NEUROMIE
Trial question
What is the effect of mechanical insufflation-exsufflation in patients with ICU-acquired weakness?
Study design
Single center
Open label
RCT
Population
Characteristics of study participants
38.0% female
62.0% male
N = 122
122 patients (46 female, 76 male).
Inclusion criteria: adult patients diagnosed with ICU-acquired weakness.
Key exclusion criteria: respiratory and/or hemodynamic instability; contraindication for the use of a facial mask; recent upper gastrointestinal surgery or bleeding; severe ventricular arrhythmia; uncontrollable vomiting; upper airway obstruction; tracheomalacia; severe sepsis; undrained pneumothorax; tracheotomized patients.
Interventions
N=61 mechanical insufflation-exsufflation (conventional chest physiotherapy associated with mechanical insufflation-exsufflation).
N=61 conventional chest physiotherapy (conventional chest physiotherapy performed for the first 48 hours).
Primary outcome
Incidence of acute respiratory failure within 48 hours after extubation
16.4%
11.5%
16.4 %
12.3 %
8.2 %
4.1 %
0.0 %
Mechanical
insufflation-exsufflation
Conventional chest
physiotherapy
No significant
difference ↔
No significant difference in incidence of acute respiratory failure within 48 hours after extubation (16.4% vs. 11.5%; RR 1.4, 95% CI -3.66 to 6.46).
Secondary outcomes
No significant difference in reintubation in 48 hours after extubation (10.7% vs. 3.6%; RR 3, 95% CI -2.3 to 8.3).
Borderline significant increase in postextubation ICU length of stay (4 days vs. 3 days).
Significant decrease in need for at least one airway suctioning during session (11.7% vs. 31.1%; RR 0.38, 95% CI 0.09 to 0.67).
Conclusion
In adult patients diagnosed with ICU-acquired weakness, mechanical insufflation-exsufflation was not superior to conventional chest physiotherapy with respect to incidence of acute respiratory failure within 48 hours after extubation.
Reference
Philippe Wibart, Thomas Réginault, Margarita Garcia-Fontan et al. Effects of mechanical in-exsufflation in preventing postextubation acute respiratory failure in intensive care acquired weakness patients: a randomized controlled trial. Crit Care Sci. 2023 Apr-Jun;35(2):168-176.
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