Mechanical Insufflation-Exsufflation as Bronchial Hygiene Technique in Critical Care Patients: Systematic Review

The bronchial hygiene of intubated patients, there is no closure of the glottis, but the increased expiratory flow is determinant to the passive expulsion of secretions in the presence of endotracheal tubes. Methods aimed at improving the effectiveness of cough are important because they facilitate weaning from mechanical ventilation and improve functional outcomes for patients. This study aimed to systematically review the outcomes enabled by the respiratory therapy using the mechanical insufflation-exsufflation in critically ill patients admitted to the intensive care unit. Trials were included from 1993 to 2015, through a systematic literature review. The databases involved were LILACS, SciELO and PubMed using the keywords “mechanical ventilation”, “physiotherapy”, “cough”, “secretion” “mechanical insufflation-exsufflation” and “device”. Two independent researchers carried out the screening of articles and included studies using the mechanical insufflation-exsufflation in critically ill patients. Initially 52 potentially relevant articles were found, only 3 (5.7%) contemplated the inclusion criteria and addressed the mechanical insufflation-exsufflation in critically ill patients. The articles analyzed, all showed significant benefits in the use of mechanical insufflation-exsufflation regarding the improvement of peripheral oxygen saturation, increased of peak expiratory flow and a decrease in the rate of re-intubation. The studies demonstrated if the mechanical insufflation-exsufflation improves bronchial hygiene when used in critically ill patients, proving to be effective equipment. The level of evidence about the theme addressed is still considered low, making necessary new studies.