Mechanical insufflation-exsufflation for invasively ventilated critically ill patients-A focus group study

Area of Science:

• Respiratory Care
• Critical Care Medicine
• Pulmonary Rehabilitation

Background:

• Mechanical Insufflation-Exsufflation (MI-E) is utilized for airway clearance across various healthcare settings, including home ventilation, long-term care, and intensive care units (ICUs).
• Understanding the decision-making processes of healthcare professionals regarding MI-E initiation, escalation, de-escalation, and discontinuation is crucial for optimizing its application in invasively ventilated patients.

Purpose of the Study:

• To explore factors influencing healthcare professionals' decisions on using Mechanical Insufflation-Exsufflation (MI-E) in invasively ventilated patients.
• To identify perceived barriers and facilitators affecting the adoption and utilization of MI-E by clinicians.

Main Methods:

• Focus groups were conducted with 35 interprofessional ICU clinicians from the Netherlands and other European countries.
• A semi-structured interview guide, informed by the Theoretical Domains Framework (TDF), was used to gather data.
• Directed content analysis was performed by two independent researchers using TDF-derived codes.

Main Results:

• Limited interprofessional knowledge and expertise regarding MI-E in invasively ventilated patients were identified, attributed to scarce evidence and adoption.
• Clinicians perceived MI-E as a potentially beneficial airway clearance intervention and a valuable component of weaning protocols, contingent on further evidence.
• Four primary themes emerged: knowledge, beliefs, clinical decision-making, and future adoption of MI-E.

Conclusions:

• Current clinical practice, knowledge, and expertise surrounding MI-E in mechanically ventilated patients reveal significant barriers and facilitators.
• There is a clear need to develop enhanced clinical expertise and robust evidence of efficacy to fully elucidate the role of MI-E as an airway clearance technique.