Effects of mechanical insufflator-exsufflator in people with spinal cord injury: a systematic review

Background: The mechanical insufflator-exsufflator (MI-E) is a medical device designed to augment the cough mechanism and could be an important add-on in the management of people with spinal cord injury (SCI), in whom ineffective cough is one of the major causes of respiratory complications. Objectives: To search and analyze the effects reported in the literature about the utilization of the MI-E in people with SCI. Methods: An electronic search was carried out in five databases seeking studies that researched the application of MI-E in adult patients with SCI. Results: Eight studies with fair (N = 5) to good (N = 3) methodological quality were included. Significant improvements were reported in peak cough flow, vital capacity, forced vital capacity, forced expiratory volume in the first second, and forced mid-expiratory flow, without any major adverse effects. The studies also reported that MI-E improved bronchial clearance, facilitated the ventilator weaning process, and helped to achieve normative values of peripheral oxygen saturation. Furthermore, participants reported high levels of satisfaction with MI-E. Conclusions: This systematic review shows that there is a lack of studies on the researched topic, especially of good-quality randomized trials. However, the present state of evidence also showed encouraging results in the use of the MI-E device in people with SCI.