Affordable Access

Access to the full text

Mechanical Insufflation-exsufflation for the Prevention of Ventilator-associated Pneumonia in Intensive Care Units: A Retrospective Cohort Study

  • Kuroiwa, Ryota1
  • Tateishi, Yoshihisa2
  • Oshima, Taku2
  • Inagaki, Takeshi1
  • Furukawa, Seiichiro1
  • Takemura, Ryo3
  • Kawasaki, Yohei4
  • Murata, Astushi1
  • 1 Division of Rehabilitation Medicine, Chiba University Hospital, Chiba, Japan
  • 2 Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
  • 3 Department of Biostatistics Unit, Keio University Hospital, Clinical and Translational Research Center, Tokyo, Japan
  • 4 Department of Biostatistics Section, Chiba University Hospital, Clinical Research Center, Chiba, Japan
Published Article
Indian Journal of Critical Care Medicine : Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine
Jaypee Brothers Medical Publishers
Publication Date
Jan 01, 2021
DOI: 10.5005/jp-journals-10071-23508
PMID: 33603304
PMCID: PMC7874278
PubMed Central


Aim Ventilator-associated pneumonia (VAP) is the most common intensive care unit (ICU)-acquired infection. The current study aimed to assess the efficacy of mechanical insufflation-exsufflation (MI-E) in preventing VAP in critically ill patients. Materials and methods This retrospective cohort study was conducted at the ICU of Chiba University Hospital between January 2014 and September 2017. The inclusion criteria were patients who required invasive mechanical ventilation ≥48 hours and those who underwent rehabilitation, including chest physical therapy (CPT). In 2015, the study institution started the use of MI-E in patients with impaired cough reflex. From January to December 2014, patients undergoing CPT were classified under the historical control group, and those who received treatment using MI-E from January 2015 to September 2017 were included in the intervention group. The patients received treatment using MI-E via the endotracheal or tracheostomy tube, with insufflation-exsufflation pressure of 15–40 cm H2O. The treatment frequency was one to three sessions daily, and a physical therapist who is experienced in using MI-E facilitated the treatment. Results From January 2015 to September 2017, 11 patients received treatment using MI-E. Of the 169 patients screened in 2014, 19 underwent CPT. The incidence of VAP was significantly different between the CPT and MI-E groups (84.2% [16/19] vs 26.4% [3/11], p = 0.011). After adjusting for covariates, a multivariate logistic regression analysis was performed, and results showed that the covariates were not associated with the incidence of VAP. Conclusion This retrospective cohort study suggests that the use of MI-E in critically ill patients is independently associated with a reduced incidence of VAP. Clinical significance Assessing the efficacy of MI-E to prevent VAP. How to cite this article Kuroiwa R, Tateishi Y, Oshima T, Inagaki T, Furukawa S, Takemura R, et al. Mechanical Insufflation-exsufflation for the Prevention of Ventilator-associated Pneumonia in Intensive Care Units: A Retrospective Cohort Study. Indian J Crit Care Med 2021;25(1):62–66.

Report this publication


Seen <100 times