Safety and Efficacy of Mechanical Insufflation/Exsufflation Cough Assistance for Preventing Postoperative Pneumonia in Neurosurgical Patients: A Combined Physiological and Cohort Study.

Background: 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.

Methods: 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).

Results: 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.

Conclusions: 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.