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- Title
Preliminary experience on the safety and tolerability of mechanical “insufflation-exsufflation” in subjects with artificial airway.
- Authors
Sánchez-García, Miguel; Santos, Passio; Rodríguez-Trigo, Gema; Martínez-Sagasti, Fernando; Fariña-González, Tomás; del Pino-Ramírez, Ángela; Cardenal-Sánchez, Carlos; Busto-González, Beatriz; Requesens-Solera, Mónica; Nieto-Cabrera, Mercedes; Romero-Romero, Francisco; Núñez-Reiz, Antonio
- Abstract
Background: Catheter suctioning of respiratory secretions in intubated subjects is limited to the proximal airway and associated with traumatic lesions to the mucosa and poor tolerance. “Mechanical insufflation-exsufflation” exerts positive pressure, followed by an abrupt drop to negative pressure. Potential advantages of this technique are aspiration of distal airway secretions, avoiding trauma, and improving tolerance.Methods: We applied insufflation of 50 cmH2O for 3 s and exsufflation of − 45 cmH2O for 4 s in patients with an endotracheal tube or tracheostomy cannula requiring secretion suctioning. Cycles of 10 to 12 insufflations-exsufflations were performed and repeated if secretions were aspirated and visible in the proximal artificial airway. Clinical and laboratory parameters were collected before and 5 and 60 min after the procedure. Subjects were followed during their ICU stay until discharge or death.Results: Mechanical insufflation-exsufflation was applied 26 times to 7 male and 6 female subjects requiring suctioning. Mean age was 62.6 ± 20 years and mean Apache II score 23.3 ± 7.4 points. At each session, a median of 2 (IQR 1; 2) cycles on median day of intubation 11.5 (IQR 6.25; 25.75) were performed. Mean insufflation tidal volume was 1043.6 ± 649.9 ml. No statistically significant differences were identified between baseline and post-procedure time points. Barotrauma, desaturation, atelectasis, hemoptysis, or other airway complication and hemodynamic complications were not detected. All, except one, of the mechanical insufflation-exsufflation sessions were productive, showing secretions in the proximal artificial airway, and were well tolerated.Conclusions: Our preliminary data suggest that mechanical insufflation-exsufflation may be safe and effective in patients with artificial airway. Safety and efficacy need to be confirmed in larger studies with different patient populations.Trial registration: EudraCT <ext-link>2017-005201-13</ext-link> (EU Clinical Trials Register).
- Subjects
ARTIFICIAL respiration; INSUFFLATION; AIRWAY (Anatomy); PATIENT safety; ENDOTRACHEAL tubes
- Publication
Intensive Care Medicine Experimental, 2018, Vol 6, Issue 1, p1
- ISSN
2197-425X
- Publication type
Article
- DOI
10.1186/s40635-018-0173-6