Comparison of Mechanical Insufflation–Exsufflation and Endotracheal Suctioning in Mechanically Ventilated Patients: Effects on Respiratory Mechanics, Hemodynamics, and Volume of Secretions

CONTEXT: Cough assist (CA) is a device to improve bronchial hygiene of patients with secretion in the airways and ineffective cough. AIMS: To compare the physiological effects and the volume of secretion of mechanical insufflation–exsufflation (CA device) with isolated endotracheal suctioning in mechanically ventilated patients. SETTINGS AND DESIGN: Randomized crossover trial. MATERIALS AND METHODS: The patients were randomly allocated to the first technique, then the following technique was performed in the next day. We collected the variables related to oxygen saturation, hemodynamics (heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure [MAP]), and respiratory mechanics (tidal volume, minute volume, respiratory rate, and lung compliance and resistance), pre- and postimplementation (immediately and after 15 and 30 min), and the aspirated volume of secretion. STATISTICAL ANALYSIS USED: We used two-way analysis of variance followed by the Student–Newman–Keuls t-test to compare the variables at different time points. Student's t-test was used to compare secretion volumes. All data were stored and analyzed in SPSS for Windows Version 19.0. The significance level was set at 5%. RESULTS: Forty-three patients were included in the study. When we compared the results before and after the application of the techniques, we observed no significant difference in lung compliance, pulmonary resistance, MAP, peripheral oxygen saturation, and secretion volume in both groups. CONCLUSIONS: The mechanical insufflation–exsufflation does not alter respiratory mechanics and hemodynamic stability, and it does not improve airway clearance in mechanically ventilated patients.