Exsufflation With Negative Pressure

Barach, Alvan L.

doi:10.1001/archinte.1954.00240300019003

Cited by 77 publications

(6 citation statements)

References 13 publications

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“…Also, the VC, pulmonary flow rates, and O 2 sat, when abnormal, improve with clearing of airway secretions and mucus by MIE [ 49 ]. Increases in VC of 15% to 40% were reported for 67 patients with ‘obstructive dyspnea,’ and 55% increases in VC for patients with NMDs using MIE with no untoward effects [ 50 ]. We reported 15% to 400% (200–800 mL) improvements in VC and normalization of O 2 sat using MIE for patients with NMD during chest infections [ 51 ].…”

Section: Assisted Coughingmentioning

confidence: 99%

Noninvasive Respiratory Management of Patients With Neuromuscular Disease

Bach

2017

Ann Rehabil Med

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This review article describes definitive noninvasive respiratory management of respiratory muscle dysfunction to eliminate need to resort to tracheotomy. In 2010 clinicians from 22 centers in 18 countries reported 1,623 spinal muscular atrophy type 1 (SMA1), Duchenne muscular dystrophy (DMD), and amyotrophic lateral sclerosis users of noninvasive ventilatory support (NVS) of whom 760 required it continuously (CNVS). The CNVS sustained their lives by over 3,000 patient-years without resort to indwelling tracheostomy tubes. These centers have now extubated at least 74 consecutive ventilator unweanable patients with DMD, over 95% of CNVS-dependent patients with SMA1, and hundreds of others with advanced neuromuscular disorders (NMDs) without resort to tracheotomy. Two centers reported a 99% success rate at extubating 258 ventilator unweanable patients without resort to tracheotomy. Patients with myopathic or lower motor neuron disorders can be managed noninvasively by up to CNVS, indefinitely, despite having little or no measurable vital capacity, with the use of physical medicine respiratory muscle aids. Ventilator-dependent patients can be decannulated of their tracheostomy tubes.

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Section: Assisted Coughingmentioning

confidence: 99%

Noninvasive Respiratory Management of Patients With Neuromuscular Disease

Bach

2017

Ann Rehabil Med

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“…In an experiment, radioactive material was inhaled into the lung of a dog and, after a six-minute application of the cough assisting device, the inhaled material had been completely removed 46. In another study, values of PCF in several different situations were compared and the authors reported the measured PCF values were much higher in the group using the cough assisting device than the measurements taken in the groups using different manual assisted coughing techniques 30,41,47. Cough assist™ not only generates a higher PCF, thereby increasing the overall removal of bronchial secretions, but also eliminates the irritation and/or damage to the airway caused by catheter suction.…”

Section: Respiratory Muscle Aidsmentioning

confidence: 99%

Pulmonary Rehabilitation in Patients with Neuromuscular Disease

Kang

2006

Yonsei Med J

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In neuromuscular disease (NMD) patients with progressive muscle weakness, respiratory muscles are also affected and hypercapnia can increase gradually as the disease progresses. The fundamental respiratory problems NMD patients experience are decreased alveolar ventilation and coughing ability. For these reasons, it is necessary to precisely evaluate pulmonary function to provide the proper inspiratory and expiratory muscle aids in order to maintain adequate respiratory function. As inspiratory muscle weakening progresses, NMD patients experience hypoventilation. At this point, respiratory support by mechanical ventilator should be initiated to relieve respiratory distress symptoms. Patients with adequate bulbar muscle strength and cognitive function who use a non-invasive ventilation aid, via a mouthpiece or a nasal mask, may have their hypercapnia and associated symptoms resolved. For a proper cough assist, it is necessary to provide additional insufflation to patients with inspiratory muscle weakness before using abdominal thrust. Another effective method for managing airway secretions is a device that performs mechanical insufflation-exsufflation. In conclusion, application of non-invasive respiratory aids, taking into consideration characterization of respiratory pathophysiology, have made it possible to maintain a better quality of life in addition to prolonging the life span of patients with NMD.

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“…Although the technique has been used since the 1950s, 25 it was only in the early 1990s that it became widely used when the Cough Assist In-Exsufflator (Phillips/Respironics, Murrysville, Pennsylvania.) became commercially available.…”

Section: Mechanical Insufflation-exsufflationmentioning

confidence: 99%

Adjunct Therapies During Mechanical Ventilation: Airway Clearance Techniques, Therapeutic Aerosols, and GasesDiscussion

Kallet

2013

Respir Care

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Mechanically ventilated patients in respiratory failure often require adjunct therapies to address special needs such as inhaled drug delivery to alleviate airway obstruction, treat pulmonary infection, or stabilize gas exchange, or therapies that enhance pulmonary hygiene. These therapies generally are supportive in nature rather than curative. Currently, most lack high-level evidence supporting their routine use. This overview describes the rationale and examines the evidence supporting adjunctive therapies during mechanical ventilation. Both mechanistic and clinical research suggests that intrapulmonary percussive ventilation may enhance pulmonary secretion mobilization and might reverse atelectasis. However, its impact on outcomes such ICU stay is uncertain. The most crucial issue is whether aerosolized antibiotics should be used to treat ventilatorassociated pneumonia, particularly when caused by multi-drug resistant pathogens. There is encouraging evidence from several studies supporting its use, at least in individual cases of pneumonia non-responsive to systemic antibiotic therapy. Inhaled pulmonary vasodilators provide at least short-term improvement in oxygenation and may be useful in stabilizing pulmonary gas exchange in complex management situations. Small uncontrolled studies suggest aerosolized heparin with N-acetylcysteine might break down pulmonary casts and relieve airway obstruction in patients with severe inhalation injury. Similar low-level evidence suggests that heliox is effective in reducing airway pressure and improving ventilation in various forms of lower airway obstruction. These therapies generally are supportive and may facilitate patient management. However, because they have not been shown to improve patient outcomes, it behooves clinicians to use these therapies parsimoniously and to monitor their effectiveness carefully. Key words: high-frequency percussive ventilation; intrapulmonary percussive ventilation; inhaled nitric oxide; aerosolized prostacyclin; aerosolized heparin; metered-dose inhalers; heliox.

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Exsufflation With Negative Pressure

Cited by 77 publications

References 13 publications

Noninvasive Respiratory Management of Patients With Neuromuscular Disease

Noninvasive Respiratory Management of Patients With Neuromuscular Disease

Pulmonary Rehabilitation in Patients with Neuromuscular Disease

Adjunct Therapies During Mechanical Ventilation: Airway Clearance Techniques, Therapeutic Aerosols, and GasesDiscussion

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