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Effects of mechanical insufflation-exsufflation in preventing respiratory failure after extubation: a randomized controlled trial.
Crit Care. 2012 Dec 12; 16(2):R48.CC

Abstract

INTRODUCTION

Weaning protocols that include noninvasive ventilation (NIV) decrease re-intubation rates and ICU length of stay. However, impaired airway clearance is associated with NIV failure. Mechanical insufflation-exsufflation (MI-E) has been proven to be very effective in patients receiving NIV. We aimed to assess the efficacy of MI-E as part of an extubation protocol.

METHOD

Patients with mechanical ventilation (MV) for more than 48 hours with specific inclusion criteria, who successfully tolerated a spontaneous breathing trial (SBT), were randomly allocated before extubation, either for (A) a conventional extubation protocol (control group), or (B) the MI-E extubation protocol (study group). During the postextubation period (48 hours), group A patients received standard medical treatment (SMT), including NIV in case of specific indications, whereas group B received the same postextubation approach plus three daily sessions of mechanical in-exsufflation (MI-E). Reintubation rates, ICU length of stay, and NIV failure rates were analyzed.

RESULTS

Seventy-five patients (26 women) with a mean age of 61.8 ± 17.3 years were randomized to a control group (n = 40; mean SAPS II, 47.8 ± 17.7) and to a study group (n = 35; mean SAPS II, 45.0 ± 15.0). MV time before enrollment was 9.4 ± 4.8 and 10.5 ± 4.1 days for the control and the study group, respectively. In the 48 hours after extubation, 20 control patients (50%) and 14 study patients (40%) used NIV. Study group patients had a significant lower reintubation rate than did controls; six patients (17%) versus 19 patients (48%), P < 0.05; respectively, and a significantly lower time under MV; 17.8 ± 6.4 versus 11.7 ± 3.5 days; P < 0.05; respectively. Considering only the subgroup of patients that used NIV, the reintubation rates related to NIV failure were significantly lower in the study group when compared with controls; two patients (6%) versus 13 (33%); P < 0.05, respectively. Mean ICU length of stay after extubation was significantly lower in the study group when compared with controls (3.1 ± 2.5 versus 9.8 ± 6.7 days; P < 0.05). No differences were found in the total ICU length of stay.

CONCLUSION

Inclusion of MI-E may reduce reintubation rates with consequent reduction in postextubation ICU length of stay. This technique seems to be efficient in improving the efficacy of NIV in this patient population.

Authors+Show Affiliations

Lung Function and Ventilation Unit, Pulmonology Department, University Hospital of São João, Faculty of Medicine, Av. Prof. Hernâni Monteiro, 4200-319 Porto, Portugal. goncalvesmr@gmail.comNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

22420538

Citation

Gonçalves, Miguel R., et al. "Effects of Mechanical Insufflation-exsufflation in Preventing Respiratory Failure After Extubation: a Randomized Controlled Trial." Critical Care (London, England), vol. 16, no. 2, 2012, pp. R48.
Gonçalves MR, Honrado T, Winck JC, et al. Effects of mechanical insufflation-exsufflation in preventing respiratory failure after extubation: a randomized controlled trial. Crit Care. 2012;16(2):R48.
Gonçalves, M. R., Honrado, T., Winck, J. C., & Paiva, J. A. (2012). Effects of mechanical insufflation-exsufflation in preventing respiratory failure after extubation: a randomized controlled trial. Critical Care (London, England), 16(2), R48. https://doi.org/10.1186/cc11249
Gonçalves MR, et al. Effects of Mechanical Insufflation-exsufflation in Preventing Respiratory Failure After Extubation: a Randomized Controlled Trial. Crit Care. 2012 Dec 12;16(2):R48. PubMed PMID: 22420538.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of mechanical insufflation-exsufflation in preventing respiratory failure after extubation: a randomized controlled trial. AU - Gonçalves,Miguel R, AU - Honrado,Teresa, AU - Winck,João Carlos, AU - Paiva,José Artur, Y1 - 2012/12/12/ PY - 2011/09/01/received PY - 2012/02/01/revised PY - 2012/03/15/accepted PY - 2012/3/17/entrez PY - 2012/3/17/pubmed PY - 2016/5/10/medline SP - R48 EP - R48 JF - Critical care (London, England) JO - Crit Care VL - 16 IS - 2 N2 - INTRODUCTION: Weaning protocols that include noninvasive ventilation (NIV) decrease re-intubation rates and ICU length of stay. However, impaired airway clearance is associated with NIV failure. Mechanical insufflation-exsufflation (MI-E) has been proven to be very effective in patients receiving NIV. We aimed to assess the efficacy of MI-E as part of an extubation protocol. METHOD: Patients with mechanical ventilation (MV) for more than 48 hours with specific inclusion criteria, who successfully tolerated a spontaneous breathing trial (SBT), were randomly allocated before extubation, either for (A) a conventional extubation protocol (control group), or (B) the MI-E extubation protocol (study group). During the postextubation period (48 hours), group A patients received standard medical treatment (SMT), including NIV in case of specific indications, whereas group B received the same postextubation approach plus three daily sessions of mechanical in-exsufflation (MI-E). Reintubation rates, ICU length of stay, and NIV failure rates were analyzed. RESULTS: Seventy-five patients (26 women) with a mean age of 61.8 ± 17.3 years were randomized to a control group (n = 40; mean SAPS II, 47.8 ± 17.7) and to a study group (n = 35; mean SAPS II, 45.0 ± 15.0). MV time before enrollment was 9.4 ± 4.8 and 10.5 ± 4.1 days for the control and the study group, respectively. In the 48 hours after extubation, 20 control patients (50%) and 14 study patients (40%) used NIV. Study group patients had a significant lower reintubation rate than did controls; six patients (17%) versus 19 patients (48%), P < 0.05; respectively, and a significantly lower time under MV; 17.8 ± 6.4 versus 11.7 ± 3.5 days; P < 0.05; respectively. Considering only the subgroup of patients that used NIV, the reintubation rates related to NIV failure were significantly lower in the study group when compared with controls; two patients (6%) versus 13 (33%); P < 0.05, respectively. Mean ICU length of stay after extubation was significantly lower in the study group when compared with controls (3.1 ± 2.5 versus 9.8 ± 6.7 days; P < 0.05). No differences were found in the total ICU length of stay. CONCLUSION: Inclusion of MI-E may reduce reintubation rates with consequent reduction in postextubation ICU length of stay. This technique seems to be efficient in improving the efficacy of NIV in this patient population. SN - 1466-609X UR - https://www.unboundmedicine.com/medline/citation/22420538/Effects_of_mechanical_insufflation_exsufflation_in_preventing_respiratory_failure_after_extubation:_a_randomized_controlled_trial_ L2 - https://ccforum.biomedcentral.com/articles/10.1186/cc11249 DB - PRIME DP - Unbound Medicine ER -