Mechanical Insufflation-Exsufflation: Considerations for Improving Clinical Practice

The provision of mechanical insufflation-exsufflation (MI-E) devices to enhance cough efficacy is increasing. Typically, MI-E devices are used to augment cough in patients with neuromuscular disorders but also in patients who are weak in an acute care setting. Despite a growing evidence base for the use of these devices, there are barriers to the provision of MI-E, including clinician lack of knowledge and confidence. Enhancing clinician education and confidence is key. Individualized or protocolized approaches can be used to initiate MI-E. Evaluation of MI-E efficacy is critical. One method to evaluate effectiveness of MI-E is the MI-E-assisted cough peak flow (CPF). However, this should always be considered alongside other factors discussed in this review. The purpose of this review is to increase the theoretical understanding of the provision and evaluation of MI-E and provide insight into how this knowledge can be applied into clinical practice. Approaches to initiation and titration can be selected based on the clinical situation, patient diagnosis (including and beyond neuromuscular disorders), and clinician's confidence.

Automated summary

The use of mechanical insufflation-exsufflation (MI-E) devices to enhance cough efficacy is on the rise. These devices are commonly used for patients with neuromuscular disorders and weak patients in acute care settings. However, there are barriers to providing MI-E, such as lack of knowledge and confidence among clinicians. Educating and building confidence in clinicians is crucial. Different approaches can be used to initiate and evaluate MI-E, including the assessment of cough peak flow (CPF). This review aims to enhance theoretical understanding and provide insights on the provision and evaluation of MI-E for clinical practice. The choice of initiation and titration methods should be based on the clinical situation, patient diagnosis (including neuromuscular disorders and beyond), and clinician's confidence.