Critically ill patients are at increased risk of morbidity and mortality due to severe organ dysfunction. Pulmonary dysfunction is among the most common non-neurologic complication in patients with acute neurological injury due to respiratory muscle weakness, depressed central respiratory drive, or impaired pharyngeal function. To date, there has been a minimal emphasis in the literature on preventive pulmonary care in patients with neurological illnesses despite the high prevalence of respiratory complications. This study aims to assess the use of the Metaneb system, a medical device designed to decrease atelectasis and improve airway clearance, in acute neurologically injured patients by analyzing its feasibility and safety. 

The primary outcome measure was all-cause discontinuation of Metaneb therapy. Secondary measures included indications for therapy and safety related measures. Forty-one patients met the inclusion criteria. Median age was 63 years (IQR: 45.5 - 69.5 years), 63.4% (n = 26) were women and 80.5% (n = 33) were Caucasian. The most common indications forMetaneb therapy were for airway clearance (70.7%; n = 29) and pulmonary hygiene (68.3%; n = 28). Median treatment days was 4 (IQR: 2 - 5.5) with a median of 2 treatments (IQR: 1- 3).  Discontinuation for clinical improvement occurred in 75.6% (n = 31). The most common safety cause for discontinuation was due to respiratory therapist being called away (15%; n = 6).

Metaneb is feasible and may be safe to use in neurocritical care patients. A prospective, randomized-controlled trial is necessary to evaluate the efficacy of this potentially prophylactic and therapeutic modality.