Zhang Ruihua, Zhang Meizhizi, Zhang Xiaoyu, Liu Yang, Li Jingyi, Wang Hui, Han Song, Huang Xiufeng, Shi Zhonghua
Intensive Care Unit, Department of Neurosurgery, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing, China.
Department of Neurosurgery, Anesthesiology, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing, China.
Neurocrit Care. 2025 Sep 22. doi: 10.1007/s12028-025-02386-y.
Postoperative pneumonia (POP) is a common complication after neurosurgery, leading to worse outcomes. Although mechanical insufflation/exsufflation cough assistance (M-I/E-ca) may improve airway clearance, its safety and efficacy in this patient group remain underexplored. This study aimed to evaluate M-I/E-ca's impact on intracranial pressure (ICP) and hemodynamics and its role in preventing POP.
This study consisted of two substudies: a prospective physiological study to evaluate ICP and hemodynamic changes and a retrospective-prospective cohort study to assess the incidence of POP. The first substudy enrolled ten patients after neurosurgery, whereas the second included 200 patients, with 100 in the M-I/E-ca group (prospective) and 100 in the control group (retrospective).
M-I/E-ca did not significantly alter ICP or hemodynamic parameters compared with the baseline. Instead, M-I/E-ca caused less disruption in ICP than traditional endotracheal suction, with insufflation/exsufflation pressure set at 40 mm Hg. The incidence of POP was 39%, with lower but not significant incidence in the M-I/E-ca (35%) compared with control (42%) groups (P = 0.309). In addition, patients in the M-I/E-ca group had significantly shorter intensive care unit (P = 0.006) and hospital (P = 0.002) stays compared with those in the control group.
M-I/E-ca is safe for patients after neurosurgery, with no significant impact on ICP or hemodynamics. Although it did not significantly reduce POP, it may contribute to shorter intensive care unit and hospital stays, suggesting potential benefits that warrant further investigation in larger studies.
术后肺炎（POP）是神经外科手术后常见的并发症，会导致更差的预后。尽管机械通气/呼气咳嗽辅助（M-I/E-ca）可能改善气道清除，但在该患者群体中的安全性和有效性仍未得到充分研究。本研究旨在评估M-I/E-ca对颅内压（ICP）和血流动力学的影响及其在预防POP中的作用。
本研究包括两个子研究：一项评估ICP和血流动力学变化的前瞻性生理学研究，以及一项评估POP发生率的回顾性-前瞻性队列研究。第一个子研究纳入了10例神经外科手术后的患者，而第二个子研究包括200例患者，其中100例在M-I/E-ca组（前瞻性），100例在对照组（回顾性）。
与基线相比，M-I/E-ca并未显著改变ICP或血流动力学参数。相反，在吹入/吸出压力设定为40mmHg时，M-I/E-ca对ICP的干扰比传统气管内吸痰小。POP的发生率为39%，M-I/E-ca组（35%）的发生率低于对照组（42%），但差异无统计学意义（P = 0.309）。此外，与对照组相比，M-I/E-ca组患者的重症监护病房住院时间（P = 0.006）和医院住院时间（P = 0.002）显著缩短。
M-I/E-ca对神经外科手术后的患者是安全的，对ICP或血流动力学无显著影响。虽然它没有显著降低POP，但可能有助于缩短重症监护病房和医院住院时间，提示其潜在益处值得在更大规模的研究中进一步探讨。
