

confidence: 99%

“…A pause duration was reported in 8/20 (40%) studies. [20][21][22][23][24]30,34,44 Five studies (25%) reported use of one insufflation prior to an exsufflation breath (not reported in the remaining studies). Flow profile was specified in only 3 (15%) studies and was set at medium (no.…”

Section: Clinical Studiesmentioning

confidence: 99%

“…Flow profile was specified in only 3 (15%) studies and was set at medium (no. ¼ 2) 20,28 or high (no. ¼ 1).…”

Section: Clinical Studiesmentioning

confidence: 99%

“…31 Use of oscillation was reported in 5/20 (25%) studies with 3/5 20,28,33 applying this option. One study applied an oscillation amplitude of 10 and frequency of 20 Hz, 20 whereas only oscillation frequency was reported in the remaining 2 studies as high 33 regimens varied across studies, with MI-E cycles being repeated up to every 20 min, 29 hourly, 32 1-2 times per day, 34 3 times a day, 22 4 times a day, 43 and most commonly up to once per day. 20,21,23,24,30,31,33,39,44 Five studies (25%) reported the inclusion of other treatment adjuncts alongside MI-E including side positioning, 43 manual assisted cough, 34 and suction.…”

Section: Clinical Studiesmentioning

confidence: 99%

“…One study applied an oscillation amplitude of 10 and frequency of 20 Hz, 20 whereas only oscillation frequency was reported in the remaining 2 studies as high 33 regimens varied across studies, with MI-E cycles being repeated up to every 20 min, 29 hourly, 32 1-2 times per day, 34 3 times a day, 22 4 times a day, 43 and most commonly up to once per day. 20,21,23,24,30,31,33,39,44 Five studies (25%) reported the inclusion of other treatment adjuncts alongside MI-E including side positioning, 43 manual assisted cough, 34 and suction. 24,41,44 Table 3 provides an overview of described settings of MI-E use in invasively ventilated critically ill participants.…”

Section: Clinical Studiesmentioning

confidence: 99%

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The Use of Mechanical Insufflation-Exsufflation in Invasively Ventilated Critically Ill Adults

et al. 2022

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Mechanical insufflation-exsufflation (MI-E) is traditionally used in the neuromuscular population. There is growing interest of MI-E use in invasively ventilated critically ill adults. We aimed to map current evidence on MI-E use in invasively ventilated critically ill adults. Two authors independently searched electronic databases MEDLINE, Embase, and CINAHL via the Ovid platform; PROSPERO; Cochrane Library; ISI Web of Science; and International Clinical Trials Registry Platform between January 1990-April 2021. Inclusion criteria were (1) adult critically ill invasively ventilated subjects, (2) use of MI-E, (3) study design with original data, and (4) published from 1990 onward. Data were extracted by 2 authors independently using a bespoke extraction form. We used Mixed Methods Appraisal Tool to appraise risk of bias. Theoretical Domains Framework was used to interpret qualitative data. Of 3,090 citations identified, 28 citations were taken forward for data extraction. Main indications for MI-E use during invasive ventilation were presence of secretions and mucus plugging (13/28, 46%). Perceived contraindications related to use of high levels of positive pressure (18/28, 68%). Protocolized MI-E settings with a pressure of 640 cm H 2 O were most commonly used, with detail on timing, flow, and frequency of prescription infrequently reported. Various outcomes were re-intubation rate, wet sputum weight, and pulmonary mechanics. Only 3 studies reported the occurrence of adverse events. From qualitative data, the main barrier to MI-E use in this subject group was lack of knowledge and skills. We concluded that there is little consistency in how MI-E is used and reported, and therefore, recommendations about best practices are not possible.

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