Effective Mechanical Insufflation-Exsufflation in a Patient With Difficulty in Sputum Discharge and Intensive Care Unit-Acquired Weakness: A Case Report

• Published in: Curēus (Palo Alto, CA) Vol. 14; no. 2; p. e21847
• Main Authors: Nonoyama, Tadayoshi, Shigemi, Hiroko, Yasutake, Chiaki, Matsumine, Akihiko, Ishizuka, Tamotsu
• Format: Journal Article
• Language: English
• Published: United States Cureus Inc 02-02-2022; Cureus
• Subjects: Anesthesia; Bronchoscopy; Case reports; Diaphragm (Anatomy); Emergency Medicine; Extubation; Flow velocity; Intensive care; Medical research; Muscle strength; Neuromuscular diseases; Ostomy; Patients; Permeability; Physical Medicine & Rehabilitation; Physical therapy; Pleural effusion; Pulmonology; Rehabilitation; Sepsis; Suctioning; Tracheotomy; Ventilators; Weaning; X-rays; mechanical insufflation-exsufflation; intensive care unit; icu-acquired weakness; respiratory care; musculoskeletal rehabilitation
• ISSN: 2168-8184; 2168-8184
• DOI: 10.7759/cureus.21847

Intensive care unit-acquired weakness (ICU-AW), a common complication in critically ill patients, may result in diaphragmatic dysfunction, which delays weaning from artificial ventilators. Here, we present the case of a patient with difficulty in sputum discharge due to ICU-AW. In the ICU, postural drainage sputum aspiration by bronchoscopy and squeezing were performed daily, but the patient's condition did not resolve. Mechanical insufflation-exsufflation (MI-E) enabled the sputum to move to the main bronchus from the peripheral bronchi, and suctioning using a bronchoscope was no longer necessary. However, the presence of sputum persisted, and MI-E was necessary after weaning, proving crucial in treating the patient with sputum discharge difficulty complicated by ICU-AW after being removed from an artificial ventilator. MI-E can be useful for patients with difficulty in sputum discharge due to ICU-AW; however, the weaning process may be prolonged in such cases.