机械性吸-呼气技术在国内气道廓清实践中的应用困境与应对策略OA

Mechanical insufflation-exsufflation(MI-E)is a mechanical cough augmentation modality within the spectrum of airway clearance techniques(ACTs).By rapidly cycling between positive-pressure insufflation and negative-pressure exsufflation,MI-E increases pre-cough inspiratory volume and cough expiratory flow,thereby facilitating proximal airway secretion clearance.MI-E has particular value in patients with neuromuscular diseases,respiratory muscle weakness,or an artificial airway,and in selected clinical settings involving mechanical ventilation,high-risk extubation or decannulation,particularly when cough is weak or ineffective.Compared with conventional ACTs that primarily aim to mobilizing peripheral airway secretions,MI-E is directed more toward cough augmentation and proximal secretion clearance.The two approaches differ in their mechanisms of action and clinical indications and should be selected,alone or in combination,according to the predominant mechanism of airway clearance impairment.In China,broader implementation of MI-E is constrained by insufficient recognition of its clinical role,lack of standardized training,inconsistent protocols for patient selection and parameter titration,inadequate criteria for treatment-response evaluation and reassessment,limited device availability and reimbursement support,low patient acceptance,insufficient continuity of out-of-hospital management,and a limited of evidence from Chinese clinical practice.Addressing these challenges requires an implementation pathway and quality evaluation framework tailored to the Chinese healthcare system,with coordinated efforts directed at clarifying the clinical role of MI-E,strengthening training systems,standardizing assessment-titration-reassessment workflows,improving device availability and reimbursement support,enhancing patient education,and expanding practiced-based clinical research.