In-line Mechanical Insufflation-Exsufflation as an Alternative to Invasive Suction for Secretion Management in Ventilated Patients, A Randomized Controlled Trial

Abstract

Background Catheter suction (CS), the standard method for airway secretion management in tracheostomized or intubated patients, is invasive and has significant hemodynamic and traumatic side effects. In-line mechanical insufflation-exsufflation (IL-MIE) is a new, non-invasive technology that clears secretions by simulating coughs without interrupting ongoing mechanical ventilation. It is not known whether IL-MIE can be safely and effectively used as an alternative to CS in these ventilated patients. Methods A randomized controlled study was conducted comparing a standard protocol of CS with automatic IL-MIE (CoughSync, Ruxin Medical Systems, Beijing) performed every 30 minutes, with CS added only if needed, in post-operative mechanically ventilated patients. Results Over 8 hours, the IL-MIE cohort required significantly fewer CS treatments per patient than the control cohort (mean 0.4 vs. 2.6, p < 0.001, n = 60 for both cohorts). Seventy-three percent of the IL-MIE subjects required no CS at all, compared to 2% in the control group (p < 0.001). At 8 hours, IL-MIE subjects had a significantly lower heart rate than control subjects (mean 90 vs. 96, p = 0.047), implying a hemodynamic advantage to IL-MIE. No significant adverse events were associated with IL-MIE. Conclusions IL-MIE minimizes the need for invasive CS without detriment to ventilatory management in mechanically ventilated patients.