Mechanical Insufflation-Exsufflation vs. Tracheal Suctioning via Tracheostomy Tubes for Patients with Amyotrophic Lateral Sclerosis

Sancho, Jesús; Servera, Emilio; Vergara, Pedro; Marín, Julio

doi:10.1097/01.phm.0000087456.28979.2e

Cited by 80 publications

(62 citation statements)

References 15 publications

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“…It involves the application of cycling positive and negative pressure to the airway, facilitating an effective cough and adequate secretion clearance. Studies examining its home-based clinical effectiveness demonstrate that it is safe and well tolerated [2][3][4] ; creates an increased peak cough flow 2,[5][6][7][8] ; results in reduced hospital stay 9 ; and when used as part of a wider home management protocol involving other therapies, such as noninvasive ventilation, achieves reduced rates of pneumonia and hospital stay. 5,6,10,11 However, there have been comparatively few studies examining the broader impact of home-based MI-E on children and their families.…”

Section: Introductionmentioning

confidence: 99%

Lifestyle Implications of Home Mechanical Insufflation-Exsufflation for Children With Neuromuscular Disease and Their Families

Moran¹,

Spittle

Delany

2014

Respir Care

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BACKGROUND: Mechanical insufflation-exsufflation (MI-E) is increasingly used in the home management of children with neuromuscular disease. Research to date has focused on the effect of MI-E on physical health. The aim of this study was to qualitatively investigate the impact of home MI-E on the child and family's lifestyle. METHODS: Eight parents and 3 children participated in semistructured interviews. RESULTS: Five themes emerged from parent interviews demonstrating: (1) lifestyle implications, (2) parents becoming experts, (3) parents developing a sense of control over their child's condition, (4) an element of extra care, and (5) impacts on the parent-child relationship. Developing themes from the child interviews showed them adjusting to and then relying on the device. Home MI-E medicalized the home, but the overall lifestyle impact was positive. CONCLUSIONS: Although involving a small number of subjects, this study demonstrated a mixture of opposing impacts of home MI-E on lifestyle, both enabling and disabling, which need to be considered when introducing home MI-E. The positive impacts included greater ability to manage the child's health, including avoidance of hospital admissions. Negative impacts were greatest for those parents who were sole operators of the device, including a frequently disrupted lifestyle.

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Section: Introductionmentioning

confidence: 99%

Lifestyle Implications of Home Mechanical Insufflation-Exsufflation for Children With Neuromuscular Disease and Their Families

Moran¹,

Spittle

Delany

2014

Respir Care

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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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“…MI-E devices effectively clear secretions in ALS patients [45] and their clinical value can be explained by the fact that they can generate expiratory flows >160 L/min [62]. Recently, it has been also demonstrated that MI-E via a tracheostomy tube is more effective in clearing airway secretions than conventional suctioning in ventilator-dependent ALS patients [63].…”

Section: Timing For Ventilatory Support and Secretion Removalmentioning

confidence: 99%

Assessment and monitoring of ventilatory function and cough efficacy in patients with amyotrophic lateral sclerosis

Chetta

Aiello

Tzani

et al. 2016

Monaldi Arch Chest Dis

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Assessing and monitoring respiratory muscle function is crucial in patients with Amyotrophic Lateral Sclerosis, since impaired function can lead to either ventilatory failure or respiratory tract infection. Spirometry, diffusing capacity of the lung, breathing pattern, sleep study, blood gas analysis and respiratory muscle strength tests, as well as cough peak flow and cough expiratory volume measurements can provide relevant information on ventilatory function and cough efficacy. With regard to respiratory muscle strength testing, the rational approach consists in starting with volitional and non-invasive tests and later using invasive and non-volitional tests. This review focuses on both ventilatory and respiratory muscle strength testing, in order to undertake a timely treatment of respiratory failure and/or impaired cough efficacy. So far, the current literature has not highlighted any gold standard which stipulates when to commence ventilation and cough support in patients with Amyotrophic Lateral Sclerosis. A composite set of clinical and functional parameters is required for treatment scheduling to monitor lung involvement and follow-up in these patients.

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Mechanical Insufflation-Exsufflation vs. Tracheal Suctioning via Tracheostomy Tubes for Patients with Amyotrophic Lateral Sclerosis

Abstract: For ventilator-dependent patients with amyotrophic lateral sclerosis, mechanical insufflation-exsufflation via a tracheostomy tube with an inflated cuff may be more effective in eliminating airway secretions than conventional tracheal suctioning.

Cited by 80 publications

References 15 publications

Lifestyle Implications of Home Mechanical Insufflation-Exsufflation for Children With Neuromuscular Disease and Their Families

Lifestyle Implications of Home Mechanical Insufflation-Exsufflation for Children With Neuromuscular Disease and Their Families

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

Assessment and monitoring of ventilatory function and cough efficacy in patients with amyotrophic lateral sclerosis

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