{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T05:25:28Z","timestamp":1793942728829,"version":"4.8.0"},"reference-count":26,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of the Intensive Care Society"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Invasively ventilated, critically ill children are at risk of retained respiratory secretions, which can obstruct airways, impair gas exchange, and cause lung collapse or ventilator-acquired pneumonia. Endotracheal suctioning partially removes secretions, but additional airway clearance interventions may be required. Mechanical insufflation-exsufflation (MI-E), is a cough augmentation device used to improve secretion clearance in adult intensive care, however it is not well characterised in paediatrics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim:<\/jats:title>\n                    <jats:p>To explore MI-E use in invasively ventilated, critically ill children.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method:<\/jats:title>\n                    <jats:p>This multi-methods study used an anonymous, electronic survey of UK-based paediatric physiotherapists. A scoping review searched seven electronic databases (1995\u20132025), using key terms (\u201cairway clearance technique*\u201d) OR (\u201cmechanical insufflation exsufflation\u201d) AND (\u201cmechanical ventilation\u201d) OR (\u201cinvasive ventilation\u201d). Data were analysed descriptively for both methods, with content analysis for free text survey responses. Mixed-evidence, narrative integration compared and contrasted survey and scoping review findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Twenty-nine physiotherapists from across the UK completed the survey, 76% (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200922\/29) were advanced specialists, and all reported access to an MI-E device. Six studies (2010\u20132024), one prospective, the remaining retrospective or case studies, were identified. Both data sources indicated MI-E was most frequently used with acutely unwell neuromuscular patients, though survey responses described a broader clinical application, including children with complex neurological conditions, general respiratory illnesses, trauma, and post-operative surgical or orthopaedic needs. MI-E settings and outcomes were inconsistently reported. Contraindications aligned across sources.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>MI-E appears increasingly accessible within paediatric critical care. Future research should assess MI-E safety in intubated patients and investigate broader critically ill populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17511437261488698","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T06:29:56Z","timestamp":1790317796000},"page":"440-450","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["The use of mechanical insufflation-exsufflation in invasively ventilated critically ill children"],"prefix":"10.1177","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9352-5388","authenticated-orcid":false,"given":"Lisa","family":"Edel","sequence":"first","affiliation":[{"name":"Physiotherapy Department, Great Ormond Street Hospital, London, UK"},{"name":"University College London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1507-6748","authenticated-orcid":false,"given":"Ema","family":"Swingwood","sequence":"additional","affiliation":[{"name":"Bristol Foundation Trust, UK"},{"name":"University of the West of England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte","family":"Donovan","sequence":"additional","affiliation":[{"name":"Physiotherapy Department, Great Ormond Street Hospital, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harriet","family":"Shannon","sequence":"additional","affiliation":[{"name":"University College London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7344-6925","authenticated-orcid":false,"given":"Emma","family":"Shkurka","sequence":"additional","affiliation":[{"name":"Physiotherapy Department, Great Ormond Street Hospital, London, UK"},{"name":"University College London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,24]]},"reference":[{"key":"e_1_3_2_2_2","unstructured":"PICANet Data Dashboard. 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