Louise Rose1, Neill K Adhikari2, Joseph Poon3, David Leasa4, Douglas A McKim5. 1. Sunnybrook Health Sciences Centre; the Lawrence S Bloomberg Faculty of Nursing, University of Toronto; the Provincial Centre of Weaning Excellence/Prolonged Ventilation Weaning Centre, Toronto East General Hospital; Mount Sinai Hospital; the Li Ka Shing Knowledge Institute, St. Michael's Hospital; and the West Park Healthcare Centre, Toronto, Ontario, Canada. louise.rose@utoronto.ca. 2. Sunnybrook Health Sciences Centre, Interdivisional Department of Critical Care, University of Toronto, Toronto, Ontario, Canada. 3. Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia. 4. Critical Care Western and London Health Sciences Centre and Western University, London, Ontario, Canada. 5. Ottawa Hospital Respiratory Rehabilitation Center, the Ottawa Hospital Sleep Centre, and the University of Ottawa, Ottawa, Ontario, Canada.
Abstract
BACKGROUND: Critically ill mechanically ventilated patients experience impaired airway clearance due to ineffective cough and impaired secretion mobilization. Cough augmentation techniques, including mechanical insufflation-exsufflation (MI-E), manually assisted cough, and lung volume recruitment, improve cough efficiency. Our objective was to describe use, indications, contraindications, interfaces, settings, complications, and barriers to use across Canada. METHODS: An e-mail survey was sent to nominated local survey champions in eligible Canadian units (ICUs, weaning centers, and intermediate care units) with 4 telephone/e-mail reminders. RESULTS: The survey response rate was 157 of 238 (66%); 78 of 157 units (50%) used cough augmentation, with 50 (64%) using MI-E, 53 (68%) using manually assisted cough, and 62 (79%) using lung volume recruitment. Secretion clearance was the most common indication (MI-E, 92%; manually assisted cough, 88%; lung volume recruitment, 76%), although the most common units (44%) used it <50% of the time. Use during weaning from invasive (MI-E, 21%; manually assisted cough, 39%; lung volume recruitment, 3%) and noninvasive ventilation (MI-E, 21%; manually assisted cough, 33%; lung volume recruitment, 21%) was infrequent. The most common diagnoses were neuromuscular disease (97%) and spinal cord injury (83%). Pneumothorax was the most frequently identified absolute contraindication for MI-E (93%) and lung volume recruitment (83%); rib fracture was most frequently identified for manually assisted cough (69%). MI-E mean inspiratory pressure was 31 cm H2O, and expiratory pressure was -32 cm H2O. Mucus plugging requiring tracheostomy inner change was the most frequent complication for MI-E (23%), chest pain for manually assisted cough (36%), and hypotension for lung volume recruitment (17%). The most commonly cited barriers were lack of expertise (70%), knowledge (65%), and resources (52%). CONCLUSIONS: We found moderate adoption of cough augmentation techniques, particularly for secretion management. Lack of expertise and knowledge are potentially modifiable barriers addressed with educational interventions.
BACKGROUND: Critically ill mechanically ventilated patients experience impaired airway clearance due to ineffective cough and impaired secretion mobilization. Cough augmentation techniques, including mechanical insufflation-exsufflation (MI-E), manually assisted cough, and lung volume recruitment, improve cough efficiency. Our objective was to describe use, indications, contraindications, interfaces, settings, complications, and barriers to use across Canada. METHODS: An e-mail survey was sent to nominated local survey champions in eligible Canadian units (ICUs, weaning centers, and intermediate care units) with 4 telephone/e-mail reminders. RESULTS: The survey response rate was 157 of 238 (66%); 78 of 157 units (50%) used cough augmentation, with 50 (64%) using MI-E, 53 (68%) using manually assisted cough, and 62 (79%) using lung volume recruitment. Secretion clearance was the most common indication (MI-E, 92%; manually assisted cough, 88%; lung volume recruitment, 76%), although the most common units (44%) used it <50% of the time. Use during weaning from invasive (MI-E, 21%; manually assisted cough, 39%; lung volume recruitment, 3%) and noninvasive ventilation (MI-E, 21%; manually assisted cough, 33%; lung volume recruitment, 21%) was infrequent. The most common diagnoses were neuromuscular disease (97%) and spinal cord injury (83%). Pneumothorax was the most frequently identified absolute contraindication for MI-E (93%) and lung volume recruitment (83%); rib fracture was most frequently identified for manually assisted cough (69%). MI-E mean inspiratory pressure was 31 cm H2O, and expiratory pressure was -32 cm H2O. Mucus plugging requiring tracheostomy inner change was the most frequent complication for MI-E (23%), chest pain for manually assisted cough (36%), and hypotension for lung volume recruitment (17%). The most commonly cited barriers were lack of expertise (70%), knowledge (65%), and resources (52%). CONCLUSIONS: We found moderate adoption of cough augmentation techniques, particularly for secretion management. Lack of expertise and knowledge are potentially modifiable barriers addressed with educational interventions.
Authors: Stuart Cleary; John E Misiaszek; Sonya Wheeler; Sanjay Kalra; Shelagh K Genuis; Wendy S Johnston Journal: Muscle Nerve Date: 2021-09-28 Impact factor: 3.852
Authors: William M Coutinho; Paulo J C Vieira; Fernanda M Kutchak; Alexandre S Dias; Marcelo M Rieder; Luiz Alberto Forgiarini Journal: Indian J Crit Care Med Date: 2018-07
Authors: Ema Swingwood; Willemke Stilma; Lyvonne Tume; Fiona Cramp; Frederique Paulus; Marcus Schultz; Wilma Scholte Op Reimer; Louise Rose Journal: Syst Rev Date: 2020-12-08