Goetz Ryan L, Vijaykumar Kadambari, Solomon George M
Department of Medicine, Tinsley Harrison Internal Medicine Residency Program, University of Alabama at Birmingham, Birmingham, AL, United States.
Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, United States.
Front Physiol. 2022 Mar 23;13:834716. doi: 10.3389/fphys.2022.834716. eCollection 2022.
The use of airway clearance strategies as supplementary treatment in respiratory disease has been best investigated in patients with cystic fibrosis (CF) and non-cystic fibrosis bronchiectasis (NCFBE), conditions which are traditionally characterized by excessive mucus stasis and mucociliary dysfunction. A variety of airway clearance therapies both pharmacological and non-pharmacological have been shown to ameliorate disease progression in this population and have hence been assimilated into routine respiratory care. This self-propagating cycle of mucus retention and airway damage leading to chronic inflammation and infections can also be applied to patients with respiratory failure requiring mechanical ventilation. Furthermore, excessive trachea-bronchial secretions have been associated with extubation failure presenting an opportunity for intervention. Evidence for the use of adjunctive mucoactive agents and other therapies to facilitate secretion clearance in these patients are not well defined, and this subgroup still remains largely underrepresented in clinical trials. In this review, we discuss the role of mucus clearance techniques with a proven benefit in patients with CF and NCFBE, and their potential role in patients requiring mechanical ventilation while highlighting the need for standardization and adoption of mucus clearance strategies in these patient populations.
气道清除策略作为呼吸系统疾病的辅助治疗手段，在囊性纤维化（CF）和非囊性纤维化支气管扩张症（NCFBE）患者中得到了最为充分的研究，这些疾病传统上的特征是黏液过度淤滞和黏液纤毛功能障碍。多种药理学和非药理学气道清除疗法已被证明可改善该人群的疾病进展，因此已被纳入常规呼吸护理。这种黏液潴留和气道损伤导致慢性炎症和感染的自我传播循环也适用于需要机械通气的呼吸衰竭患者。此外，气管支气管分泌物过多与拔管失败有关，这为干预提供了机会。在这些患者中使用辅助黏液活性药物和其他疗法促进分泌物清除的证据尚不明确，并且该亚组在临床试验中的代表性仍然很低。在本综述中，我们讨论了在CF和NCFBE患者中已证实有益的黏液清除技术的作用，以及它们在需要机械通气的患者中的潜在作用，同时强调在这些患者群体中标准化和采用黏液清除策略的必要性。
