Preliminary experience on the safety and tolerability of mechanical “insufflation-exsufflation” in subjects with artificial airway

被引：23

作者：

Sánchez-García M. ^{[1
]}

Santos P. ^{[2
]}

Rodríguez-Trigo G. ^{[3
]}

Martínez-Sagasti F. ^{[1
]}

Fariña-González T. ^{[1
]}

del Pino-Ramírez Á. ^{[1
]}

Cardenal-Sánchez C. ^{[1
]}

Busto-González B. ^{[1
]}

Requesens-Solera M. ^{[1
]}

Nieto-Cabrera M. ^{[1
]}

Romero-Romero F. ^{[1
]}

Núñez-Reiz A. ^{[1
]}

机构：

[1] Critical Care Department, Hospital Clínico San Carlos, c/Prof. Martín Lagos s/n, Madrid

[2] Physiotherapy and Rehabilitation Service, Hospital Clínico San Carlos, c/Prof. Martín Lagos s/n, Madrid

[3] Service of Pulmonology, Hospital Clínico San Carlos, c/Prof. Martín Lagos s/n, Madrid

来源：

Intensive Care Medicine Experimental | / 6卷 / 1期

关键词：

Airway clearance; Artificial airway; Endotracheal aspiration; Endotracheal intubation; Mechanical insufflation-exsufflation; Respiratory tract secretions; Safety; Secretion suctioning;

D O I：

10.1186/s40635-018-0173-6

中图分类号：

学科分类号：

摘要：

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 2017-005201-13 (EU Clinical Trials Register). © 2018, The Author(s).

引用

共 23 条

[1]

AARC clinical practice guidelines. Endotracheal suctioning of mechanically ventilated patients with artificial airways 2010, Respir Care, 55, pp. 758-764, (2010)

[2]

Robleda G., Roche-Campo F., Membrilla-Martinez L., Fernandez-Lucio A., Villamor-Vazquez M., Merten A., Gich I., Mancebo J., Catala-Puigbo E., Banos J.E., Evaluación del dolor durante la movilización y la aspiración endotraqueal en pacientes críticos, Med Int, 40, pp. 96-104, (2016)

[3]

Puntillo K.A., Max A., Timsit J.F., Vignoud L., Chanques G., Robleda G., Roche-Campo F., Mancebo J., Divatia J.V., Soares M., Ionescu D.C., Grintescu I.M., Vasiliu I.L., Maggiore S.M., Rusinova K., Owczuk R., Egerod I., Papathanassoglou E.D., Kyranou M., Joynt G.M., Burghi G., Freebairn R.C., Ho K.M., Kaarlola A., Gerritsen R.T., Kesecioglu J., Sulaj M.M., Norrenberg M., Benoit D.D., Seha M.S., Hennein A., Periera F.J., Benbenishty J.S., Abroug F., Aquilina A., Monte J.R., An Y., Azoulay E., De

[4]

Liu X.W., Jin Y., Ma T., Qu B., Liu Z., Differential effects of endotracheal suctioning on gas exchanges in patients with acute respiratory failure under pressure-controlled and volume-controlled ventilation, Biomed Res Int, 2015, (2015)

[5]

Jongerden I.P., Rovers M.M., Grypdonck M.H., Bonten M.J., Open and closed endotracheal suction systems in mechanically ventilated intensive care patients: a meta-analysis, Crit Care Med, 35, pp. 260-270, (2007)

[6]

Fernandez-Carmona A., Olivencia-Pena L., Yuste-Ossorio M.E., Penas-Maldonado L., Ineffective cough and mechanical mucociliary clearance techniques, Med Int, (2017)

[7]

Sancho J., Servera E., Vergara P., Marin J., Mechanical insufflation-exsufflation vs. tracheal suctioning via tracheostomy tubes for patients with amyotrophic lateral sclerosis: a pilot study, Am J Phys Med Rehabil, 82, pp. 750-753, (2003)

[8]

Pillastrini P., Bordini S., Bazzocchi G., Belloni G., Menarini M., Study of the effectiveness of bronchial clearance in subjects with upper spinal cord injuries: examination of a rehabilitation programme involving mechanical insufflation and exsufflation, Spinal Cord, 44, pp. 614-616, (2006)

[9]

Bach J.R., Goncalves M., Ventilator weaning by lung expansion and decannulation, Am J Phys Med Rehabil, 83, pp. 560-568, (2004)

[10]

Vianello A., Corrado A., Arcaro G., Gallan F., Ori C., Minuzzo M., Bevilacqua M., Mechanical insufflation-exsufflation improves outcomes for neuromuscular disease patients with respiratory tract infections, Am J Phys Med Rehabil, 84, pp. 83-88, (2005)

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