Effect of mechanical insufflation-exsufflation technique on the prevention and treatment of pulmonary infection in ICU patients with weak or absent cough reflex

doi:10.3969/j.issn.1004-583X.2026.08.004

Abstract

Abstract:

Objective To investigate the efficacy of the mechanical insufflation-exsufflation (MI-E) in preventing and treating pulmonary infection in intubated or tracheostomized ICU patients with weak or absent cough reflex. Methods A randomized controlled trial was conducted in 115 intubated or tracheostomized patients with weak or absent cough reflex admitted to the ICU of Hebei General Hospital from January 2022 to December 2023, including 57 patients in the observation group and 58 in the control group. The control group received conventional airway clearance measures, such as chest percussion and sputum expectoration, postural drainage, nebulization, induced coughing, and suctioning. The observation group received airway clearance using the MI-E to simulate physiological coughing. The two groups were compared in terms of percutaneous oxygen saturation (SpO₂), blood gas parameters, incidence of pulmonary infection, pulmonary infection control rate, Clinical Pulmonary Infection Score (CPIS), ICU length of stay (days), and total hospital stay (days). Results After treatment, the observation group had better SpO₂ and blood gas parameters than the control group: SpO₂ (95.84±1.77)% vs (92.84±1.23)%, arterial partial pressure of oxygen (PaO₂) (82.45±2.91) mmHg vs (70.89±2.06) mmHg, arterial partial pressure of carbon dioxide (PaCO₂) (37.29±0.88) mmHg vs (41.10±1.06) mmHg, alveolar-arterial oxygen difference (A-aDO₂) (28.32±3.03) mmHg vs (35.55±2.46) mmHg, and oxygenation index (301.65±9.21) mmHg vs (280.98±4.90) mmHg. The incidence of pulmonary infection in the observation group was 3.5% (2/57), lower than 15.5% (9/58) in the control group (P<0.05); the pulmonary infection control rate in the observation group was 38.6% (22/57), higher than 20.7% (12/58) in the control group (P<0.05). The CPIS score in the observation group was (5.53±1.12), lower than that in the control group (6.48±0.10) (P<0.05). The length of ICU stay in the observation group was (7.41±0.67) d, shorter than that in the control group (10.06±0.98) d (P<0.05). There was no statistically significant difference in total length of hospital stay between the two groups (P>0.05). Conclusion Applying the MI-E for airway management in intubated or tracheostomized ICU patients with weak or absent cough reflex can significantly reduce sputum retention, improve blood gas parameters such as the oxygenation index, control pulmonary infection, and shorten ICU stay. The technique is feasible, safe, and worthy of wider clinical application.

Key words: pneumonia, endotracheal intubation, tracheostomy, mechanical insufflation-exsufflation (MI-E), cough reflex, airway secretions

CLC Number:

R563.1

Chen Zhi, Ding Pengyan, Hao Guizhen, Li Yulong, Niu Shiliang, Shen Limin, Liu Chunxia. Effect of mechanical insufflation-exsufflation technique on the prevention and treatment of pulmonary infection in ICU patients with weak or absent cough reflex[J]. Clinical Focus, 2026, 41(8): 695-699.

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URL: https://www.lchc.cn/EN/10.3969/j.issn.1004-583X.2026.08.004

https://www.lchc.cn/EN/Y2026/V41/I8/695

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References 22

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组别	例数	性别(例)		年龄 (岁)	APACHⅡ评分 (分)	原发病[例(%)]
组别	例数	男	女	年龄 (岁)	APACHⅡ评分 (分)	COPD	神经肌肉疾病	脑卒中	颅脑损伤	重症肺炎
观察组	57	33	24	68.4±14.8	21.6±5.4	7(12.3)	17(29.8)	8(14.0)	18(31.6)	7(12.3)
对照组	58	36	22	68.1±11.2	20.9±7.5	6(10.3)	17(29.3)	9(15.5)	18(31.0)	8(13.8)
χ²/t值		0.209		0.132	1.279	0.194
P值		0.648		0.895	0.203	0.996

组别	例数	性别(例)		年龄 (岁)	APACHⅡ评分 (分)	原发病[例(%)]
组别	例数	男	女	年龄 (岁)	APACHⅡ评分 (分)	COPD	神经肌肉疾病	脑卒中	颅脑损伤	重症肺炎
观察组	57	33	24	68.4±14.8	21.6±5.4	7(12.3)	17(29.8)	8(14.0)	18(31.6)	7(12.3)
对照组	58	36	22	68.1±11.2	20.9±7.5	6(10.3)	17(29.3)	9(15.5)	18(31.0)	8(13.8)
χ²/t值		0.209		0.132	1.279	0.194
P值		0.648		0.895	0.203	0.996

组别	例数		SpO₂(%)			PaO₂(mmHg)			PaCO₂(mmHg)
组别	例数		治疗前	治疗后		治疗前		治疗后	治疗前		治疗后
观察组	57		89.89±1.84	95.84±1.77^*		62.41±1.72		82.45±2.91^*	48.01±3.28		37.29±0.88^*
对照组	58		90.10±2.17	92.84±1.23^*		62.80±2.19		70.89±2.06^*	48.86±2.04		41.10±1.06^*
t值			-0.557	10.571		-1.070		24.593	-1.667		-15.758
P值			0.579	<0.01		0.287		<0.01	0.098		<0.01
组别		A-aDO₂(mmHg)					氧合指数(mmHg)
组别		治疗前			治疗后		治疗前			治疗后
观察组		40.26±3.17			28.32±3.03^*		244.03±7.61			301.65±9.21^*
对照组		39.86±3.97			35.55±2.46^*		246.80±8.71			280.98±4.90^*
t值		0.598			-14.074		-1.814			15.064
P值		0.551			<0.01		0.072			<0.01

组别	例数		SpO₂(%)			PaO₂(mmHg)			PaCO₂(mmHg)
组别	例数		治疗前	治疗后		治疗前		治疗后	治疗前		治疗后
观察组	57		89.89±1.84	95.84±1.77^*		62.41±1.72		82.45±2.91^*	48.01±3.28		37.29±0.88^*
对照组	58		90.10±2.17	92.84±1.23^*		62.80±2.19		70.89±2.06^*	48.86±2.04		41.10±1.06^*
t值			-0.557	10.571		-1.070		24.593	-1.667		-15.758
P值			0.579	<0.01		0.287		<0.01	0.098		<0.01
组别		A-aDO₂(mmHg)					氧合指数(mmHg)
组别		治疗前			治疗后		治疗前			治疗后
观察组		40.26±3.17			28.32±3.03^*		244.03±7.61			301.65±9.21^*
对照组		39.86±3.97			35.55±2.46^*		246.80±8.71			280.98±4.90^*
t值		0.598			-14.074		-1.814			15.064
P值		0.551			<0.01		0.072			<0.01

组别	例数	肺部感染发生率	肺部感染控制率
观察组	57	2(3.5)	22(38.6)
对照组	58	9(15.5)	12(20.7)
χ²值		4.792	4.427
P值		0.029	0.035