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Preliminary experience on the safety and tolerability of mechanical “insufflation-exsufflation” in subjects with artificial airway
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....
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer International Publishing
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5882479/ https://www.ncbi.nlm.nih.gov/pubmed/29616357 http://dx.doi.org/10.1186/s40635-018-0173-6 |
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author | 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 |
author_facet | 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 |
author_sort | Sánchez-García, Miguel |
collection | PubMed |
description | 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 cmH(2)O for 3 s and exsufflation of − 45 cmH(2)O 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). |
format | Online Article Text |
id | pubmed-5882479 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-58824792018-04-11 Preliminary experience on the safety and tolerability of mechanical “insufflation-exsufflation” in subjects with artificial airway 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 Intensive Care Med Exp Research 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 cmH(2)O for 3 s and exsufflation of − 45 cmH(2)O 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). Springer International Publishing 2018-04-03 /pmc/articles/PMC5882479/ /pubmed/29616357 http://dx.doi.org/10.1186/s40635-018-0173-6 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. |
spellingShingle | Research 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 Preliminary experience on the safety and tolerability of mechanical “insufflation-exsufflation” in subjects with artificial airway |
title | Preliminary experience on the safety and tolerability of mechanical “insufflation-exsufflation” in subjects with artificial airway |
title_full | Preliminary experience on the safety and tolerability of mechanical “insufflation-exsufflation” in subjects with artificial airway |
title_fullStr | Preliminary experience on the safety and tolerability of mechanical “insufflation-exsufflation” in subjects with artificial airway |
title_full_unstemmed | Preliminary experience on the safety and tolerability of mechanical “insufflation-exsufflation” in subjects with artificial airway |
title_short | Preliminary experience on the safety and tolerability of mechanical “insufflation-exsufflation” in subjects with artificial airway |
title_sort | preliminary experience on the safety and tolerability of mechanical “insufflation-exsufflation” in subjects with artificial airway |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5882479/ https://www.ncbi.nlm.nih.gov/pubmed/29616357 http://dx.doi.org/10.1186/s40635-018-0173-6 |
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