Summary of the best evidence for the use of mechanical insufflation-exsufflation technique in invasive mechanical ventilation patients / 中华危重病急救医学

Objective:To search and evaluate the literatures on the application of mechanical insufflation-exsufflation technique (MI-E) in patients with invasive mechanical ventilation in China and abroad, and to summarize the best evidence to provide evidence-based basis for clinical practice.Methods:The literatures related to the use of MI-E technique in invasive mechanical ventilation patients were searched from the establishment of the database to April 1, 2022 in BMJ Best Practice, UpToDate Clinical Advisor, Scottish Intercollegiate Guidelines Network (SIGN), Guidelines International Network (GIN), National Institute for Health and Care Excellence (NICE), National Guideline Clearinghouse (NGC), Registered Nurses' Association of Ontario (RNAO), medlive, Cochrane Library, Joana Briggs Instiute, Web of Science, PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), SinoMed, China National Knowledge Infrastructure (CNKI), Wanfang Database, China Science and Technology Journal Database, and Website of American Association for Respiratory Care, including guideline, expert consensus, clinical decision, evidence summary, systematic review and randomized controlled trial. The JBI Center for Evidence-Based Health Care Expert Consensus Evaluation Criteria (2016) was used to evaluate the quality of the included systematic reviews; the JBI Center for Evidence-Based Health Care Evaluation Criteria for Randomized Controlled Trials was used to evaluate the quality of the included randomized controlled trial. Two researchers independently evaluated the quality of literature, and extracted and summarized the evidence based on professional judgment.Results:A total of 7 literatures were enrolled, including 3 systematic reviews and 4 randomized controlled trials. After quality evaluation, 7 articles were all enrolled. Thirteen best evidences were formed from four aspects of indications, contraindications, parameter settings, and attention.Conclusions:The study summarizes the best evidence for the application of MI-E technique in invasive mechanical ventilation patients. It is recommended that medical staff undergo professional training, combined with their professional judgment as well as the patient's clinical specific conditions and willingness, and accurately apply MI-E technology to invasive mechanical ventilation patients.

Noninvasive Respiratory Management of Patients With Neuromuscular Disease

This review article describes definitive noninvasive respiratory management of respiratory muscle dysfunction to eliminate need to resort to tracheotomy. In 2010 clinicians from 22 centers in 18 countries reported 1,623 spinal muscular atrophy type 1 (SMA1), Duchenne muscular dystrophy (DMD), and amyotrophic lateral sclerosis users of noninvasive ventilatory support (NVS) of whom 760 required it continuously (CNVS). The CNVS sustained their lives by over 3,000 patient-years without resort to indwelling tracheostomy tubes. These centers have now extubated at least 74 consecutive ventilator unweanable patients with DMD, over 95% of CNVS-dependent patients with SMA1, and hundreds of others with advanced neuromuscular disorders (NMDs) without resort to tracheotomy. Two centers reported a 99% success rate at extubating 258 ventilator unweanable patients without resort to tracheotomy. Patients with myopathic or lower motor neuron disorders can be managed noninvasively by up to CNVS, indefinitely, despite having little or no measurable vital capacity, with the use of physical medicine respiratory muscle aids. Ventilator-dependent patients can be decannulated of their tracheostomy tubes.

Mechanical insufflation-exsufflation for airway mucus clearance in patients with artificial airway / 中国实用护理杂志

Objective To explore the clinical effect of application of mechanical insufflation-exsufflation (MI-E) for airway mucus clearance in patients with artificial airway.Methods 72 patients were divided into the observation group (36 cases) and the control group (36 cases)according to admission order by random number table.All subjects were given with individual treatment and nursing,while the control group was given with the application of rock sputum ejection machine twice per day,the observation group was given with application of both cough assist and rock sputum ejection machine for sputum excretion.The clinical effect of airway mucus clearance after 5 days' treatment was compared between two groups.Results Compared with the control group,oxygenation index after 5 days' treatment in the observation group increased [(48.16±9.57) kPa vs.(37.99±14.67) kPa,t=-3.48,P＜0.01],clinical pulmonary infection score [(3.39±0.77) scores vs.(5.33±1.47) scores] and procalcitonin level [0.10 (0.07,0.27) μg/L vs.0.43 (0.12,0.79) μg/L] were lower (t=-7.02,Z=-3.28,P＜0.01),the mean sputum amount was bigger [(3.64±0.43) ml vs.(2.31 ±0.44) ml] (t=-4.84,P＜0.01),and the mean interval of suction was longer [(97.81 ±7.28) min vs.(82.00±8.88) min](t=-3.08,P＜0.05).Conclusions MI-E can clear the airway secretion effectively so as to improve oxygenation and the inflammatory markers.And MI-E is a simple,noninvasive and safe technique.

Soporte respiratorio muscular para evitar el fallo respiratorio y la traqueotomía: ventilación no invasiva y técnicas de tos asistida / Respiratory muscle aids to prevent respiratory failure and tracheotomy: Noninvasive mechanical ventilation and mechanically assisted coughing

El propósito de este artículo es describir el uso de técnicas de soporte respiratorio muscular no invasivo con el fin de prevenir la insuficiencia respiratoria y el fallo ventilatorio, permitiendo la extubación y decanulación de pacientes considerados "imposibles de destetar''. La aplicación de presión en la vía aérea de forma no invasiva durante la inspiración puede proporcionar un soporte ventilatorio continuo en pacientes con poca o inexistente capacidad vital. Así mismo, podrá alcanzarse un pico flujo espiratorio efectivo en pacientes con una disfunción severa de los músculos espiratorios. En abril de 2010 un consenso clínico de 19 centros en 18 países describió 1623 pacientes neuromusculares con atrofia muscular espinal tipo 1, distrofia muscular de Duchenne (DMD) y esclerosis lateral amiotrófica que sobrevivieron utilizando soporte ventilatorio continuo sin necesidad de traqueotomía. De esta serie de pacientes, 76 (47%) precisaron ventilación no invasiva continua en un periodo de seguimiento de 15 años. De estos 76.22 (30.1%) de los enfermos fueron extubados y 35 (4.6%) decanulados en cuatro centros especializados. En estos centros se extuban rutinariamente pacientes con distrofia muscular de Duchenne considerados "imposibles de destetar", de forma que ninguno de sus más de 250 enfermos ha requerido traqueotomía. Esta aproximación en el tratamiento se está abriendo camino en varios centros de España, México y América45.

The purpose of this article is to describe the use of noninvasive inspiratory and expiratory muscle aids to prevent ventilatory insufficiency and failure, and to permit the extubation and tracheostomy tube decannulation in "unweanable" patients. Noninvasive airway pressure aids can provide a continuous support to respiratory ventilation for patients with little or no vital capacity and can provide effective cough flows in patients with severely dysfunctional expiratory muscles. In April 2010, a consensus of clinicians from 19 centers in 18 countries reported the experience of noninvasive ventilation in 1623 patients with spinal muscular atrophy type 1 (SMA1), Duchenne muscular dystrophy (DMD), and amyotrophic lateral sclerosis (ALS), who survived without tracheotomy. The survival was for more than 15 years in 76 patients. Among these 76 patients, 22 (30.1%) were extubated and 35 (4.6%) were decannulated in four specialized centers. In these centers, unweanable DMD patients are routinely extubated; none of over 250 such patients has undergone tracheotomy. This approach is now being introduced into different centers in Spain, Mexico and the United States.

New therapeutic techniques and strategies in pulmonary rehabilitation

Patients with chronic obstructive pulmonary disease (COPD) or those with paralytic restrictive pulmonary syndromes caused by progressive neuromuscular disease, kyphoscoliosis or traumatic quadriplegia may require frequent hospitalization because of respiratory impairment and have increased morbidity and mortality. Pulmonary rehabilitation has been shown to decrease the frequency of hospitalization, ameliorate symptoms, increase exercise tolerance, and in one study, prolong life for individuals with COPD. It is now recognized that principles of pulmonary rehabilitation can also be used to avoid hospitalization, intubation, tracheostomy and bronchoscopy while enhancing quality of life, decreasing cost, and greatly prolonging life for individuals with paralytic restrictive syndromes and global alveolar hypoventilation as well.