Efficacy of Mechanical Insufflation-Exsufflation Devices as Analyzed in Lung Models: Systematic Review and Network Meta-Analysis of Peak Expiratory Flow Data.
Raúl Escudero-Romero, Merete Salveson Engeset, Tiina Maarit Andersen et al.
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In 30 seconds
This systematic review and network meta-analysis examined peak expiratory flow (PEF) generated by mechanical insufflation-exsufflation (MI-E) devices in adult mechanical lung models. Eleven experimental studies published from 2002 to 2024 evaluated six devices across simulated lung mechanics. Higher pressure pairs (+50/-50 cm H₂O) produced greater PEF than lower pressures, particularly in obstructive models, with a mean difference of 134 L/min (95% CI 2-267). The review also found substantial variation in methodological quality and reporting, limiting comparisons between bench studies and translation to clinical care.
Key findings
- Eleven studies evaluated six MI-E devices in adult mechanical lung models.
- In obstructive models, +50/-50 cm H₂O produced greater PEF than lower pressures (mean difference = 134 L/min, 95% CI 2-267).
- Methodological quality varied widely, with limited reporting of calibration, sensor characteristics, and reproducibility.
Why it matters
MI-E performance in lung models varies with both pressure settings and simulated respiratory mechanics, so a single setting may not yield the same airflow across different conditions. The findings help clarify device behaviour under controlled conditions, while the inconsistent methods and calibration reporting caution against treating bench comparisons as direct evidence of clinical effectiveness.
What to keep in mind
The evidence comes from bench studies using mechanical lung models, not patients. Methodological quality varied, and limited calibration and reproducibility reporting constrained comparability.