Raúl Escudero-Romero

Background: Mechanical insufflation-exsufflation (MI-E) devices support airway clearance by generating positive and negative pressure cycles that simulate a cough. Bench studies using lung models provide a controlled environment to investigate device performance and optimize settings; however, the lack of methodological standardization limits reproducibility and clinical translation. Methods: A systematic review and network meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered in PROSPERO (International Prospective Register of Systematic Reviews) (CRD42023486537). Experimental studies using adult mechanical lung models were identified from MEDLINE, Embase, and Web of Science (search updated November 2024). Two reviewers independently extracted data and assessed methodological quality using a customized risk-of-bias tool specifically developed for bench studies of respiratory devices. The primary outcome was peak expiratory flow (PEF); secondary outcomes included insufflation and exsufflation parameters. Random-effects meta-analyses were performed. Results: Eleven studies (2002–2024) met the inclusion criteria, encompassing 6 MI-E devices and a range of simulated lung mechanics. The most frequently used settings were +40/−40 cm H ₂ O with 3-s insufflation, 1-s exsufflation, and 1-s pause. Higher pressure pairs (+50/−50 cm H ₂ O) produced significantly greater PEF compared with lower pressures, particularly in obstructive models (mean difference = 134 L/min, 95% CI 2–267). Methodological quality varied widely, with limited information on calibration, sensor characteristics, and study reproducibility. Conclusions: Higher pressure differentials generally enhance PEF, but optimal MI-E settings are not universal. MI-E performance depends on pressure settings and simulated respiratory mechanics. Clinically, these findings support individualized adjustment of MI-E parameters based on patient-specific characteristics. The lack of methodological standardization and calibration reporting limits comparability. A structured protocol for MI-E bench studies is proposed to enhance reproducibility, transparency, and translational relevance.

Introduction: Acute Respiratory Distress Syndrome (ARDS) is a critical condition characterised by acute respiratory failure due to increased alveolar-capillary membrane permeability. This leads to non-cardiogenic pulmonary oedema, hypoxemia, and impaired respiratory compliance, significantly impacting patients’ survival and quality of life. The management of ARDS involves various ventilatory and non-ventilatory therapies. Understanding the optimal timing and application of these therapies is crucial for improving patient outcomes. Aim of the study: This scoping review aims to identify and synthesise the ventilatory techniques used in managing ARDS, focusing on their temporality and the interplay between different therapies. The study seeks to synthesize the available evidence and summarize current management strategies, highlighting areas for further research and improvement in ARDS care. Material and Methods: A systematic search of PubMed, EBSCO, and ScienceDirect databases was conducted, following the Joanna Briggs Institute guidelines (2015), for articles published between 2013 and 2023. Studies involving adult patients (18 years or older) diagnosed with ARDS and receiving ventilatory support in the ICU were included. Exclusion criteria included other acute respiratory pathologies, clinically extreme obese patients, and patients with tracheostomy. Results: 437 articles were identified through the database search, of which 23 met the inclusion criteria and were included in the final review. Most articles were published between 2015–2019 (43.5%), originated from the USA (34.78%), and employed observational study designs (73.91%). The included studies reported on patients aged between 23 and 79 years, with intrapulmonary causes being the most common aetiology for ARDS. Various ventilatory strategies were identified, including conventional oxygen therapy, high-flow nasal cannula (HFNC), non-invasive ventilation (NIV), invasive ventilation (IMV), and combined approaches. Temporality was reported in 35% of the articles, but none of them as their primary focus. Conclusions: The review highlights the diversity of ventilatory techniques employed in ARDS management and the importance of individualizing treatment strategies based on patient response and disease severity. The temporality of these interventions remains a crucial aspect, requiring further investigation to establish clearer guidelines for optimizing the timing and sequence of ventilatory support in ARDS. The findings underscore the need for future research to focus on patient-centred outcomes and the long-term implications of ARDS management, including quality of life and functional status.

Objective: This systematic review aims to assess the effectiveness of respiratory physiotherapy techniques in oxygenation, chest X-ray findings, and lung auscultation in paediatric patients aged 0 to 18 years diagnosed with atelectasis. Methods: A comprehensive search was conducted in the PubMed, PEDro, Web of Science, and Cochrane Library databases. Results: Eight randomised clinical trials were included, involving 430 children ranging from 35 weeks of gestational age to 14 years. These trials evaluated various respiratory physiotherapy techniques and their effects on oxygenation and chest radiograph outcomes. The methodological quality of the studies ranged from acceptable to good, according to the PEDro scale. Conclusions: Recent evidence indicates that respiratory physiotherapy is effective and safe in the paediatric population with atelectasis. Both manual and instrumental techniques demonstrated efficacy, with instrumental techniques showing superior outcomes in many cases.