A Successful Prevention of Reintubation Using the Mechanical Insufflation-Exsufflation in a Critically Ill Patient With Impaired Airway Mucus Expectoration: A Case Report.

Publication date: Oct 01, 2023

We report a case of post-extubation respiratory failure due to insufficient airway mucus expectoration that was successfully treated using mechanical insufflation-exsufflation (MI-E). A 32-year-old woman with a long-term history of steroid therapy for Blau syndrome was admitted to our intensive care unit with refractory hypoxemia due to pneumonia associated with the novel coronavirus disease 2019. Mechanical ventilation with veno-venous extracorporeal membrane oxygenation (VV-ECMO) was required due to severe hypoxemia. She was weaned from VV-ECMO on the 10th day and extubated on the 13th day. A few hours after extubation, she presented respiratory distress due to massive pulmonary atelectasis caused by sputum accumulation as a result of the impaired cough reflex. MI-E was applied to facilitate coughing and sputum expectoration. MI-E dramatically improved the atelectasis and prevented reintubation. This case suggests that MI-E, which is primarily used to treat chronic neuromuscular diseases, may also be effective in treating acute respiratory failure.

Concepts Keywords
10th acute respiratory failure
Coronavirus airway management
Hours cough augmentation
Hypoxemia intensive care unit
Therapy mechanical insufflation-exsufflation
musculoskeletal rehabilitation
reintubation
respiratory care

Semantics

Type Source Name
disease MESH Critically Ill
disease VO report
disease MESH respiratory failure
disease IDO history
disease MESH Blau syndrome
disease MESH pneumonia
disease MESH coronavirus disease 2019
disease MESH pulmonary atelectasis
disease MESH neuromuscular diseases
disease VO effective

Original Article

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