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Objective: To evaluate the feasibility of adding mechanical insufflation-exsufflation (MI-E) to a weaning protocol for tracheostomized patients undergoing prolonged mechanical ventilation (MV).

Design: Single-center, open-label, randomized, controlled pilot and feasibility study.

Setting: Intensive care unit in Brazil.

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Article Synopsis
  • Existing Mechanical Insufflation-Exsufflation (MI-E) devices fail to adequately control cough airflow pressure during expiration, risking airway collapse and damage.
  • This study aims to improve cough assist systems by implementing PID and adaptive control methods to better regulate airway pressure.
  • The adaptive control method enhances pressure tracking and peak flow rates for mucus clearance, demonstrating significant clinical safety and therapeutic benefits, particularly for critically ill patients with mucus clearance challenges.
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Accuracy of Real-Time Data Provided by Mechanical Insufflation-Exsufflation Devices.

Respir Care

October 2024

Drs Martinez-Alejos, Fresnel, and Lebret are affiliated with the Kernel Biomedical. Rouen, France.

Background: Mechanical insufflation-exsufflation (MI-E) is crucial to assist patients with impaired cough, especially those with neuromuscular diseases. Despite recent advancements that enable real-time display of peak expiratory flow (PEF) and inspiratory volume, accurately monitoring these parameters with MI-E devices during treatment can still present challenges.

Methods: A bench study that used a mechanical lung connected to 3 MI-E devices (EOVE-70; E-70 and Comfort Cough II) was conducted to evaluate PEF and inspiratory volume monitoring accuracy.

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Dyspnea is a common symptom in neuromuscular disorders and, although multifactorial, it is usually due to respiratory muscle involvement, associated musculoskeletal changes such as scoliosis or, in certain neuromuscular conditions, cardiomyopathy. Clinical history can elicit symptoms such as orthopnea, trepopnea, sleep disruption, dysphagia, weak cough, and difficulty with secretion clearance. The examination is essential to assist with the diagnosis of an underlying neurologic disorder and determine whether dyspnea is from a cardiac or pulmonary origin.

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[Expert recommendations on the clinical application of mechanical insufflation-exsufflation in mechanically ventilated patients (2024)].

Zhonghua Wei Zhong Bing Ji Jiu Yi Xue

August 2024

Corresponding author: Wang Yuefu, Department of Surgical Critical Care Medicine, Emergency and Critical Care Medical Center, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, Email: Zhu Fengxue, Department of Critical Care Medicine, Peking University People's Hospital, Beijing, 100044, Email: Zhou Jianxin, Chinese Society of Critical Care Medicine, Beijing, 100038, Email:

Mechanical ventilated patients are a high-risk group with impaired cough ability and require corresponding medical techniques for cough assistance to clear airway secretions. Mechanical insufflation-exsufflation (MI-E) technology is widely used in patients with cough weakness caused by neuromuscular diseases. However, there is currently a lack of standardized application procedures for mechanically ventilated patients who retain artificial airways, which can affect treatment outcomes.

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