Cough augmentation techniques for people with chronic neuromuscular disorders

Morrow, Brenda; Argent, Andrew C.; Zampoli, Marco; Human, Anri; Corten, Lieselotte; Toussaint, Michel

doi:10.1002/14651858.cd013170.pub2

Cited by 20 publications

(17 citation statements)

References 75 publications

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“…Both absolute and standardized LFTs were measured and reported according to the European Respiratory Society Guidelines and the Global Lung Function Initiative. 30 Although a recent Cochrane review suggested that Peak Cough Flow (PCF) improves after a range of cough augmenting techniques compared to unassisted cough, 31 we decided not to use this as an outcome parameter. Measurement of PCF requires an additional maneuver which may result in fatigue with negative impact on LFT results.…”

Section: Methodsmentioning

confidence: 99%

Short-term effect of air stacking and mechanical insufflation–exsufflation on lung function in patients with neuromuscular diseases

et al. 2022

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Air stacking (AS) and mechanical insufflation–exsufflation (MI-E) aim to increase cough efficacy by augmenting inspiratory lung volumes in patients with neuromuscular diseases (NMDs). We studied the short-term effect of AS and MI-E on lung function. We prospectively included NMD patients familiar with daily AS or MI-E use. Studied outcomes were forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and peak expiratory flow (PEF) prior to, immediately after, and up to 2 h after treatment. Paired sample T-test and Wilcoxon signed-rank test was used. Sixty-seven patients participated. We observed increased FVC and FEV1 immediately after AS with a mean difference of respectively 0.090 L (95% CI 0.045; 0.135, p < .001) and 0.073 L (95% CI 0.017; 0.128, p = .012). Increased FVC immediately after MI-E (mean difference 0.059 L (95% CI 0.010; 0.109, p = .021) persisted 1 hour (mean difference 0.079 L (95% CI 0.034; 0.125, p = .003). The effect of treatment was more pronounced in patients diagnosed with Spinal Muscular Atrophy, compared to patients with Duchenne muscular dystrophy. AS and MI-E improved FVC immediately after treatment, which persisted 1 h after MI-E. There is insufficient evidence that short-lasting increases in FVC would explain the possible beneficial effect of AS and MI-E.

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Section: Methodsmentioning

confidence: 99%

Short-term effect of air stacking and mechanical insufflation–exsufflation on lung function in patients with neuromuscular diseases

et al. 2022

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“…Although a previous study that investigated the use of MI-E in healthy Landrace-Large White female pigs showed that +40/-70 cmH 2 O was the most effective pressure combination [ 17 ], MI-E settings with a pressure of ±40 cmH 2 O are most commonly used in invasively ventilated critically ill patients [ 18 ]. Previous studies demonstrated the safety of MI-E; [ 19 , 20 ] however, conflicting findings have been reported [ 21 ]. Since another study demonstrated that pressures of ±54 cmH 2 O were tolerated well [ 10 ], we assumed that a pressure of ±40 cmH 2 O may also be tolerated.…”

Section: Discussionmentioning

confidence: 99%

Effects of mechanical insufflation-exsufflation on ventilator-free days in intensive care unit subjects with sputum retention; a randomized clinical trial

Kubota,

Hashimoto,

Yoshikawa

et al. 2024

PLoS ONE

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Background Mechanical insufflation-exsufflation (MI-E) facilitates extubation. However, its potential to reduce the duration of ventilator use remains unclear. Therefore, the present study investigated whether the use of MI-E shortened the duration of mechanical ventilation in patients with high sputum retention. Methods A randomized open-label trial was conducted at a single intensive care unit (ICU) in Japan between November 2017 and June 2019. Ventilated subjects requiring suctioning at least once every hour due to sputum retention were randomly assigned to the MI-E group or conventional care group. The primary endpoint was the number of ventilator-free days on day 28. Secondary endpoints were ventilator days in surviving subjects, the length of ICU stay, and mortality and tracheostomy rates among survivors. Results Forty-eight subjects (81% males) with a median age of 72 years (interquartile range [IQR], 65–85 years) were enrolled. There were 27 subjects in the MI-E group and 21 in the control group. The median number of ventilator-free days was 21 (IQR, 13–24) and 18, respectively (IQR, 0–23) (P = .38). No significant differences were observed in the ICU length of stay (median, 10 days (IQR, 7–12) vs 12 days (IQR, 6–15); P = .31), mortality rate (19% vs 15%; odds ratio [OR], 1.36 [0.28–6.50]; P = .69), or tracheostomy rate among survivors (14% vs 28%; OR, 0.40 [0.08–1.91]; P = .25). Conclusion In ventilated subjects in the ICU with high sputum retention, the use of MI-E did not significantly increase the number of ventilator-free days over that with conventional care.

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“…However, daily versus continuous rental costs and the accessibility to MI-E should be taken into account when prescribing the device. As a preventive measure, the optimal frequency of MI-E use remains unknown [45]. Furthermore, on an individual level, the need for airway clearance may change with disease progression and added morbidities [35].…”

Section: Discussionmentioning

confidence: 99%

Home Use of Mechanical Insufflation/Exsufflation in Adult Patients in Western Switzerland

Mitropoulou¹,

Heinzer²,

Janssens³

et al. 2023

Respiration

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Background: Mechanical insufflation/exsufflation (MI-E) devices are often prescribed to patients with inefficient cough and recurrent infections, but their use in the home setting is not well characterized. Objective: The objective of this study was to report a real-life experience and identify factors that are associated with home MI-E use in adult patients. Methods: This is a cross-sectional observational study of adult subjects with neurological disease using MI-E at home for more than 3 months. Results: A total of 43 patients were included. Median age (interquartile range) was 48 (31–64) years. The most common diagnosis was muscular dystrophy (n = 15), followed by multiple sclerosis (n = 7) and amyotrophic lateral sclerosis (n = 7). 24 subjects (56%) reported using the MI-E at least once weekly. Based on device data downloads, the median objective use was 23% of days analysed (approximately 2 times per week). The vast majority (94%) of all participants reported using the device at least daily during an infectious episode, while 62% reported having used the device in emergency situations such as bronchoaspiration. Reported use correlated well with objective use (r = 0.82). Most subjects reported an improvement in their respiratory health (64%) and were satisfied with the device (78%). Higher reported and objective use were associated with increased symptoms (p = 0.001) and higher satisfaction with the device (p = 0.008). We found no association between frequency of use and baseline cough peak flow (CPF), bulbar impairment, non-invasive ventilation use, living environment, or supervised administration. Conclusion: Regular home MI-E use was associated with greater symptom burden and overall satisfaction with the device and was not influenced by baseline CPF. Patients without substantial bronchorrhea might not use the MI-E regularly but might still need to use the device at home during acute events. Therefore, familiarity with the MI-E via appropriate and repeated practical training is crucial.

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Cough augmentation techniques for people with chronic neuromuscular disorders

Abstract: Analysis 3.1. Comparison 3: Mechanical insu lation-exsu lation (MI-E) versus mechanical insu lation (MI) plus manually assisted cough (MAC), Outcome

Cited by 20 publications

References 75 publications

Short-term effect of air stacking and mechanical insufflation–exsufflation on lung function in patients with neuromuscular diseases

Short-term effect of air stacking and mechanical insufflation–exsufflation on lung function in patients with neuromuscular diseases

Effects of mechanical insufflation-exsufflation on ventilator-free days in intensive care unit subjects with sputum retention; a randomized clinical trial

Home Use of Mechanical Insufflation/Exsufflation in Adult Patients in Western Switzerland

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