Mechanical Insufflation-Exsufflation Device Prescription for Outpatients With Tetraplegia

Crew, James; Svircev, Jelena N.; Burns, Stephen P.

doi:10.1080/10790268.2010.11689687

Cited by 26 publications

(20 citation statements)

References 21 publications

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“…In particular, those with a prior history of smoking have been shown to benefit from consistent MIE use. 25 Although there are several published reports and guidelines supporting the use of MIE in individuals with SCI, there is no evidence-based literature describing or supporting the use of HFPV specifically for SCI. 3,21,31,32 The limitation of this study is that we cannot specifically describe the effectiveness of just HFPV or MIE in this patient population because a combination of respiratory care interventions (HVtV, HFPV, and MIE) was used in almost all of the subjects.…”

Section: Discussionmentioning

confidence: 99%

“…MIE use has been shown to improve pulmonary function parameters and is associated with decreased respiratory hospitalizations for persons with SCI who have a history of smoking. 24,25 Although there is often a concern for barotrauma with MIE use in those with SCI, pneumothorax is uncommon when MIE is utilized at appropriate pressures such as +40 mm Hg and -40 mm Hg. 26 At our center, an individual with cervical SCI with atelectasis and/or pneumonia will receive HFPV therapy followed by MIE every 2 to 4 hours around the clock.…”

Section: Secretion Managementmentioning

confidence: 99%

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Specialized Respiratory Management for Acute Cervical Spinal Cord Injury: A Retrospective Analysis

Wong¹,

Shem²,

Crew³

2012

Topics in Spinal Cord Injury Rehabilitation

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Background:In individuals with cervical spinal cord injury (SCI), respiratory complications arise within hours to days of injury. Paralysis of the respiratory muscles predisposes the patient toward respiratory failure. Respiratory complications after cervical SCI include hypoventilation, hypercapnea, reduction in surfactant production, mucus plugging, atelectasis, and pneumonia. Ultimately, the patient must use increased work to breathe, which results in respiratory fatigue and may eventually require intubation for mechanical ventilation. Without specialized respiratory management for individuals with tetraplegia, recurrent pneumonias, bronchoscopies, and difficulty in maintaining a stable respiratory status will persist. Objective: This retrospective analysis examined the effectiveness of specialized respiratory management utilized in a regional SCI center. Methods: Individuals with C1-C4 SCI (N = 24) were the focus of this study as these neurological levels present with the most complicated respiratory status. Results: All of the study patients' respiratory status improved with the specialized respiratory management administered in the SCI specialty unit. For a majority of these patients, respiratory improvements were noted within 1 week of admission to our SCI unit. Conclusion: Utilization of high tidal volume ventilation, high frequency percussive ventilation, and mechanical insufflationexsufflation have demonstrated efficacy in stabilizing the respiratory status of these individuals. Optimizing respiratory status enables the patients to participate in rehabilitation therapies, allows for the opportunity to vocalize, and results in fewer days on mechanical ventilation for patients who are weanable.

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Section: Discussionmentioning

confidence: 99%

Section: Secretion Managementmentioning

confidence: 99%

Specialized Respiratory Management for Acute Cervical Spinal Cord Injury: A Retrospective Analysis

Wong¹,

Shem²,

Crew³

2012

Topics in Spinal Cord Injury Rehabilitation

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“…The use of mechanical devices such as intrapulmonary percussive ventilation [28] and mechanical insufflation-exsufflation (MIE) [18] has not been prospectively assessed in acute patients undergoing mechanical ventilation. Retrospective studies suggest their efficacy for reducing the number of hospitalizations in chronic patients [47] and for reducing the weaning time [18]. In a survey on the use of MIE, only 49% of the centers that responded acknowledged using the technique routinely [48].…”

Section: Ventilation Modesmentioning

confidence: 99%

Respiratory Management in the Patient with Spinal Cord Injury

Galeiras

Sedes

Fariña

et al. 2013

BioMed Research International

132

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Spinal cord injuries (SCIs) often lead to impairment of the respiratory system and, consequently, restrictive respiratory changes. Paresis or paralysis of the respiratory muscles can lead to respiratory insufficiency, which is dependent on the level and completeness of the injury. Respiratory complications include hypoventilation, a reduction in surfactant production, mucus plugging, atelectasis, and pneumonia. Vital capacity (VC) is an indicator of overall pulmonary function; patients with severely impaired VC may require assisted ventilation. It is best to proceed with intubation under controlled circumstances rather than waiting until the condition becomes an emergency. Mechanical ventilation can adversely affect the structure and function of the diaphragm. Early tracheostomy following short orotracheal intubation is probably beneficial in selected patients. Weaning should start as soon as possible, and the best modality is progressive ventilator-free breathing (PVFB). Appropriate candidates can sometimes be freed from mechanical ventilation by electrical stimulation. Respiratory muscle training regimens may improve patients' inspiratory function following a SCI.

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“…18 As many physiotherapy treatments available become impractical in patients with advanced neuromuscular disease, MI-E could represent an alternative. 19,20 MI-E devices deliver a positive pressure to the airway (insufflation) and then rapidly shift to negative pressure (exsufflation). 21 They can be used with an oronasal interface or with an endotracheal or tracheostomy tube.…”

Section: Introductionmentioning

confidence: 99%

Use of Mechanical Insufflation-Exsufflation Devices for Airway Clearance in Subjects With Neuromuscular Disease

Auger¹,

Hernando²,

Galmiche³

2017

Respir Care

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The aim of this systematic review is to examine the benefit/risk ratio of the use of mechanical insufflation-exsufflation (MI-E) devices for airway clearance in patients with neuromuscular diseases. A search was conducted for relevant studies in MEDLINE, the Cochrane Library, and the Health Technology Assessment Database using the main key words: cough, airway clearance, in-exsufflation. The search limits were studies published in English and French between 1970 and 2014 (literature watch until December 2015). The methodological quality of the studies was assessed using (1) the Cochrane Collaboration's risk of bias tool for randomized controlled trials and (2) the Institute of Health Economics' 20-item checklist for comparative and observational studies. Data were extracted into an evidence table according to (1) study design, (2) population characteristics (including age and type of diseases) and intervention (MI-E associated or not with other interventions), (3) outcome measures, and (4) key findings. Twelve studies met the inclusion criteria (4 randomized controlled trials, 3 comparative studies, and 5 observational studies). The quality of the selected studies was poor. None of the studies reported survival outcome. All studies evaluated change of pulmonary function parameters, such as peak expiratory flow. This review underlines the lack of robust data on mechanical medical devices used for airway clearance. The current scientific evidence does not support the use of MI-E for cough augmentation in patients with neuromuscular diseases, but health-care professionals are faced with the reality of medical practice and the absence of alternatives. Most European and American guidelines recommend the use of MI-E despite low-level evidence. However, even if performing comparative trials in a specific population is difficult, the medical device industry should provide reliable data to assist health-care professionals, providers, and payers in the decision-making process. This is the only way to ensure the best treatment for patients.

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Mechanical Insufflation-Exsufflation Device Prescription for Outpatients With Tetraplegia

Cited by 26 publications

References 21 publications

Specialized Respiratory Management for Acute Cervical Spinal Cord Injury: A Retrospective Analysis

Specialized Respiratory Management for Acute Cervical Spinal Cord Injury: A Retrospective Analysis

Respiratory Management in the Patient with Spinal Cord Injury

Use of Mechanical Insufflation-Exsufflation Devices for Airway Clearance in Subjects With Neuromuscular Disease

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