Lung Volume Recruitment Slows Pulmonary Function Decline in Duchenne Muscular Dystrophy

McKim, Douglas; Katz, Sherri L.; Barrowman, Nicholas J.; Ni, Andy; LeBlanc, Carole

doi:10.1016/j.apmr.2012.02.024

Cited by 92 publications

(101 citation statements)

References 43 publications

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“…7 A recent study showed that for 22 patients with advanced Duchenne muscular dystrophy (DMD), regular use of a lung recruitment maneuver by air stacking via resuscitation bag is able to reduce annual decline of VC from 4.7% to 0.5% predicted. 8 The British Thoracic Society guidelines recommend the application of volume recruitment and deep lung insufflation techniques when the VC falls below 40% predicted, 9 but there are no data or clear recommendation whether the deep lung insufflation techniques should be used only to augment insufficient cough in situations with increased pulmonary secretions or additionally in the infection-free interval serving as internal physiotherapy. The addition of the mechanical exsufflation to a deep lung insufflation in the MI-E might further improve the mobility of the stiff thorax and help to clear retained airway secretions that reduce lung compliance.…”

Section: Introductionmentioning

confidence: 99%

Mechanical insufflation/exsufflation improves vital capacity in neuromuscular disorders

et al. 2014

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Inherited neuromuscular disorders inevitably result in severe lung volume restriction associated with high morbidity and mortality. The aim of this retrospective study was to evaluate the long-term effects of the regular use of mechanical insufflation/exsufflation on the course of the vital capacity. This retrospective data analysis included 21 patients (16.1 + 6.5 years) with neuromuscular disorders and severe lung volume restriction using nocturnal noninvasive ventilation. The patients were advised to regularly use the mechanical insufflation/ exsufflation twice a day for 10 minutes applying sets of three insufflation/exsufflation breath via face mask irrespective of respiratory tract infection. Data on the course of vital capacity were collected 2 years prior and 2 years after the introduction of regular use of mechanical insufflation/exsufflation. Before the introduction of mechanical insufflation/exsufflation vital capacity decreased from 0.71 + 0.38 L to 0.50 + 0.24 L in the last year and from 0.88 + 0.45 L to 0.71 + 0.38 L in the next to last year. In the first year, after regular use of mechanical insufflation/exsufflation vital capacity significantly increased by 28% (from 0.50 L to 0.64 L)-after the second year the vital capacity increase remained stable (0.64 vs. 0.65 L). These data suggest that the regular use of mechanical insufflation/exsufflation improves vital capacity in patients with neuromuscular disorders and severe lung volume restriction.

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Section: Introductionmentioning

confidence: 99%

Mechanical insufflation/exsufflation improves vital capacity in neuromuscular disorders

et al. 2014

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“…Although many centers worldwide have reported successfully using MIE via noninvasive interfaces to prevent pneumonia and ARF, [40][41][42][43][44][45] only our group 19,20,31 and one other 46 have reported its use via tracheostomy tubes. MIE use with intubated subjects had only been described in our 2010 study 18 and in European subjects with lung disease.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Mechanical Insufflation-Exsufflation in Extubating Unweanable Subjects With Restrictive Pulmonary Disorders

et al. 2014

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BACKGROUND: Subjects who do not pass ventilator weaning parameters but whose ambient air oxyhemoglobin saturation can be normalized by mechanical insufflation-exsufflation (MIE) can be extubated to continuous noninvasive ventilatory support (CNVS) with MIE used to maintain extubation. Our aim was to study MIE-associated changes in breathing tolerance, pulse oximetry, and vital capacity (VC) for consecutive unweanable subjects. METHODS: A retrospective chart review was performed for consecutively referred intubated subjects with single-organ (respiratory muscle) failure. At presentation, CO 2 was normalized by adjusting ventilator settings and VC was measured (point 1). Then, MIE was used via the tube up to every h until oximetry remained > 95% on ambient air and VC was remeasured (point 2) immediately before extubation. Subjects who could not meet ventilator weaning criteria and had no ventilator-free breathing ability upon extubation to CNVS were enrolled. Post-extubation, the MIE was used to maintain oximetry > 95% in room air. VC and breathing tolerance were remeasured within 3 weeks (point 3). RESULTS: Ninetyseven of 98 subjects were successfully extubated despite 45 having been CNVS-dependent for 4 months to 18 y before being intubated. Sixty-nine of the 98 were intubated for 24.9 ؎ 22 (range 1-158) d and failed 0 -6 (mean 1.7) extubation attempts before being transferred and successfully extubated in 2.24 ؎ 1.78 (range < 1-8) d to CNVS. VC increased by 270% (P < .001) from points 1 to 3. Weaning from CNVS to part-time NVS was achieved by all 52 subjects who had not been CNVS-dependent before intubation. One subject underwent tracheotomy. CONCLUSIONS: Many unweanable subjects can be extubated to CNVS and MIE. The latter can normalize O 2 saturation, increase VC, and facilitate extubation.

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“…Although discussion of these complementary therapies is beyond the scope of this paper, the importance of complete respiratory care and follow-up in these patients cannot be over-emphasized. 14,17,18,21,22 The patient has still not required a tracheostomy, more than 7 years after it was originally recommended.…”

Section: Rise Timementioning

confidence: 99%

“…Although a more sustained T I may improve nocturnal ventilation, lung recruitment, and atelectasis, regular lung volume recruitment maneuvers with a modified manual resuscitation bag (often referred to as breath-stacking) were also initiated to improve lung compliance and cough efficiency. 14,17 Use of the CoughAssist device (Philips Home Healthcare Solutions, Monroeville, Pennsylvania) was re-emphasized to aid in secretion clearance. 18 Two weeks after our initial meeting the patient reported by telephone that he was now able to sleep through most nights without calling to be turned, compared to 4 or 5 times a night previously.…”

Section: Rise Timementioning

confidence: 99%

Data Downloads for Effective Noninvasive Ventilation in Patients With Neuromuscular Respiratory Failure

2013

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Lung Volume Recruitment Slows Pulmonary Function Decline in Duchenne Muscular Dystrophy

Cited by 92 publications

References 43 publications

Mechanical insufflation/exsufflation improves vital capacity in neuromuscular disorders

Mechanical insufflation/exsufflation improves vital capacity in neuromuscular disorders

Efficacy of Mechanical Insufflation-Exsufflation in Extubating Unweanable Subjects With Restrictive Pulmonary Disorders

Data Downloads for Effective Noninvasive Ventilation in Patients With Neuromuscular Respiratory Failure

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