IPPB-assisted coughing in neuromuscular disorders

Dohna-Schwake, Christian; Ragette, R.; Teschler, Helmut; Voït, Thomas; Mellies, Uwe

doi:10.1002/ppul.20406

Cited by 91 publications

(56 citation statements)

References 25 publications

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“…The usefulness of assisted coughing by intermittent positive pressure breathing to enhance peak cough flow could be shown in a recent investigation. 17 In 12 of 15 patients of our study population assisted coughing was also helpful to overcome acute chest infection. Only three patients prolonged ventilation time.…”

Section: Discussionmentioning

confidence: 90%

“…Assisted coughing techniques such as glossopharyngeal breathing, the in-/exsufflator or IPPB (Intermittent Positive Pressure Breathing) assisted coughing demonstrated positive effects on peak cough flows in neuromuscular patients. [11][12][13][14][15][16][17] Additional treatment such as early antibiotic treatment or influenza and pneumococcal vaccination may help to prevent severe respiratory complications.…”

Section: Introductionmentioning

confidence: 99%

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Non‐invasive ventilation reduces respiratory tract infections in children with neuromuscular disorders

Dohna-Schwake¹,

Podlewski²,

Voït³

et al. 2007

Pediatric Pulmonology

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Summary. Non-invasive ventilation (NIV) has been shown to improve gas exchange and survival in patients with chronic neuromuscular disorders. Little is known about its influence on respiratory tract infections (RTIs). Twenty-four patients with regular use of NIVand 11 patients without NIV with neuromuscular disorders answered a questionnaire concerning the use of NIV and assisted coughing techniques, the status of influenza and pneumococcus vaccination, and the frequency and severity of RTIs. Additionally, we performed a retrospective chart review of twelve patients who were ventilated over a period of at least 5 years. In the first year of NIV consultations of a general practitioner due to RTI decreased from 9.2 AE 20.8 to 3.2 AE 5.3 per year (P < 0.005), the number of antibiotic treatment due to RTI decreased from 4.1 AE 3.4 to 1.9 AE 2.2 per year (P < 0.005) and the number of hospital admissions due to RTI decreased from 1.6 AE 1.7 to 0.7 AE 1.3 per year (P < 0.005). Vaccinations against influenza and/or pneumococcus did not have a significant influence on the rate of infections. In 12 patients using NIV for more than 5 years the incidence of RTI requiring hospital admission decreased from 0.54 AE 0.41/year in the pre-ventilation period to 0.12 AE 0.09/year in the NIV period (P < 0.005). NIV had a favorable impact on respiratory infectious complications in children with neuromuscular disorders.

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Section: Discussionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Non‐invasive ventilation reduces respiratory tract infections in children with neuromuscular disorders

Dohna-Schwake¹,

Podlewski²,

Voït³

et al. 2007

Pediatric Pulmonology

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“…Despite the broad range reported in the literature, the improvements seen in this present study align with the change from unassisted cough peak flow to air stacking-assisted cough peak flow values of ϩ35% to ϩ71% that other authors report. 11,13,14,26 A recent study reported that air stacking can be learned by children with severe muscle weakness. 27 In 18 subjects affected by spinal muscular atrophy and congenital muscular dystrophy, air stacking was shown to be an effective airway clearance therapy.…”

Section: Discussionmentioning

confidence: 99%

“…When hyperinflated in this manner to maximum insufflation capacity, subsequent cough maneuvers are performed with increased inspiratory volume. Air is passively delivered using a positive pressure device, such as a ventilator or resuscitator bag, 11 or via glossopharyngeal breathing. 12 When using glossopharyngeal breathing or a ventilator, patients need to coordinate both opening of their glottis during each insufflation and closure at the end in order to hold the stacked air and increase inspiratory capacity.…”

Section: What Is Air Stacking?mentioning

confidence: 99%

Cough Augmentation in Subjects With Duchenne Muscular Dystrophy: Comparison of Air Stacking via a Resuscitator Bag Versus Mechanical Ventilation

Toussaint¹,

Pernet²,

Steens³

et al. 2015

Respir Care

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BACKGROUND: Air stacking improves cough effectiveness in people with Duchenne muscular dystrophy (DMD) and respiratory muscle weakness. However, it is not known whether air stacking is more effective via a resuscitator bag or a home ventilator. METHODS: This prospective randomized study investigated the effect of air stacking via a volume-cycled home ventilator versus via a resuscitator bag in participants with DMD. Maximum insufflation capacity and peak expiratory flow during spontaneous (cough peak flow) and air stacking-assisted cough maneuvers (air stacking-assisted cough peak flow) were measured. RESULTS: Fifty-two adult DMD subjects receiving noninvasive ventilation were included in the study: 27 participants performed air stacking via their home ventilator (home-ventilator group; age ‫؍‬ 25.3 ؎ 5.1 y; forced vital capacity (FVC) ‫؍‬ 809 ؎ 555 mL), and 25 participants used a resuscitator bag (resuscitator-bag group; age ‫؍‬ 24.7 ؎ 5.7 y, FVC ‫؍‬ 807 ؎ 495 mL). Following a single training session, air stacking could be performed successfully by 89% (home ventilator) and 88% (resuscitator bag) of participants. There were comparable maximum insufflation capacities (1,481 mL for the home-ventilator group vs 1,344 mL for the resuscitator-bag group, P ‫؍‬ .33) and mean air stacking-assisted cough peak flow values (199 L/min for the home-ventilator group vs 186 L/min for the resuscitator-bag group, P ‫؍‬ .33) between techniques. Air stacking-assisted cough peak flow increased significantly compared with baseline in both groups (mean increase: ؉51% [home ventilator] vs ؉49% [resuscitator bag], P < .001), with individual air stacking-assisted cough peak flow improvements ranging from ؊20 to 245%. CONCLUSIONS: Cough augmentation is an important component of the respiratory management of people with a neuromuscular disorder. No difference in cough effectiveness as measured by air stacking-assisted cough peak flow was found in air stacking via a ventilator compared with via a resuscitator bag. Both methods achieved mean air stacking-assisted cough peak flow values of >160 L/min. Provision of an inexpensive resuscitator bag can effectively improve cough capacity, and it is simple to use, which may improve access to respiratory care in people with DMD.

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“…As consequências diretas desse acometimento são a diminuição da pressão gerada durante a tosse levando a episódios de broncoaspiração e retenção de secreções em vias aéreas 8,15 . Sabe-se que o treino de força no músculo reto abdominal através de dispositivos de expiração forçada, melhora o recrutamento de fibras, e consequentemente a tosse, mas existe uma série de condições clínicas e limitações que contraindica o uso destes para essa finalidade [16][17][18][19] . Além disso, já existem evidências que a eletroestimulação transcutânea em musculatura respiratória tem bons efeitos em pacientes crônicos, inclusive neurológicos, em quadros de atrofia muscular [20][21][22][23][24][25] .…”

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Eficácia da eletroestimulação muscular expiratória na tosse de pacientes após acidente vascular encefálico

Meireles

Queiroz

et al. 2012

Fisioter. Pesqui.

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-Aceito para publicação: out. 2012 -Fonte de financiamento: nenhuma -Conflito de interesse: nada a declarar -Apresentação em evento científico: Este estudo teve seus resultados parciais apresentados de forma oral na VII Jornada Científica da Faculdade ASCES e foi apresentado na íntegra em formato de pôster no XVI Simpósio Internacional de Fisioterapia Respiratória (XVI SIFR) -Parecer de aprovação no Comitê de Ética e Pesquisa da Faculdade ASCES nº 119/10.ABSTRACT | Individuals with sequelae of stroke present as a common complication hypotonia and weakness of trunk muscles, in special the rectus abdominal muscle which is the main muscle activated for cough. The electrical stimulation (ES) is being widely used to fiber recruitment in many muscle groups and pathologies. The present study aimed to evaluate the efficiency of electrical stimulation with median frequencies (ETMF) in expiratory muscles strength and cough in patients with sequels of stroke. It is a quasi-experimental study (before and after) where 11 individuals were selected after stroke between 40 and 65 years, both sexes and hemodynamically stable. Patients were evaluated about clinic and respiratory scores (ventilometer, peak of expiratory flow (PEF) and manometer (MIP and MEP) and submitted to the protocol, which consisted of ETMF in expiratory muscle (abdominals rectus) with the unit of Russian current with 2,500 Hz carrier frequency modulated at 40 Hz for 15 minutes by 15 sessions. In the initial assessment evidenced decreasing in inspiratory and expiratory muscular strength (MIP, MEP) and PEF when compared to predicted values in literature. In the end of ETMF it happened an increase in MIP, MEP without statistical significance (p=0.18 and p=0.29) but the PEF has had an increase of 283.73 L/minute to 347.27 L/minute (p=0.03). It can be seen that the ETMF was effective in the improvement of the parameters evaluated, with PEF being the greatest impact and statistical significance, RESUMO | Indivíduos com sequelas de acidente vascular encefálico (AVE) apresentam como complicação comum a hipotonia de tronco com consequente fraqueza da sua musculatura, em especial, o reto abdominal que é o principal músculo acionado para a tosse. As correntes elétricas têm sido amplamente utilizadas para recrutamento de fibras musculares nas mais diversas patologias. O presente estudo teve como objetivo avaliar a eficácia da eletroestimulação transcutânea de média frequência (ETMF) na força muscular expiratória e tosse de pacientes com sequela de AVE. Trata-se de um estudo quase-experimental (antes e depois) onde foram selecionados 11 indivíduos pós-AVE entre 40 a 65 anos, ambos os sexos e estáveis hemodinamicamente. Os pacientes foram avaliados quanto a parâmetros clínicos e pneumofuncionais (ventilometria, pico de fluxo expiratório (PFE) e manovacuometria) e submetidos ao protocolo, que constava de ETMF no músculo reto abdominal com o aparelho de corrente Russa, frequência portadora de 2.500 Hz modulada a 40 Hz, durante 15 minutos, por 15 sessões. Na avaliação inicia...

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IPPB-assisted coughing in neuromuscular disorders

Cited by 91 publications

References 25 publications

Non‐invasive ventilation reduces respiratory tract infections in children with neuromuscular disorders

Non‐invasive ventilation reduces respiratory tract infections in children with neuromuscular disorders

Cough Augmentation in Subjects With Duchenne Muscular Dystrophy: Comparison of Air Stacking via a Resuscitator Bag Versus Mechanical Ventilation

Eficácia da eletroestimulação muscular expiratória na tosse de pacientes após acidente vascular encefálico

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