Preventing mucus plugging in invasively ventilated intensive care unit patients—routine or personalized care and ‘primum non nocere’

Abstract

Preventing mucus plugging in invasively ventilated intensive care unit patients-routine or personalized care and 'primum

An Update on Cardiorespiratory Physiotherapy during Mechanical Ventilation

“…28,29 However, for patients requiring MV, sputum production may be increased and the mucociliary transport system impaired caused by the presence of an artificial airway (including an inflated cuff tube), airway dehydration/delivery of relatively dry gases, infection, loss of cilia, change in cilia movement patterns, and cough inefficiency. [30][31][32][33][34][35][36][37][38] Also, patient positioning, muscular weakness, and immobility may further promote sputum retention due to gravitational forces, decreased lung ventilation, and cough strength. 39 Therefore, physiotherapy treatments to clear retained secretions are an essential component of the management of these patients in ICU.…”

Airway Clearance Techniques for Mechanically Ventilated Patients: Insights for Optimization

“…The only criteria that could indicate secretion retention in their population was mechanical ventilation for > 48 h. 71 It is important to emphasize that, as with any other airway clearance technique, there is no evidence to support the use of MI-E on a routine basis. 72 Recently, MI-E has been recommended for use with ventilated patients with signs of secretion retention and with a weak cough determined by a cough peak flow < 60 L/min to facilitate weaning or to reduce the risk of reintubation. 73 However, there is still minor evidence endorsing these recommendations.…”

Underlying mucus plugging during central line placement: a time-sensitive diagnostic dilemma

“…In critically ill patients and postoperative patients with impaired cough reflex, an imbalance between mucus production and clearance occurs [1]. Despite diligent respiratory care, this imbalance may eventually lead to clinically significant mucus plugging, increasing morbidity and mortality [2].…”

“…In critically ill patients and postoperative patients with impaired cough reflex, an imbalance between mucus production and clearance occurs [ 1 ]. Despite diligent respiratory care, this imbalance may eventually lead to clinically significant mucus plugging, increasing morbidity and mortality [ 2 ]. When combined with invasive procedures such as central line placement, clinical management can become challenging, leading to diagnostic and therapeutic uncertainty.…”