Efficacy and Safety of Mechanical Insufflation-Exsufflation in Invasively Ventilated Critically Ill Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Zhiqun Liu, Guiling Liao, Hui Wen and 5 others
PMID 42638196WHAT IT FOUND
Mechanical insufflation-exsufflation, alone or added to suctioning or physiotherapy, increased sputum clearance in invasively ventilated ICU adults, but did not significantly improve oxygenation, ventilator-free days or ICU stay.
Use it as an adjunct for retained secretions, not as a proven way to shorten ventilation.
Key findings
01MI-E, alone or added to usual airway care, increased sputum clearance compared with control interventions (SMD 0.63, 95% CI 0.32 to 0.93; p < 0.0001; I² 38%).
02MI-E did not significantly change oxygenation (MD 0.28%, 95% CI -0.53 to 1.09; p 0.50; I² 9%).
03MI-E did not significantly differ from control in ventilator-free days (21 vs 18 days, p 0.38) or ICU stay (10 vs 12 days, p 0.31).
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for RNs
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What it does not show
Only five randomized trials were included, with 310 participants, so the evidence base is small. Most trials were not blinded because physiotherapy interventions cannot be blinded, and allocation concealment was unclear in three trials. Three crossover trials did not report paired or first-period data, so they were analysed as if the groups were independent, which can make the pooled estimate less precise. Airway resistance and lung compliance could not be pooled because some studies reported only change scores or graph-only data. Ventilator-free days and ICU length of stay came from one trial only. MI-E pressure settings, timing, comparator techniques and outcome definitions differed across studies. Publication bias cannot be excluded.
Declared interests
This study was supported by grants from the Hunan Provincial Natural Science Foundation. The authors declared no conflicts of interest.
The easy way to misread this
Do not read the sputum clearance result as proof that MI-E improves patient outcomes. Oxygenation did not change significantly, and the only trial that measured ventilator-free days and ICU length of stay found no significant differences.