A utilização do insuflador-exsuflador mecânico como técnica de higiene brônquica em pacientes crí­ticos

Authors

  • William Maia Coutinho Centro Universitário Metodista (IPA), Porto Alegre/RS
  • Alexandre Simões Dias Universidade Federal do Rio Grande do Sul, Porto Alegre/RS
  • Luiz Alberto Forgiarini Junior Centro Universitário Metodista (IPA), Porto Alegre/RS

DOI:

https://doi.org/10.33233/fb.v17i3.490

Abstract

Introdução: O desenvolvimento de equipamentos com o objetivo de auxiliar a manutenção da higiene das vias aéreas de doentes hospitalizados proporcionou uma alternativa terapêutica para doentes com tosse ineficaz, seja pela utilização de via aérea artificial ou por incapacidade. O insuflador-exsuflador mecânico objetiva auxiliar na higiene das vias aéreas em pacientes com tosse inefetiva. Este equipamento pode ser benéfico em pacientes intubados, traquestomizados ou incapazes de realizar tosse efetiva. Objetivo: Descrever, através de uma revisão da literatura, os benefí­cios da utilização de insuflador-exsuflador mecânico em pacientes crí­ticos, seja através da utilização de suporte ventilatório ou não, assim como os principais desfechos clí­nicos encontrados nesta população. Material e métodos: Foi realizada uma pesquisa nas bases de dados Lilacs, Medline, Pubmed. Resultados: Foram identificados 23 artigos abordando a utilização do insuflador-exsuflador mecânico e a sua eficácia na higiene brônquica. Conclusão: Diversos estudos abordaram que este equipamento aprimora a higiene brônquica de pacientes com e sem suporte ventilatório invasivo, demonstrando ser uma estratégia segura e viável.

Palavras-chave: ventilação artificial, tosse, secreção, depuração mucociliar, pico de fluxo expiratório. 

Author Biographies

William Maia Coutinho, Centro Universitário Metodista (IPA), Porto Alegre/RS

Acadêmico de fisioterapia do Centro Universitário Metodista (IPA)

Alexandre Simões Dias, Universidade Federal do Rio Grande do Sul, Porto Alegre/RS

Ft., D.Sc.,  Docente do Programa de PoÌs-Graduação em CieÌ‚ncias do Movimento Humano e Ciências PneumoloÌgicas, Universidade Federal do Rio Grande do Sul, Porto Alegre/RS

Luiz Alberto Forgiarini Junior, Centro Universitário Metodista (IPA), Porto Alegre/RS

Docente do Programa de PoÌs-Graduação em Reabilitação e Inclusão e Programa de Pós-graduação em Biociências e Reabilitação, Centro Universitário Metodista – IPA, Porto Alegre/RS  

References

Chartwin M, Simonds AK. The addition of mechanical insufflation/exsufflation shortens airway– clearance sessions in neuromuscular patients with chest infection. Respir Care 2009;54(11):1473-9.

Morrow B, Zampoli M, Van Aswegen H, Argent A. Mechanical insufflation-exufflation for people with neuromuscular disorders (review). Cochrane Database Syst Rev 2013;12:1-34.

Mahede T, Davis G, Rutkay A, Baxendale S, Sun W, Dawkins H et al. Use of mechanical airway clearance devices in the home by people with neuromuscular disorders: effects on health service use and lifestyle benefits. Orphanet J Rare Dis 2015;10:54.

Moran F, Spittle A, Delany C. Lifestyle implications of home mechanical insufflation-exsufflation for children with neuromuscular disease and their families. Respir Care 2015;60(7):967-74.

Homnick DN. Mechanical insufflation-exsufflation for airway mucus clearance. Respir Care 2007;52(10):1296-5.

Nakagawa NK, Franchini ML, Driusso P, Oliveira LR, Saldiva PHN, Lorenzi-Filho G. Mucociliary clearance is impaired in acutely ill patients. Chest 2005;128(4):2772-7.

Maggiore SM, Lellouche F, Pignataro C, Girou E, Maitre B, Richard JCM, et al. Decreasing the adverse effects of endotracheal suctioning during mechanical ventilation by changing practice. Respir Care 2013;58(10):1588-97.

Rello J, Paiva JA, Baraibar J, Barcenilla F, Bodi M, Castander D, et al. International conference for the development of consensus on the diagnosis and treatment of ventilator-associated pneumonia. Chest 2001;120(3):955-70.

Toussaint M. The Use of mechanical insufflation-exsufflation via artificial airways. Respiratory Care 2011;56(8):1217-9.

Volsko TA. Airway clearance therapy: finding the evidence. Respiratory Care 2013;58(10): 1669-78.

Chatwin M, Ross E, Hart N, Nickol AH, Polkey MI, Simonds AK. Cough augmentation with mechanical insufflation/exsufflation in patients with neuromuscular weakness. Eur Respir J 2003;21(3):502-8.

Vianello A, Corrado A, Arcaro G, Gallan F, Ori C, Minuzzo M, et al. Mechanical insufflation-exsufflation improves outcomes for neuromuscular disease patients with respiratory tract infections. Am J Phys Med Rehabil 2005;84(2):83-8.

Chatwin M, Bush A, Simonds AK. Outcome of goal-directed noninvasive ventilation and mechanical insufflation/exsufflation in spinal muscular atrophy type I. Arch Dis Child 2011; 96(5):426-32.

Vitacca M, Paneroni M, Trainini D, Bianchi L, Assoni G, Saleri M, et al. At home and on demand mechanical cough assistance program for patients with amyotrophic lateral sclerosis. Am J Phys Med Rehabil 2010;89(5):401-6.

Winck JC, Gonçalves MR, Lourenço C, Viana P, Almeida J, Bach JR. Effects of mechanical insufflation-exsufflation on respiratory parameters for patients with chronic airway secretion encumbrance. Chest 2004;126(3):774-80.

Prevost S, Brooks D, Bwititi PT. Mechanical insufflation-exsufflation: practice patterns among respiratory therapists in Ontario. Can J Respir Ther 2015;51(2):33-8.

Bach JR, Sinquee DM, Saporito LR, Botticello AL. Efficacy of mechanical insufflation-exsufflation in extubating unweanable subjects with restrictive pulmonary disorders. Respir Care 2015;60(4):477-83.

Bach JR. Mechanical insufflation-exsufflation. Comparison of peak expiratory flows with manually assisted and unassisted coughing techniques. Chest 1993;104(5):1553-62.

Sancho J, Servera E, Vergara P, Marín J. Mechanical insufflation-exsufflation vs. tracheal suctioning via tracheostomy tubes for patients with amyotrophic lateral sclerosis - a pilot study. Am J Phys Med Rehabil 2003;82(10):750-3.

Sancho J, Servera E, Díaz J, Marín J. Efficacy of mechanical insufflation-exsufflation in medically stable patients with amyotrophic lateral sclerosis. Chest 2004;125(4):1400-5.

Crew JD, Svircev JN, Bums SP. Mechanical insufflation-exsufflation device prescription for outpatients with tetraplegia. J Spinal Cord Med 2010;33(2):128-34.

Guérin C, Bourdin G, Leray V, Delannoy B, Bayle F, Germain M et al. Performance of the cough assist insufflation-exsufflation device in the presence of an endotracheal tube or tracheostomy tube: a bench study. Respir Care 2011;56(8):1108-14.

Bourdin G, Guérin C, Leray V, Delannoy B, Debord S, Bayle F et al. Comparison of alpha 200 and cough assist as intermittent positive pressure breathing devices: a bench study. Respir Care 2012;57(7):1129-36.

Gonçalves MR, Honrado T, Winck JC, Paiva JA. Effects of mechanical insufflation-exsufflation in preventing respiratory failure after extubation: a randomized controlled trial. Critical Care 2012;16:R48.

Porot V, Guérin C. Bench assessment of a new insufflation-exsufflation device. Respir Care 2013;58(9):1536-40.

Bach JR, Gonçalves MR, Hamdani I, Winck JC. Extubation of patients with neuromuscular weakness: a new management paradigm. Chest 2010;137(5):1032-9.

Boitano LJ. Management of airway clearance in neuromuscular disease. Respir Care 2006;51(8):913-24.

Rosiere J, Vader J, Cavin MS, Grant K, Larcinese A, Voellinerg R, et al. Appropriateness of respiratory care: evidence-based guidelines. Swiss Med Wkly 2009;139(27-28):387-92.

Published

2016-10-20