Airway clearance techniques for the intubated adult: a scoping review

Gabriella Cork*, Clare Wade, Alison Gordon, Anna Vaughan-France, Amelia Palmer, Katy Walker, Una Jones

*Corresponding author for this work

Research output: Contribution to journalLiterature reviewpeer-review

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Abstract

Objective
The aim of this scoping review was to understand the extent and type of evidence available in relation to airway clearance techniques in the intubated adult.

Introduction
This review was commissioned by the Association of Chartered Physiotherapists in Respiratory Care (ACPRC) special interest group as a method of summarising the available evidence on this topic on behalf of its members. Airway clearance in the intubated adult is a key objective of respiratory physiotherapists and although evidence-based guidelines exist in this area, there is no recent summary regarding the extent of the literature which could inform future research and clinical practice.

Inclusion criteria
Studies which investigated adults who were intubated either via an endo-tracheal or tracheostomy tube met the criteria. All study designs, including reviews, case reports and animal studies, which reported any physiotherapy-related airway clearance techniques were included.

Methods
The following databases were searched: SCOPUS, PubMed, PEDro, CINAHL Plus, and Clinical Trials Registry. The search was completed in December 2021 and limited to full text papers published since 2011. Following the key word search strategy, each title and abstract was screened for relevance to the scoping review aim and the study design was identified. Population, intervention, comparator and outcome (PICO) data extraction was completed for all included papers in order to identify themes. The number and type of evidence retrieved, as well as key themes and outcomes were summarised.

Results
The scoping review identified 138 suitable papers for inclusion. Of these, 11 were systematic reviews and 39 were randomised clinical trials, representing a moderately large evidence-base on this topic. Also included were other experimental, observational and qualitative studies, narrative reviews and animal and bench studies. Key interventions were identified including multi-modal chest physiotherapy, hyperinflation and manual chest compression techniques. Reported outcome measures were mainly short-term, such as sputum yield and oxygenation, whilst longer-term outcome measures such as ICU length of stay and ventilator-associated pneumonia (VAP) rates were reported less frequently. Outcome measures related to physiological stability were also reported by some studies.

Findings of the review were that airway clearance techniques for the intubated adult appear to be safe. There is a moderate body of evidence regarding their efficacy for short-term outcomes such as sputum yield, oxygenation and respiratory mechanics. There is limited evidence regarding their efficacy for longer-term outcomes.

Conclusion
This scoping review summarises the extent of available evidence regarding airway clearance for intubated adults. Future research should focus on the effects of airway clearance techniques on longer-term outcome measures such as VAP rates and extubation outcome.
Original languageEnglish
Pages (from-to)120-139
Number of pages20
JournalJournal of the Association of Chartered Physiotherapists in Respiratory Care
Volume54
Issue number3
DOIs
Publication statusPublished - 31 Dec 2022

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