Impact of a Mechanical Insufflator–Exsufflation on the Need for Tracheal Suctioning in Intubated Patients

Abstract

Background:

Mechanical insufflation–exsufflation (MI–E) improves tracheal secretion clearance in patients with neuromuscular disease. Whether it could mitigate the need for tracheal suctioning without altering comfort and safety in intubated patients free of neuromuscular disease admitted in the ICU is unknown.

Methods:

Prospective, randomized, crossover open-label study. Intubated patients without preexisting neuromuscular diseases were included. Two tracheal suctioning strategies were compared: suctioning with prior use of MI–E versus standard suctioning. The primary outcome was the number of tracheal suctioning procedures over a 24-h period. Secondary outcomes included sputum volume collected, blood gas, pain, and adverse events related to suctioning.

Results:

The study enrolled 40 subjects over a 2-year period. Out of the 201 tracheal suctioning procedures performed during the 24-h MI–E period, 130 (65%) were actually preceded by the use of MI–E. The number of tracheal suctioning procedures was 5 [3–8] during the 24-h MI–E period and 5 [4–8] during the 24-h standard suctioning period (P = .99). There was no difference between MI–E and the standard suctioning 24-h study periods in terms of the volume of secretions suctioned (10 [5–20] mL vs 15 [5–28] mL, P = .81) and behavioral pain scale (4 [3–4] vs 4 [3–5], P = .51). There was no difference in terms of blood gas, arterial desaturation, or any adverse events. No pneumothoraces were observed.

Conclusion:

In subjects intubated in the ICU, the systematic use of MI–E before tracheal suctioning did not reduce the number of suctioning procedures but was not associated with a higher prevalence of adverse events.

Keywords

mechanical in-exsufflation tracheal suctioning intensive care unit mechanical ventilation weaning acute respiratory failure

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