RT Journal Article
SR Electronic
T1 Focus group on mechanical in- exsufflation in invasively ventilated intensive care patients.
JF ERJ Open Research
JO erjor
FD European Respiratory Society
SP 22
DO 10.1183/23120541.RFMVC-2020.22
VO 6
IS suppl 4
A1 Willemke Stilma
A1 Frederique Paulus
A1 Marcus Schultz
A1 Bea Spek
A1 Wilma Scholte Op Reimer
A1 Louise Rose
YR 2020
UL http://openres.ersjournals.com/content/6/suppl_4/22.abstract
AB 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.FootnotesCite 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).