Benefits of interventions for respiratory secretion management in adult palliative care patients—a systematic review

Table 4 Evidence summary

Intervention	Disease	Critically relevant for clinical decision											Relevant for Clinical Decision						Less Relevant for Clinical Decision
Intervention	Disease	Comfort	Effectiveness	Health related quality of life	Survival	Resting dyspnoea	Hospital days	Hospital admission	Intervention duration	Respiratory complications	Tracheotomy prev/removal	Cough	Oxygenation	Dyspnoea during exercise	PCF	FEV1	FVC	Secretion Amount	PaCO2, Ph	Chest Tightness	Airway Resistance	PIMax	PEMax
Mechanical insufflator-exsufflator	COPD	---	---	---	---	↓ 3	---	---	---	---	---	---	↑ 3	---	↔ 3	---	---	---	---	---	---	---	---
	SCI	---	---	---	---	---	---	↔ 3	---	↔ 3	---	---	↔ 3	---	↑ 3	↑ 3	↑ 3	---	↔ 3	---	---	---	---
	NMD	↑ 1^a	↑ 3	↔ 2	↑2	↓ 3	↔ 2	↕ 2	↓ 3	↕2	↑2	---	↑ 3	---	↑ 1^a	---	↑3	---	---	---	---	---	---
EMT	MS	---	↑ 2	---	---	---	---	---	---	---	---	---	---	---	---	---	---	---	---	---	---	↕ 2	↕ 2
MAC	NMD	↑3	↑ 2	---	---	---	---	---	---	---	---	---	---	---	↑ 2	---	---	---	---	---	---	---	↑3
PEP Mask	COPD	---	---	---	---	---	↔ 2	---	---	↔ 2	---	↑ 2	↔ 2	↕ 2	---	↔ 2	↔ 2	↔ 2	↑ 2	---	---	---	---
PEP Mask	CF	---	---	---	---	---	---	---	---	---	---	---	---	---	---	---	---	---	---	↓3	---	---	---
FES	SCI	---	---	---	---	---	---	---	---	---	---	---	---	---	---	---	---	---	---	---	---	---	↑3
Percussive ventilation	NMD	---	---	---	---	---	---	---	---	---	---	---	---	---	---	---	---	↑ 2	---	---	↔ 2	---	---
Vibratory vest	NMD	---	---	---	↔ 3	---	---	---	---	↔ 3	---	---	---	---	---	---	↔ 3	---	---	---	---	---	---
Tracheotomy	NMD	---	---	---	↑2	---	---	---	---	---	---	---	---	---	---	---	---	---	---	---	---	---	---

OCEBM levels of evidence: 1- Systematic reviews / 2- Randomized controlled trials or observational studies with dramatic effect / 3: Non-randomized trials/follow-up studies
PCF Peak cough flow, FEV₁ Forced expiratory volume in the first second, FVC Forced vital capacity, PaCO₂ Arterial pressure of carbon dioxide, PIMax Maximum inspiratory pressure, PEMax Maximum expiratory pressure, COPD Chronic obstructive pulmonary disease, SCI Spinal cord injury, NMD Neuromuscular disease, EMT Expiratory muscle training, MS Multiple sclerosis, MAC Manually assisted cough, PEP Positive expiratory pressure, CF Cystic fibrosis, FES Functional electrical stimulation; ↑: increase; ↓: decrease; ↕: conflicting results; ↔: No change. ^aConsidered the systematic review from Morrow and colleagues [46]

ISSN: 1472-684X