Effects of mechanical insufflation-exsufflation in preventing respiratory failure after extubation: a randomized controlled trial

• Type: Article in International Scientific Journal
• Date: 2012

Authors

Goncalves, MR (Author) FMUP; Honrado, T (Author) Other; Winck, JC (Author) Other; Paiva, J-A (Author) FMUP

Journal

Title: Critical Care

Vol. 16

Final page: R48

ISSN: 1364-8535

Publisher: Springer Nature

Indexing

ISI Web of Knowledge - 65 Citations

Scopus - 81 Citations

Other information

Authenticus ID: P-002-EC4

DOI: 10.1186/cc11249

Abstract (EN): 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.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 8