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Focus group on mechanical in- exsufflation in invasively ventilated intensive care patients.

Willemke Stilma, Frederique Paulus, Marcus Schultz, Bea Spek, Wilma Scholte Op Reimer, Louise Rose
ERJ Open Research 2020 6: 22; DOI: 10.1183/23120541.RFMVC-2020.22
Willemke Stilma
1Amsterdam University of Applied Sciences and Amsterdam UMC, Amsterdam, Netherlands
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  • For correspondence: w.stilma@amsterdamumc.nl
Frederique Paulus
2Amsterdam UMC and Amsterdam University of Applied Sciences, Amsterdam, Netherlands
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Marcus Schultz
3Amsterdam UMC, University of Oxford, Mahidol University, Amsterdam, Netherlands
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Bea Spek
4Amsterdam UMC , Amsterdam, Netherlands
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Wilma Scholte Op Reimer
5Amsterdam University of Applied Sciences, Amsterdam, Netherlands
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Louise Rose
6Kings College London and Sunnybrook Health Science Centre and University of Toronto, London, United Kingdom
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Abstract

Introduction: Few data described practicalities of using mechanical insufflation-exsufflation (MI-E) for invasively ventilated ICU patients and evidence for benefit of their use is lacking.

Aim and objective: To identify barriers and facilitators to use MI-E in invasively ventilated ICU patients, and to explore reasons for their use in various patient indications.

Methods: Four focus group discussions; 3 national (Dutch) and 1 with international representation, each with a purposeful interprofessional sample of a maximum 10 participants with experience in using MI-E in invasively ventilated patients. We developed a semi-structured interview guide informed by the Theoretical Domain Framework. An observer was present in each session. Sessions were audio recorded and transcribed verbatim. Data were analysed using content analysis.

Results: Barriers for MI-E use were lack of evidence and lack of expertise in MI-E, as well as lack of device availability. Facilitators were experience with MI-E and perceived clinical improvement in patients with MI-E use. Common reasons to start using MI-E were difficult weaning, recurrent atelectasis and pneumonia. Main contraindications were, bullous emphysema, ARDS, high PEEP, hemodynamic instability, recent pneumothorax. There was substantial variability on used technical settings of MI-E in invasively ventilated patients.

Conclusions: Key barriers and facilitators to MI-E were lack of evidence, available expertise and perceived clinical improvement. Variability on technical settings likely reflect lack of evidence. Future studies should focus on settings, safety and feasibility of MI-E in invasively ventilated patients before studies on effect can be conducted.

  • Mechanical ventilation - interactions and complications
  • Cough
  • Critically ill patients

Footnotes

Cite this article as: ERJ Open Research 2020; 6: Suppl. 4, 22.

This is an ERS Respiratory Failure and Mechanical Ventilation Conference abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).

  • Copyright ©the authors 2020
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Focus group on mechanical in- exsufflation in invasively ventilated intensive care patients.
Willemke Stilma, Frederique Paulus, Marcus Schultz, Bea Spek, Wilma Scholte Op Reimer, Louise Rose
ERJ Open Research Feb 2020, 6 (suppl 4) 22; DOI: 10.1183/23120541.RFMVC-2020.22

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Focus group on mechanical in- exsufflation in invasively ventilated intensive care patients.
Willemke Stilma, Frederique Paulus, Marcus Schultz, Bea Spek, Wilma Scholte Op Reimer, Louise Rose
ERJ Open Research Feb 2020, 6 (suppl 4) 22; DOI: 10.1183/23120541.RFMVC-2020.22
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