Objective measurement of lung volume recruitment therapy: laboratory and clinical validation

Abstract

Lung volume recruitment manoeuvres are often prescribed to maintain respiratory health in neuromuscular disease. Unfortunately, no current system accurately records delivered dose. This study determined the performance characteristics of a novel, objective, manual lung volume recruitment bag counter (‘the counter’) with bench and healthy volunteer testing, as well as in individuals with neuromuscular disease. We undertook (1) bench test determination of activation threshold, (2) bench and healthy volunteer fidelity testing during simulated patient interface leak and different pressure compressions and (3) comparisons with self-report in individuals with neuromuscular disease. The data are reported as summary statistics, compression counts, percentage of recorded versus delivered compressions and concordance (Cohen’s kappa (K) and absolute agreement).ResultsMinimum counter activation pressure under conditions of zero leak was 1.9±0.4 cm H2O. No difference was observed between the number of repetitions delivered and recorded during high airway pressure condition. Interface leak approximating 25% resulted in underestimation of repetition counts, and once the leak was at 50% or beyond, the counter recorded no activity. Faster sampling frequency collected data with more fidelity. Counter data agreed with diary self-report during community trials (16 participants, 960 participant days, 77% agreement, Cohen’s Κ=0.66 and p<0.001). Disagreement typically favoured more diary reported (18%) than counter (5%) sessions.ConclusionsThe performance characteristics of a new lung volume recruitment counter have been established in both laboratory and community settings. Objective usage and dosage data should accelerate new knowledge development and better translation of lung volume recruitment therapy into policy and practice.

Addition of respiratory exercises to conventional rehabilitation for children and adolescents with cerebral palsy: a systematic review and meta-analysis

“…Future well-controlled RCTs are required to reinforce the recommendation of respiratory exercise as an important rehabilitation treatment in people with cerebral palsy. Successful propositions of breathing exercises with other populations may provide a new direction for exercise prescription, such as lung volume recruitment [35]. In addition, it will be important to match exercise prescription to clinical/treatment characteristics of a patient subgroup or individual patient.…”

A Randomized Controlled Clinical Trial of Lung Volume Recruitment in Adults with Neuromuscular Disease

“…Self-report methods of adherence overestimate LVR use ( 26 ); hence, it is critical that future studies collect objective measures of LVR. Participant-reported outcomes and qualitative data evaluating participant-perceived benefits and barriers to treatment are also necessary.…”

“…Participants in the LVR arm were prescribed five sets of five maximal inflations per session. The number of compressions per maximal inflation was individualized ( 26 ), and peak inflation pressure was maintained at <50 cm H 2 O. A previously validated counter fitted to the LVR kit recorded use objectively (1.6-L manual resuscitation bag, one-way in-line valve, mouthpiece, and nose clip or oronasal mask; LVR kit item number 1034502; Mercury Medical) ( 26 ).…”

Understanding the experiences of lung volume recruitment among boys with Duchenne muscular dystrophy: A multicenter qualitative study

“…Age, baseline FVC %‐predicted (based on Stanojevic normative equations), 21 and LVR adherence data were obtained from trial data. Adherence to LVR was collected over the 2 years of the main study using a data logging device in‐line with the self‐inflating bag with one‐way valve that recorded LVR use, 22 as well as a self‐report diary. The threshold for meeting adherence was the use of LVR at least once per day for at least 50% of days, based on both the data logging device and self‐report diary, as per an a priori adherence definition determined by a consensus of investigators.…”