Mechanical insufflation-exsufflation for clinical outcomes in mechanically ventilated critically ill patients: A systematic review and meta-analysis
8 affiliations
- 1Department of Physical Therapy, School of Health Sciences Tokyo University of Technology
- 2Department of Rehabilitation Services Tokai University Hospital
- 3Department of Physical Therapy, Faculty of Health Sciences SBC Tokyo Medical University
- 4Division of Physical Therapy, Department of Rehabilitation, School of Nursing and Rehabilitation Showa Medical University
- 5Department of Rehabilitation Showa General Hospital
- 6Department of Rehabilitation Shinshu University Hospital
- 7Department of Rehabilitation St. Marianna University Hospital
- 8Department of Physical Therapy, Faculty of Health Science Kyorin University
Abstract
Background: This systematic review and meta-analysis aimed to evaluate the clinical efficacy of mechanical insufflation-exsufflation (MI-E) compared with usual care in mechanically ventilated critically ill adults. # Methods We searched Embase, MEDLINE via PubMed, CINAHL, and the Cochrane Library for randomized controlled trials (RCTs) published up to April 2026 that compared MI-E with usual care in mechanically ventilated adults. The primary outcome was duration of mechanical ventilation. Secondary outcomes included the amount of aspirated airway secretions, respiratory system compliance, airway resistance, length of ICU stay, and mortality. Meta-analysis was performed when at least two studies provided clinically and methodologically comparable data. The certainty of evidence was assessed using the GRADE approach. # Results Six RCTs involving 492 participants were included. For the primary outcome of mechanical ventilation duration, only one RCT contributed to the effect estimate (MD, −2.67 days; 95% CI, −6.91 to 1.57; very-low-certainty evidence). MI-E increased the amount of aspirated airway secretions compared with usual care (MD, 1.47 g; 95% CI, 0.74 to 2.19; very-low-certainty evidence). No statistically significant differences were observed in respiratory system compliance or airway resistance. ICU length of stay also showed no difference (2 RCTs; MD, −1.75 days; 95% CI, −4.61 to 1.10; very-low-certainty evidence). Mortality was evaluated by one RCT (risk ratio, 1.56; 95% CI, 0.44 to 5.50; very-low-certainty evidence). # Conclusions The effects of MI-E on clinical outcomes in mechanically ventilated critically ill patients remain uncertain because the available evidence is of low to very low certainty. MI-E may improve airway secretion clearance; however, evidence regarding mechanical ventilation duration, ICU length of stay, and mortality remains very uncertain. Further high-quality randomized controlled trials are required.
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BibTeX
@article{takahashi2026mechanical,
title = {{Mechanical insufflation-exsufflation for clinical outcomes in mechanically ventilated critically ill patients: A systematic review and meta-analysis}},
author = {Yuta Takahashi and Tsuyoshi Ichikawa and Soh Imamura and Hiroyasu Inoue and Tatsuya Okawa and Yusuke Kawamura and Yasunari Sakai and Shuichi Nakada and Shinya Matsushima and Shuhei Yamamoto},
journal = {Canadian Journal of Respiratory Therapy: CJRT = Revue Canadienne de la Thérapie Respiratoire : RCTR},
year = {2026},
month = nov,
doi = {10.29390/001c.172969},
url = {https://doi.org/10.29390/001c.172969},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Mechanical insufflation-exsufflation for clinical outcomes in mechanically ventilated critically ill patients: A systematic review and meta-analysis
AU - Yuta Takahashi
AU - Tsuyoshi Ichikawa
AU - Soh Imamura
AU - Hiroyasu Inoue
AU - Tatsuya Okawa
AU - Yusuke Kawamura
AU - Yasunari Sakai
AU - Shuichi Nakada
AU - Shinya Matsushima
AU - Shuhei Yamamoto
PY - 2026
DA - 2026/11/02
JO - Canadian Journal of Respiratory Therapy: CJRT = Revue Canadienne de la Thérapie Respiratoire : RCTR
DO - 10.29390/001c.172969
UR - https://doi.org/10.29390/001c.172969
AB - Background: This systematic review and meta-analysis aimed to evaluate the clinical efficacy of mechanical insufflation-exsufflation (MI-E) compared with usual care in mechanically ventilated critically ill adults. # Methods We searched Embase, MEDLINE via PubMed, CINAHL, and the Cochrane Library for randomized controlled trials (RCTs) published up to April 2026 that compared MI-E with usual care in mechanically ventilated adults. The primary outcome was duration of mechanical ventilation. Secondary outcomes included the amount of aspirated airway secretions, respiratory system compliance, airway resistance, length of ICU stay, and mortality. Meta-analysis was performed when at least two studies provided clinically and methodologically comparable data. The certainty of evidence was assessed using the GRADE approach. # Results Six RCTs involving 492 participants were included. For the primary outcome of mechanical ventilation duration, only one RCT contributed to the effect estimate (MD, −2.67 days; 95% CI, −6.91 to 1.57; very-low-certainty evidence). MI-E increased the amount of aspirated airway secretions compared with usual care (MD, 1.47 g; 95% CI, 0.74 to 2.19; very-low-certainty evidence). No statistically significant differences were observed in respiratory system compliance or airway resistance. ICU length of stay also showed no difference (2 RCTs; MD, −1.75 days; 95% CI, −4.61 to 1.10; very-low-certainty evidence). Mortality was evaluated by one RCT (risk ratio, 1.56; 95% CI, 0.44 to 5.50; very-low-certainty evidence). # Conclusions The effects of MI-E on clinical outcomes in mechanically ventilated critically ill patients remain uncertain because the available evidence is of low to very low certainty. MI-E may improve airway secretion clearance; however, evidence regarding mechanical ventilation duration, ICU length of stay, and mortality remains very uncertain. Further high-quality randomized controlled trials are required.
SN - 1205-9838
SN - 2368-6820
ER -