2018
DOI: 10.1016/j.rmed.2018.01.012
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Airway clearance techniques in neuromuscular disorders: A state of the art review

Abstract: This is a unique state of the art review written by a group of 21 international recognized experts in the field that gathered during a meeting organized by the European Neuromuscular Centre (ENMC) in Naarden, March 2017. It systematically reports the entire evidence base for airway clearance techniques (ACTs) in both adults and children with neuromuscular disorders (NMD). We not only report randomised controlled trials, which in other systematic reviews conclude that there is a lack of evidence base to give an… Show more

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Cited by 212 publications
(334 citation statements)
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References 116 publications
(163 reference statements)
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“…The use of asymmetric MI‐E treatment pressures is also recommended in adult patients with dysfunction in bulbar innervated muscles because high P i results in laryngeal closure . This might be highly relevant in children with severe Spinal Muscular Atrophy type 1, who may also have a bulbar innervated muscle dysfunction and which may be a possible challenge to treatment efficacy . However, the laryngeal collapsibility during MI‐E is not systematically examined in pediatric NMD diagnoses but underlines the importance to take upper airway collapsibility into consideration when using the MI‐E in small children.…”
Section: Discussionmentioning
confidence: 99%
See 1 more Smart Citation
“…The use of asymmetric MI‐E treatment pressures is also recommended in adult patients with dysfunction in bulbar innervated muscles because high P i results in laryngeal closure . This might be highly relevant in children with severe Spinal Muscular Atrophy type 1, who may also have a bulbar innervated muscle dysfunction and which may be a possible challenge to treatment efficacy . However, the laryngeal collapsibility during MI‐E is not systematically examined in pediatric NMD diagnoses but underlines the importance to take upper airway collapsibility into consideration when using the MI‐E in small children.…”
Section: Discussionmentioning
confidence: 99%
“…A weak cough in children with neuromuscular disorders (NMDs) due to insufficient inspiratory volumes and/or reduced expiratory airflow velocity may increase the risk of respiratory failure, tracheostomy, and premature death . Respiratory management guidelines for NMD recommend the use of mechanically assisted cough utilizing the technique of mechanical insufflation‐exsufflation (MI‐E), especially in children with the weakest cough, as it increases the peak cough flow (PCF) and thus assists airway clearance …”
Section: Introductionmentioning
confidence: 99%
“…Neuromuscular disorders (NMDs) with onset in infancy and childhood such as spinal muscular atrophy (SMA), Duchenne muscular dystrophy (DMD) and congenital myopathies or muscular dystrophies may be complicated by weak cough and increased susceptibility to recurrent respiratory tract infections (RTIs). This is a major cause of morbidity and mortality and various care guidelines, therefore, advise early start of airway clearance techniques (ACTs) to prevent RTIs …”
Section: Introductionmentioning
confidence: 99%
“…Cough peak flow (CPF) is a measurement commonly used to evaluate the cough strength, which reflects the ability to expel airway secretions [1,2,3,4,5,6,7] and can predict the extubation [7,8] and reintubation outcomes [9,10,11]. Values of CPF below 160 L/min have been associated with infective airway clearance [6,7,12] and patients who can generate a CPF of more than 270 L/min have little risk of developing respiratory failure during upper respiratory tract infections [13].…”
Section: Introductionmentioning
confidence: 99%
“…However, not all medical facilities provide these devices [14]. Moreover, the complex device setup, including firmly attaching the facemasks and infection control filters on the patient [1], imposes burdens on both patients and their caregivers. In addition, the measured CPF value can vary depending on the type of facemask and filter.…”
Section: Introductionmentioning
confidence: 99%