Effects of Vibrating Mesh Nebulisation in Patients on Long-term Tracheostomy Ventilation: a Pilot Randomised Crossover Trial

Inclusion Criteria: * Patients receiving long-term tracheostomy ventilation as inpatients of the Lane Fox Respiratory Service at Guy's and St Thomas' NHS Foundation Trust * Requiring prolonged mechanical ventilation for at least 6 hours per day for at least 21 days * Has a cuffed tracheostomy in situ * Aged 18-80 years old * Receiving normal (0.9%) saline or hypertonic saline nebulisation at the time of enrolment into the study * Requiring and tolerating tracheal suctioning for secretion management * Able to communicate symptom burden to the research team * Able to give informed consent for participation in the study * Clinical stability, with no requirement for changes in ventilatory support, as assessed by the responsible clinician for at least 48 hours prior to enrolment in study Exclusion Criteria: * Severe, non-respiratory organ dysfunction including, but not limited to: * Congestive cardiac failure * Cardiac arrhythmia * End-stage malignancy * End-stage renal failure * Acute pulmonary pathology requiring emergency treatment including, but not limited to: * Ventilator associated pneumonia at the time of screening * Pneumothorax * Pulmonary embolism * Severe cognitive impairment * Psychosocial factors that would preclude completion of the study protocol * Previous intolerance of aerosolised hypertonic 3% saline or nebulised salbutamol