Cough augmentation techniques for extubation or weaning critically ill patients from mechanical ventilation (Review)

Critically-ill adults and children who need assistance from machines (ventilators) to help them breathe may have difficulty coughing and clearing secretions. Techniques such as building up the volume of air in the lungs over a number of breaths (breathstacking), manually- and mechanically-assisted cough with an insufflation-exsufflation (MI-E) device can be used to encourage people to cough. Very low-quality evidence from single trial findings suggests that cough-promoting techniques might increase successful removal of the breathing tube and decrease the time spent on mechanical ventilation, while not causing harm.

• 1
  One trial of 75 participants reported that extubation success (defined as no need for reintubation within 48 hours) was higher in the mechanical insufflation-exsufflation (MI-E) group (82.9% versus 52.5%, P < 0.05)
• 2
  One trial reported a statistically significant reduction in mechanical ventilation duration favouring MI-E (mean difference -6.1 days, 95% CI -8.4 to -3.8, very low-quality evidence).
• 3
  Adverse events (reported by two trials) included one participant receiving the MI-E protocol experiencing haemodynamic compromise.