DISCUSSION
a neuromuscular disorder, respiratory muscle weakness, tachycardia, respiratory failure, ICUAW, ARF, cough, acute respiratory failure
ARF, RESPIRATORY FAILURE, ACUTE RESPIRATORY FAILURE, ACUTE RESPIRATORY FAILURE, NEUROMUSCULAR DISORDER, COMPLICATIONS
This is the first study evaluating the efficacy of mechanical
insufflation-exsufflation to prevent ARF in a population of intensive care-acquired
weakness ICU patients. The combination of CCPT and MI-E to prevent acute respiratory
failure 48 hours after extubation in patients with ICUAW seems to be ineffective.
Similarly, the reintubation rate, postextubation ICU length of stay, and mortality
at Day 90 were also similar. However, less tracheal suctioning was needed in the
MI-E Group.After extubation, ARF may be related to respiratory muscle weakness and a decrease in
airway clearance efficiency.The in-exsufflation pressure set was +40/-40cmHAnother aspect to be considered is the implementation of NIV as standard care
postextubation in the ICU. Many authors have confirmed that prophylactic and early
use of NIV can decrease the incidence of respiratory failure after
extubation.Acute respiratory failure, reintubation rate and postextubation ICU length are the
most correlated outcomes with mortality.Tracheal suctioning is related to major complications such as tachycardia,
derecruitment, and tracheal mucosa injury.Winck et al. reported a study in 2004 where PCEF was assessed prior to and after MI-E
application. In this study, patients with a neuromuscular disorder increased their
PCEF from 180 to 220L/minute (p < 0.005).However, our results were contradictory to those reported previously. Of note, all
our patients were intubated for a short period of time, so we can expect a lower
impact of PCEF. Consequently, this could explain the absence of no significance
observed in the PCEF evolution in the MI-E Group. Furthermore, PCEF only obtained
correct measurements adequate to be analyzed in 66% of the patients, but this
parameter was a criterion for exit from the study, since PCEF ≥ 270L/minute
was considered a cutoff for an effective cough.Several limitations of this study merit consideration. The major limitation of this
study was that the sample size was not achieved, thus decreasing the study power as
we had a substantially underpower of 12% than the assumed in the sample size
calculation, so our non-significant results should be interpreted with
precaution.Despite this, the probability of finding a significant difference in the primary
outcome as mentioned above is very weak. Therefore, it seems that the possibility of
incurring a type II error is extremely low. A large number of patients using
prophylactic NIV after extubation may explain the low ARF rate in the two
groups.The etiologies of acute respiratory failure etiology are heterogeneous and vast. As
shown recently by Jaber S et al.