Mechanical insufflation-exsufflation (MI-E) is an established airway clearance technique for patients with chronic conditions like neuromuscular diseases. However, its use in critically ill ICU patients remains inconsistent and lacks standardized guidelines. Despite growing research, current practices vary widely in patient selection, treatment protocols, and safety management, with limited high-quality evidence to support clear recommendations. To address this gap, an international, multidisciplinary Delphi consensus study is needed to establish expert-based best practices and feasible guidelines for the safe and effective implementation of MI-E in the intensive care setting.
Healthcare professionals with documented clinical experience in critical care medicine, pulmonology, anesthesiology, respiratory therapy, or physiotherapy with involvement in airway clearance strategies.
Demonstrated experience or recognized expertise in the clinical use of MI-E, either in critically ill patients or in patients with complex respiratory conditions.
A minimum of 5 years of clinical experience in their respective field, or a proven academic or clinical contribution related to MI-E.
Willingness to participate in multiple Delphi rounds and to provide informed consent.
Lack of direct clinical or academic experience related to MI-E or airway clearance techniques.
Inability or unwillingness to provide informed consent.
Failure to complete the first Delphi round after formal invitation and consent.
Withdrawal of consent at any stage of the Delphi process.
experts on MI-E
Cohort
Prospective
Delphi Questionnaire
Other interventionStatements on MI-E topics, rated along their level of appropriateness on a scale from 1 to 5. Multiple rounds are organised to reach consensus on a topic.
Primary Consensus Output
Number (or Proportion) of clinical practice statements achieving international expert consensus on the use of Mechanical Insufflation-Exsufflation (MI-E) in critically ill patients.
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Medipol University
Lead sponsor
International Association of Non Invasive Ventilation
Collaborator
International Academy of Non Invasive Ventilation
Collaborator
International College of Experts of Non Invasive Ventilation
Collaborator
