Mechanical Insufflation-Exsufflation in Preventing Post Extubation Respiratory Failure in Patient With Critical Care Neuromyopathy

Critical Care Neuromyopathy (CCN) occur in 25% of patient in Intensive Care Unit (ICU). Respiratory failure after extubation is a relevant consequences of poor airway clearance due to respiratory muscle weakness. Respiratory failure is a major cause for reintubation which increase severity of illness, this is an independent risk factor for nosocomial pneumonia, increased hospital stay and mortality. Currently, respiratory physiotherapy includes, manual expiration assist often associated with nasotracheal aspiration. Despite of this care, respiratory failure occur in 30% of patients within 48 after planned extubation. MI-E has been evaluated for neuromuscular disease patient, and increase peak cough flow and the airway clearance. So the beneficials effects of MI-E should be confirmed in a trial in this specific population.

We planned to conduct a study evaluating the efficacy of MI-E in the prevention of extubation failure and mortality in these patients. If no signs of respiratory failure appeared after 120 min of a spontaneous breathing trial, patients will be extubated and randomly allocated after extubation to MI-E group or control group. The clinical follow-up will be as follow: the incidence of extubation failure, the reintubation, the ICU or 28-day survival,90-day survival, ICU length of stay.

Inclusion criteria

• Male or female patient aged ≥ 18 years.
• Patient admitted in participant ICU.
• Patient intubated for 48 hours at least.
• Patient presenting an ICU acquired neuromuscular disorders.

Exclusion criteria

• Respiratory or haemodynamic instability.
• Patient having a contraindication to use face mask (Recent facial surgery, severe craniofacial trauma,…) gastroesophageal surgery.
• Severe ventricular rhythm disorders.
• Patient with tracheotomy.
• Uncontrollable vomiting.
• Severe sepsis.
• Upper airway disorders.
• Upper gastrointestinal bleeding.
• Any decision to limit therapeutic effort in the ICU.
• Patient with limit therapeutic effort in the ICU with unsuccessful spontaneous respiratory trial.