Cough augmentation techniques compared with no cough augmentation techniques for critically‐ill, mechanically‐ventilated adults and children

Patient or population: critically‐ill mechanically‐ventilated adults and children requiring extubation from mechanical ventilation

Settings: High acuity setting including ICUs, weaning centres, respiratory intermediate care units, and high‐dependency units in Europe and North America

Intervention: Cough augmentation techniques including lung volume recruitment, manually‐assisted cough and mechanical insufflation‐exsufflation

Comparison: No cough augmentation

Extubation success^a

RR 1.58 (1.13 to 2.20)

75 participants
1 trial

⊕⊝⊝⊝
very low¹

Duration of mechanical ventilation^b

Mean difference ‐6.1 days (‐8.4 to ‐3.8)

75 participants
1 trial

⊕⊝⊝⊝
very low¹

ICU mortality^a

Not calculable, as no event rates in the 1 trial reporting data on this outcome

75 participants
1 trial

⊕⊝⊝⊝
very low¹

Adverse events

1. Hypotension^c

2. Hypertension^d

3. Secretion encumbrance resulting in severe hypoxaemia requiring reintubation^c

RR 3.4 (0.1 to 81.3)

RR 3.0 (0.1 to 65.9)

RR 0.25 (0.1 to 1.1)

75 participants
1 trial

20 participants

1 trial

75 participants
1 trial

⊕⊝⊝⊝
very low²

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk Ratio

^aAssumed risk is derived from a large international cohort study of mechanical ventilation and weaning by Esteban 2013 and refers to the rate of reintubation reported in this study.

^bAssumed risk is derived from a large international cohort study of mechanical ventilation and weaning by Esteban 2008.

^cAssumed risk is derived from adverse events (hypotension and hypoxaemia) reported in a systematic review of recruitment manoeuvres in people with acute lung injury (Fan 2008).

^dAssumed risk is derived from rates of hypertension noted during 6691 episodes of endotracheal suctioning (Evans 2014).

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.