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- Title
Comparison of Mechanical Insufflation-Exsufflation and Hypertonic Saline and Hyaluronic Acid With Conventional Open Catheter Suctioning in Intubated Patients.
- Authors
Sánchez-García, Miguel; Álvarez-González, Manuel; Domingo-Marín, Sara; del Pino-Ramírez, Ángela; Martínez-Sagasti, Fernando; González-Arenas, Paloma; Cardenal-Sánchez, Carlos; Velasco-López, Elena; Núñez-Reiz, Antonio
- Abstract
BACKGROUND: Open respiratory secretion suctioning with a catheter causes pain and tracheobronchial mucosal injury in intubated patients. The goal of mechanical insufflation-exsufflation (MI-E) is to move secretions proximally and noninvasively by generating a high peak expiratory air flow. Nebulized hypertonic saline with hyaluronic acid (HS-HA) may facilitate suctioning by hydration. We assessed the safety and tolerance of a single session of airway clearance with MI-E and HS-HA in critically ill intubated patients. METHODS: Adults with a cuffed artificial airway were randomized to (1) open suctioning, (2) open suctioning after HS-HA, (3) MI-E, or (4) MI-E with HS-HA. Adverse events, pain and sedation/agitation scores, and respiratory and hemodynamic variables were collected before, during, and 5-min and 60-min post intervention. RESULTS: One-hundred twenty subjects were enrolled and completed the study. Median (interquartile range [IQR]) Acute Physiology and Chronic Health Evaluation II (APACHE II) score was 22 (16--28); median (IQR) age was 69.0 (57.0--75.7) y, and 90 (75%) were male. Baseline respiratory and hemodynamic variables were comparable. Adverse events occurred in 30 subjects (25%), with no between-group differences. Behavioral pain equivalents and Richmond Agitation-Sedation Scale were higher during suctioning in groups 1 (P < .001) and 2 (P < .001). Independent predictive variables for higher pain and agitation/sedation scores were study groups 1 and 2 and simultaneous analgosedation, respectively. Noradrenaline infusion rates were lower at 60 min in groups 2 and 4. PaO2/FIO2 had decreased at 5 min after open suctioning in group 1 and increased at 60 min in group 3. CONCLUSIONS: We observed no difference in adverse events. MI-E avoids pain and agitation.
- Subjects
PATIENT safety; DATA analysis; STATISTICAL significance; HYPERTONIC saline solutions; HYALURONIC acid; STATISTICAL sampling; KRUSKAL-Wallis Test; FISHER exact test; MULTIPLE regression analysis; TREATMENT effectiveness; RANDOMIZED controlled trials; CHI-squared test; DESCRIPTIVE statistics; TRACHEA intubation; LONGITUDINAL method; ODDS ratio; ARTIFICIAL respiration; INSUFFLATION; ONE-way analysis of variance; STATISTICS; ANALYSIS of variance; COMPARATIVE studies; ADVERSE health care events; CONFIDENCE intervals; DATA analysis software; CRITICALLY ill patient psychology; ENDOTRACHEAL suctioning
- Publication
Respiratory Care, 2024, Vol 69, Issue 5, p575
- ISSN
0020-1324
- Publication type
Article
- DOI
10.4187/respcare.11566