{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T21:51:27Z","timestamp":1790459487552,"version":"4.1.0"},"reference-count":27,"publisher":"SAGE Publications","issue":"12","license":[{"start":{"date-parts":[[2022,8,30]],"date-time":"2022-08-30T00:00:00Z","timestamp":1661817600000},"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":["Respir Care"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Mechanical insufflation-exsufflation (MI-E) has been proposed as a potential strategy to generate high expiratory flows and simulate cough in the critically ill. However, efficacy and safety of MI-E during invasive mechanical ventilation are still to be fully elucidated. This study in intubated and mechanically ventilated pigs aimed to evaluate the effects of 8 combinations of insufflation-exsufflation pressures during MI-E on mucus displacement, respiratory flows, as well as respiratory mechanics and hemodynamics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>\n                      Six healthy Landrace-Large White female pigs were orotracheally intubated, anesthetized, and invasively ventilated for up to 72 h. Eight combinations of insufflation-exsufflation pressures (+40\/\u221240, +40\/\u221250, +40\/\u221260, +40\/\u221270, +50\/\u221240, +50\/\u221250, +50\/\u221260, +50\/\u221270 cm H\n                      <jats:sub>2<\/jats:sub>\n                      O) were applied in a randomized order. The MI-E device was set to automatic mode, medium inspiratory flow, and an inspiratory-expiratory time 3 and 2 s, respectively, with a 1-s pause between cycles. We performed 4 series of 5 insufflation-exsufflation cycles for each combination of pressures. Velocity and direction of movement of a mucus simulant containing radio-opaque markers were assessed through sequential lateral fluoroscopic images of the trachea. We also evaluated respiratory flows, respiratory mechanics, and hemodynamics before, during, and after each combination of pressures.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      In 3 of the animals, experiments were conducted twice; and for the remaining 3, they were conducted once. In comparison to baseline mucus movement (2.85 \u00b1 2.06 mm\/min), all insufflation-exsufflation pressure combinations significantly increased mucus velocity (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .01). Particularly, +40\/\u221270 cm H\n                      <jats:sub>2<\/jats:sub>\n                      O was the most effective combination, increasing mucus movement velocity by up to 4.8-fold (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001). Insufflation pressure of +50 cm H\n                      <jats:sub>2<\/jats:sub>\n                      O resulted in higher peak inspiratory flows (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .004) and inspiratory transpulmonary pressure (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001) than +40 cm H\n                      <jats:sub>2<\/jats:sub>\n                      O.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>\n                      MI-E appeared to be an efficient strategy to improve mucus displacement during invasive ventilation, particularly when set at +40\/\u221270 cm H\n                      <jats:sub>2<\/jats:sub>\n                      O. No safety concerns were identified although a transient significant increase of transpulmonary pressure was observed.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.4187\/respcare.10173","type":"journal-article","created":{"date-parts":[[2022,8,30]],"date-time":"2022-08-30T08:00:21Z","timestamp":1661846421000},"page":"1508-1516","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":20,"title":["Effects of Mechanical Insufflation-Exsufflation With Different Pressure Settings on Respiratory Mucus Displacement During Invasive Ventilation"],"prefix":"10.1177","volume":"67","author":[{"given":"Joan-Daniel","family":"Mart\u00ed","sequence":"first","affiliation":[{"name":"Cardiac Surgery Critical Care Unit, Institut Clinic Cardiovascular, Hospital Cl\u00ednic, Barcelona, Spain; and Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer, Barcelona, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Mart\u00ednez-Alejos","sequence":"additional","affiliation":[{"name":"Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer, Barcelona, Spain; and Saint Eloi Department of Critical Care Medicine and Anesthesiology, Montpellier University Hospital and School of Medicine, Montpellier, France."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xabier","family":"Pilar-Diaz","sequence":"additional","affiliation":[{"name":"Bordeaux University Hospital, Bordeaux, France."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hua","family":"Yang","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Critical Care Unit, Institut Clinic Cardiovascular, Hospital Cl\u00ednic, Barcelona, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Pagliara","sequence":"additional","affiliation":[{"name":"Policlinico San Martino, Genova, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denise","family":"Battaglini","sequence":"additional","affiliation":[{"name":"Policlinico San Martino, Genova, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Meli","sequence":"additional","affiliation":[{"name":"ASST Santi Paolo e Carlo, Milano, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milan","family":"Yang","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Critical Care Unit, Institut Clinic Cardiovascular, Hospital Cl\u00ednic, Barcelona, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joaquim","family":"Bobi","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Critical Care Unit, Institut Clinic Cardiovascular, Hospital Cl\u00ednic, Barcelona, Spain; and Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer, Barcelona, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monsterrat","family":"Rigol","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Critical Care Unit, Institut Clinic Cardiovascular, Hospital Cl\u00ednic, Barcelona, Spain; and Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer, Barcelona, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oystein","family":"Tronstad","sequence":"additional","affiliation":[{"name":"Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia; and Physiotherapy Department, The Prince Charles Hospital, Brisbane, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcia Souza","family":"Volpe","sequence":"additional","affiliation":[{"name":"Department of Sciences of Human Movement, Universidade Federal de S\u00e3o Paulo, S\u00e3o Paulo, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcelo Britto","family":"Passos Amato","sequence":"additional","affiliation":[{"name":"Cardio-Pulmonary Department, Pulmonary Division, Heart Institute (Incor), Hospital Das Cl\u00ednicas da FMUSP, University of S\u00e3o Paulo, S\u00e3o Paulo, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluigi Li","family":"Bassi","sequence":"additional","affiliation":[{"name":"Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer, Barcelona, Spain; Physiotherapy Department, The Prince Charles Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia; Queensland University of Technology, Brisbane, Australia; and Uniting Care Hospitals, St Andrew\u2019s War Memorial and Wesley Hospital Intensive Care Units, Brisbane, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antoni","family":"Torres","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Critical Care Unit, Institut Clinic Cardiovascular, Hospital Cl\u00ednic, Barcelona, Spain; and Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer, Barcelona, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2022,8,30]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1186\/s40560-017-0229-9"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.68.6.774"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.105.1.237"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-198612000-00007"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e31819868e0"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.07521328"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-008-1026-7"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.07521296"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1136\/thx.56.6.438"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.122.1.92"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1097\/00002060-200208000-00004"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.PHM.0000137309.34404.BC"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.01121"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1186\/s40635-018-0173-6"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.06253"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.4103\/ijccm.IJCCM_164_18"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.resp.2019.05.008"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.08641"},{"key":"e_1_3_2_20_2","volume-title":"Guide for the care and use of laboratory animals. (NIH Publication No.86-23)","author":"National Institutes of Health","year":"1996","unstructured":"National Institutes of Health. Guide for the care and use of laboratory animals. (NIH Publication No.86-23). Washington, District of Columbia: US Government Printing Office; 1996."},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e318236efb5"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1986.60.3.901"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1987.62.3.959"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1986.60.3.908"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.95.3.658"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.10550758"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.08531287"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.05965"}],"container-title":["Respiratory Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.4187\/respcare.10173","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.4187\/respcare.10173","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.4187\/respcare.10173","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T09:38:47Z","timestamp":1775468327000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.4187\/respcare.10173"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,30]]},"references-count":27,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2022,12]]}},"alternative-id":["10.4187\/respcare.10173"],"URL":"https:\/\/doi.org\/10.4187\/respcare.10173","relation":{},"ISSN":["0020-1324"],"issn-type":[{"value":"0020-1324","type":"print"}],"subject":[],"published":{"date-parts":[[2022,8,30]]}}}