Effects of mechanical insufflation-exsufflation in preventing respiratory failure after extubation a randomized controlled trial.docVIP
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Effects of mechanical insufflation-exsufflation in preventing respiratory failure after extubation a randomized controlled trial
Gon?alvesetal.CriticalCare2012,16:R48
/content/16/2/R48
RESEARCH
OpenAccess
Effectsofmechanicalinsufflation-exsufflationin
preventingrespiratoryfailureafterextubation:a
randomizedcontrolledtrial
MiguelRGon?alves1,2*,TeresaHonrado2,Jo?oCarlosWinck1andJoséArturPaiva2
Abstract
Introduction:Weaningprotocolsthatincludenoninvasiveventilation(NIV)decreasere-intubationratesandICU
lengthofstay.However,impairedairwayclearanceisassociatedwithNIVfailure.Mechanicalinsufflation-exsufflation
(MI-E)hasbeenproventobeveryeffectiveinpatientsreceivingNIV.WeaimedtoassesstheefficacyofMI-Eas
partofanextubationprotocol.
Method:Patientswithmechanicalventilation(MV)formorethan48hourswithspecificinclusioncriteria,who
successfullytoleratedaspontaneousbreathingtrial(SBT),wererandomlyallocatedbeforeextubation,eitherfor(A)
aconventionalextubationprotocol(controlgroup),or(B)theMI-Eextubationprotocol(studygroup).Duringthe
postextubationperiod(48hours),groupApatientsreceivedstandardmedicaltreatment(SMT),includingNIVin
caseofspecificindications,whereasgroupBreceivedthesamepostextubationapproachplusthreedailysessions
ofmechanicalin-exsufflation(MI-E).Reintubationrates,ICUlengthofstay,andNIVfailurerateswereanalyzed.
Results:Seventy-fivepatients(26women)withameanageof61.8±17.3yearswererandomizedtoacontrol
group(n=40;meanSAPSII,47.8±17.7)andtoastudygroup(n=35;meanSAPSII,45.0±15.0).MVtimebefore
enrollmentwas9.4±4.8and10.5±4.1daysforthecontrolandthestudygroup,respectively.Inthe48hours
afterextubation,20controlpatients(50%)and14studypatients(40%)usedNIV.Studygrouppatientshada
significantlowerreintubationratethandidcontrols;sixpatients(17%)versus19patients(48%),P0.05;
respectively,andasignificantlylowertimeunderMV;17.8±6.4versus11.7±3.5days;P0.05;respectively.
ConsideringonlythesubgroupofpatientsthatusedNIV,thereintubationratesrelatedtoNIVfailurewere
significantlylowerinthestudygroupwhencomparedwithcontrols;twopatients(6%)versus13(33%);P0.05,
respectively.MeanICUlengthofstayafterextubationwassignificantlyl
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