Decanulation of patients with severe respiratory muscle insufficiency: Efficacy of mechanical insufflation-exsufflation

Bach, John R.; Saporito, Louis R.; Shah, Harsh; Sinquee, Diane

doi:10.2340/16501977-1874

Cited by 65 publications

(51 citation statements)

References 27 publications

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“…is approach is complemented by advanced secretion management strategies i.e., air-stacking and mechanical insufflation exsufflation (MI-E) and also incorporates specifically designed protocols to decannulate tracheostomized patients to 24-hour full ventilatory support [5,6]. According to these protocols, an assisted PECF > 160 L/ min effected by a combination of MI-E and abdominal thrust is associated with a very high rate of tracheostomy decannulation success [110,120].…”

Section: Discussionmentioning

confidence: 99%

Respiratory Involvement in Patients with Neuromuscular Diseases: A Narrative Review

et al. 2019

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Respiratory muscle weakness is a major cause of morbidity and mortality in patients with neuromuscular diseases (NMDs). Respiratory involvement in NMDs can manifest broadly, ranging from milder insufficiency that may affect only sleep initially to severe insufficiency that can be life threatening. Patients with neuromuscular diseases exhibit very often sleep-disordered breathing, which is frequently overlooked until symptoms become more severe leading to irreversible respiratory failure necessitating noninvasive ventilation (NIV) or even tracheostomy. Close monitoring of respiratory function and sleep evaluation is currently the standard of care. Early recognition of sleep disturbances and initiation of NIV can improve the quality of life and prolong survival. This review discusses the respiratory impairment during sleep in patients with NMDs, the diagnostic tools available for early recognition of sleep-disordered breathing and the therapeutic options available for overall respiratory management of patients with NMDs.

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Section: Discussionmentioning

confidence: 99%

Respiratory Involvement in Patients with Neuromuscular Diseases: A Narrative Review

et al. 2019

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“…Beck et al evaluated voluntary cough and found that in patients with severe respiratory muscle insufficiency and a PCF of less than 160 L/min, decannulation was unsuccessful due to difficulty in keeping the airway clear after extubation and decannulation [20]. Lasserson et al reported that PCF of involuntary cough was less than that of voluntary cough, explaining that this was related to differences between the two types of cough in terms of the functional organization of muscle activation [21].…”

Section: Discussionmentioning

confidence: 99%

A novel reflex cough testing device

et al. 2017

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BackgroundThe reflex cough test is useful for detecting silent aspiration, a risk factor for aspiration pneumonia. However, assessing the risk of aspiration pneumonia requires measuring not only the cough reflex but also cough strength. Currently, no reflex cough testing device is available that can directly measure reflex cough strength. We therefore developed a new testing device that can easily and simultaneously measure cough strength and the time until the cough reflex, and verified whether screening with this new instrument is feasible for evaluating the risk of aspiration pneumonia.MethodsThis device consists of a special pipe with a double lumen, a nebulizer, and an electronic spirometer. We used a solution of prescription-grade L-tartaric acid to initiate the cough reflex. The solution was inhaled through a mouthpiece as a microaerosol produced by an ultrasonic nebulizer. The peak cough flow (PCF) of the induced cough was measured with the spirometer.The 70 patients who participated in this study comprised 49 patients without a history of pneumonia (group A), 21 patients with a history of pneumonia (group B), and 10 healthy volunteers (control group).ResultsWith the novel device, PCF and time until cough reflex could be measured without adverse effects. The PCF values were 118.3 ± 64.0 L/min, 47.7 ± 38.5 L/min, and 254.9 ± 83.8 L/min in group A, group B, and the control group, respectively. The PCF of group B was significantly lower than that of group A and the control group (p < 0.0001), while that of group B was significantly lower than that of the control group (p < 0.0001). The time until the cough reflex was 4.2 ± 5.9 s, 7.0 ± 7.0 s, and 1 s in group A, group B, and the control group, respectively. This duration was significantly longer for groups A and B than for the control group (A: p < 0.001, B: p < 0.001), but there was no significant difference between groups A and B (p = 0.0907).ConclusionOur newly developed device can easily and simultaneously measure the time until the cough reflex and the strength of involuntary coughs for assessment of patients at risk of aspiration pneumonia.Electronic supplementary materialThe online version of this article (doi:10.1186/s12890-017-0365-y) contains supplementary material, which is available to authorized users.

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“…Furthermore, at the end of the MI-E treatment there is application of insufflation, which provides inspiration to appropriate functional residual capacity (Hull et al 2012). MI-E can be used with various interfaces on patients who are spontaneously breathing, intubated or tracheotomized (Miske et al 2004, Bach et al 2014.…”

Section: Combination Of Assisted Inspiration and Expirationmentioning

confidence: 99%

A Review on Cough Augmentation Techniques: Assisted Inspiration, Assisted Expiration and Their Combination

Spinou

2020

Physiol Res

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Cough is an important mechanism of airway clearance. In patients who present weak and ineffective cough, augmentation techniques aim to assist or simulate the maneuver. These techniques target different phases of the cough cycle, mainly the inspiratory and expiratory phases, through assisted inspiration, assisted expiration and their combination. They include the manual hyperinflation, ventilator hyperinflation, glossopharyngeal breathing, manually assisted cough and mechanical insufflator-exsufflator, each applied individually or in different combinations. The aim of this review is to investigate the effectiveness and safety of cough augmentation techniques. Findings support that all commonly used techniques can theoretically improve airway clearance, as they generate higher cough peak flows compared to unassisted cough. Still, the studies assessing cough augmentation present considerable limitations and the direct comparison of different techniques is challenging. Current evidence indicate that cough peak flow shows higher increase with the combination of assisted inspiration and expiration, and improvement is greater in patients with lower unassisted values. Associated adverse events are infrequent.

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Decanulation of patients with severe respiratory muscle insufficiency: Efficacy of mechanical insufflation-exsufflation

Abstract: Many ventilator users can be decanulated in outpatient clinics to continuous noninvasive intermittent positive pressure ventilatory support with mechanical insufflation-exsufflation used to increase vital capacity, SpO2, and autonomous ability to breathe.

Cited by 65 publications

References 27 publications

Respiratory Involvement in Patients with Neuromuscular Diseases: A Narrative Review

Respiratory Involvement in Patients with Neuromuscular Diseases: A Narrative Review

A novel reflex cough testing device

A Review on Cough Augmentation Techniques: Assisted Inspiration, Assisted Expiration and Their Combination

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