TY - JOUR
T1 - Mechanical insufflation-exsufflation for invasively ventilated critically ill patients—A focus group study
T2 - a focus group study
AU - Stilma, Willemke
AU - Verweij, Lotte
AU - Spek, Bea
AU - Scholte op Reimer, Wilhelmina Johanna Maria
AU - Schultz, Marcus Josephus
AU - Paulus, Frederique
AU - Rose, Louise
N1 - Funding Information: Research time for analysis provided by Amsterdam University of Applied Sciences, Urban Vitality for LV; WS holds a personal (PhD fellowship) grant from NWO Netherlands Organisation for Scientific Research, number 023.011.016. Funding information Publisher Copyright: © 2022 The Authors. Nursing in Critical Care published by John Wiley & Sons Ltd on behalf of British Association of Critical Care Nurses.
PY - 2023/11
Y1 - 2023/11
N2 - Introduction: Mechanical Insufflation-Exsufflation (MI-E) is used as an airway clearance intervention in primary care (home ventilation), long-term care (prolonged rehabilitation after intensive care, neuromuscular diseases, and spinal cord injury), and increasingly in acute care in intensive care units (ICU). Aim: We sought to develop in-depth understanding of factors influencing decision-making processes of health care professionals regarding initiation, escalation, de-escalation, and discontinuation of MI-E for invasively ventilated patients including perceived barriers and facilitators to use. Methods: We conducted focus groups (3 in the Netherlands; 1 with participants from four European countries) with clinicians representing the ICU interprofessional team and with variable experience of MI-E. The semi-structured interview guide was informed by the Theoretical Domains Framework (TDF). Two researchers independently coded data for directed content analysis using codes developed from the TDF. Results: A purposive sample of 35 health care professionals participated. Experience varied from infrequent to several years of frequent MI-E use in different patient populations. We identified four main themes: (1) knowledge; (2) beliefs; (3) clinical decision-making; and (4) future adoption. Conclusion: Interprofessional knowledge and expertise of MI-E in invasively ventilated patients is limited due to minimal available evidence and adoption. Participants believed MI-E a potentially useful intervention for airway clearance and inclusion in weaning protocols when more evidence is available. Relevance to Clinical Practice: This focus group study provides an overview of current practice, knowledge and expertise, and barriers and facilitators to using MI-E in mechanically ventilated patients. From these data, it is evident there is a need to develop further clinical expertise and evidence of efficacy to further understand the role of MI-E as an airway clearance technique for ventilated patients.
AB - Introduction: Mechanical Insufflation-Exsufflation (MI-E) is used as an airway clearance intervention in primary care (home ventilation), long-term care (prolonged rehabilitation after intensive care, neuromuscular diseases, and spinal cord injury), and increasingly in acute care in intensive care units (ICU). Aim: We sought to develop in-depth understanding of factors influencing decision-making processes of health care professionals regarding initiation, escalation, de-escalation, and discontinuation of MI-E for invasively ventilated patients including perceived barriers and facilitators to use. Methods: We conducted focus groups (3 in the Netherlands; 1 with participants from four European countries) with clinicians representing the ICU interprofessional team and with variable experience of MI-E. The semi-structured interview guide was informed by the Theoretical Domains Framework (TDF). Two researchers independently coded data for directed content analysis using codes developed from the TDF. Results: A purposive sample of 35 health care professionals participated. Experience varied from infrequent to several years of frequent MI-E use in different patient populations. We identified four main themes: (1) knowledge; (2) beliefs; (3) clinical decision-making; and (4) future adoption. Conclusion: Interprofessional knowledge and expertise of MI-E in invasively ventilated patients is limited due to minimal available evidence and adoption. Participants believed MI-E a potentially useful intervention for airway clearance and inclusion in weaning protocols when more evidence is available. Relevance to Clinical Practice: This focus group study provides an overview of current practice, knowledge and expertise, and barriers and facilitators to using MI-E in mechanically ventilated patients. From these data, it is evident there is a need to develop further clinical expertise and evidence of efficacy to further understand the role of MI-E as an airway clearance technique for ventilated patients.
KW - barriers and facilitators
KW - cough assist
KW - critical care
KW - invasive ventilation
KW - mechanical insufflation-exsufflation
UR - http://www.scopus.com/inward/record.url?scp=85143242321&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/nicc.12858
DO - https://doi.org/10.1111/nicc.12858
M3 - Article
C2 - 36464804
SN - 1362-1017
VL - 28
SP - 923
EP - 930
JO - Nursing in critical care
JF - Nursing in critical care
IS - 6
ER -