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

Abstract

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/.

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

“…[13][14][15] The scoping review protocol has been previously published. 16 There were no amendments made to the protocol during the conduct of the scoping review.…”

“…Furthermore, we did not exclude studies based on study design and did not restrict article selection based on language. 16 The search criteria were applied between January 1990-April 2021 using electronic databases MEDLINE, Embase, and CINAHL via the Ovid platform. PROSPERO and Cochrane Library were searched for relevant reviews, ISI Web of Science for conference abstracts, and the International Clinical Trials Registry Platform (trialsearch.…”

Effectiveness of Cough Assist in the Extubation of Adult Patients: Systematic Review and Meta-Analysis

“…The search for predictors of extubation failure is a majortopic in ICU research. It is estimated that, among patients with prolonged ICU stay, about 85% have failed extubation, with a consequent increase in comorbidity and costs [9].Excess secretions has been lengthy recognized as an important factor in the outcome of extubation [10,11].Mokhlesiet al [12] wrote that the evaluation of endotracheal secretions, patient's mental state and pre-extubation PaCO2 could be used to predict extubation failure even in patients who had successfully passed a spontaneous breathing trial. In substantial agreement, Kulkarni et al [13] stated that the efficacy of coughing, the reduced amount of secretions and an adequate state of vigilance are necessary prerequisites for successful extubation, andSmina et al [14]reported that cough capacity, measured objectively, is a major predictor of extubationfailure.Other studiesunderlined that extubation failure is often mediated by an ICU-associated "acquired weakness", which is frequently observed in individuals undergoing prolonged mechanical ventilation and limits at the same time the ability to mobilize adequate air volumes through the lungs and to clear the airways through effective coughing [15].…”

Intra-abdominal pressure for predicating extubation failure in mechanically ventilated patients: it does work

“…The strength of the respiratory muscles affects the outcome of extubation. Patients with a higher rate of failure in extubation often have insufficient respiratory muscle strength and weaker cough intensity [18,35]. There are many studies that use peak cough flow rate as the evaluation of cough intensity in MV patients and use it to predict the outcome of extubation [36].…”