Lung Inflation Training Using a Positive End-expiratory Pressure Valve in Neuromuscular Disorders

Abstract

Objective Respiratory muscle weakness causes alveolar hypoventilation and reduced lung compliance in neuromuscular disorders. Lung inflation is important to prevent secondary pulmonary complications however respiratory and laryngeal dysfunction often hamper lung inflation. There is a need for a convenient and lowcost device that enables effective lung inflation. We tested a lung inflation training method using a positive end-expiratory pressure (PEEP) valve. Methods Vital capacity (VC), maximum insufflation capacity (MIC) and peak cough flow (PCF) as well as PEEP lung inflation capacity (PIC) were assessed in 93 neuromuscular patients. Consecutive PIC training was done for 4 months in six tracheostomized Duchenne muscular dystrophy (DMD) patients and PIC was assessed before and after training. Results PIC training was practicable in all participants and no serious adverse events were detected. PIC was significantly higher than VC or MIC in all disorders, although MIC was higher than VC in DMD only. Patients with dysphagia showed lower MIC and PCF compared with non dysphagic patients. PIC was as low as 345±77 mL in tracheostomized DMD patients; however consecutive training increased it up to 619±205 mL. Conclusion The PEEP valve enabled effective lung inflation regardless of laryngeal function. Consecutive training can improve lung condition even in advanced cases. Early introduction of PIC training could be effective at preventing respiratory complications in patients with neuromuscular disorders.

The role of lung volume recruitment therapy in neuromuscular disease: a narrative review

“…Commercially available LVR kits contain a one-way valve, thereby avoiding the need for adequate bulbar function, and are used to achieve LIC (Figure 1). A proportion of children and young people with NMDs are unable to participate fully in some LVR techniques due to cognitive, developmental, or behavioural limitations, and alternative techniques have been proposed to augment lung volume in cohorts unable to follow commands (165)(166)(167). "Involuntary breath stacking" using a facemask and one-way valve alone is another method described by Jenkins et al This technique achieves inflation volumes similar to "voluntary breath stacking" (spontaneous breath stacking with glottic control) but lower than "supported breath stacking" using an LVR kit with a one-way valve (167).…”

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

“…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] .…”