Mechanical Insufflation-exsufflation for the Prevention of Ventilator-associated Pneumonia in Intensive Care Units: A Retrospective Cohort Study

Ryota Kuroiwa; Yoshihisa Tateishi; Taku Oshima; Takeshi Inagaki; Seiichiro Furukawa; Ryo Takemura; Yohei Kawasaki; Astushi Murata

doi:10.5005/jp-journals-10071-23508

Mechanical Insufflation-exsufflation for the Prevention of Ventilator-associated Pneumonia in Intensive Care Units: A Retrospective Cohort Study

Indian J Crit Care Med. 2021 Jan;25(1):62-66. doi: 10.5005/jp-journals-10071-23508.

Authors

Ryota Kuroiwa¹, Yoshihisa Tateishi², Taku Oshima², Takeshi Inagaki¹, Seiichiro Furukawa¹, Ryo Takemura³, Yohei Kawasaki⁴, Astushi Murata¹

Affiliations

¹ Division of Rehabilitation Medicine, Chiba University Hospital, Chiba, Japan.
² Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan.
³ Department of Biostatistics Unit, Keio University Hospital, Clinical and Translational Research Center, Tokyo, Japan.
⁴ Department of Biostatistics Section, Chiba University Hospital, Clinical Research Center, Chiba, Japan.

Abstract

Aim: Ventilator-associated pneumonia (VAP) is the most common intensive care unit (ICU)-acquired infection. The current study aimed to assess the efficacy of mechanical insufflation-exsufflation (MI-E) in preventing VAP in critically ill patients.

Materials and methods: This retrospective cohort study was conducted at the ICU of Chiba University Hospital between January 2014 and September 2017. The inclusion criteria were patients who required invasive mechanical ventilation ≥48 hours and those who underwent rehabilitation, including chest physical therapy (CPT). In 2015, the study institution started the use of MI-E in patients with impaired cough reflex. From January to December 2014, patients undergoing CPT were classified under the historical control group, and those who received treatment using MI-E from January 2015 to September 2017 were included in the intervention group. The patients received treatment using MI-E via the endotracheal or tracheostomy tube, with insufflation-exsufflation pressure of 15-40 cm H₂O. The treatment frequency was one to three sessions daily, and a physical therapist who is experienced in using MI-E facilitated the treatment.

Results: From January 2015 to September 2017, 11 patients received treatment using MI-E. Of the 169 patients screened in 2014, 19 underwent CPT. The incidence of VAP was significantly different between the CPT and MI-E groups (84.2% [16/19] vs 26.4% [3/11], p = 0.011). After adjusting for covariates, a multivariate logistic regression analysis was performed, and results showed that the covariates were not associated with the incidence of VAP.

Conclusion: This retrospective cohort study suggests that the use of MI-E in critically ill patients is independently associated with a reduced incidence of VAP.

Clinical significance: Assessing the efficacy of MI-E to prevent VAP.

How to cite this article: Kuroiwa R, Tateishi Y, Oshima T, Inagaki T, Furukawa S, Takemura R, et al. Mechanical Insufflation-exsufflation for the Prevention of Ventilator-associated Pneumonia in Intensive Care Units: A Retrospective Cohort Study. Indian J Crit Care Med 2021;25(1):62-66.

Keywords: Airway clearance; Chest physical therapy; Critically ill patients; Mechanical insufflation-exsufflation; Ventilator-associated pneumonia.