Survey of Use of the Insufflator-Exsufflator in Patients With Spinal Cord injury

Schmitt, James K.; Stiens, Steven A.; Trincher, Rose; Lam, Mylam; Sarkarati, Mehdii; Linder, Steven H; Ho, Chester

doi:10.1080/10790268.2007.11753923

Cited by 14 publications

(11 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Compared to the manual cough assist ("quad cough") technique, MIE provides much higher peak expiratory flow (7.47 L/s vs 3.4 L/s). 34 It appears that the use of MIE in individuals with SCI may have been increasing since Bach's article was published in 1993; but in a most recent study by Schimdt, 35 only about 64% of the acute rehabilitation facility was using the MIE device. Given how well the MIE treatment works on secretion management in individuals with acute cervical SCI, the MIE device should be available at all acute rehabilitation facilities that treat individuals with SCI.…”

Section: Discussionmentioning

confidence: 99%

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

Wong¹,

Shem²,

Crew³

2012

Topics in Spinal Cord Injury Rehabilitation

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

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

Wong¹,

Shem²,

Crew³

2012

Topics in Spinal Cord Injury Rehabilitation

View full text Add to dashboard Cite

show abstract

“…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

View full text Add to dashboard Cite

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.

show abstract

“…A more recent study indicated comparable inpatient usage experience (51%) and somewhat more prevalent (42%) experience using it with outpatients, although the low response rate in that survey (16%) may have biased those findings (12). Patients typically prefer MIE over suctioning (13), and in outpatient settings the treatments are most commonly administered by family members or other caregivers, not nurses (12). Medical complications associated with the use of MIE appear to be rare (14), although barotrauma is a potential concern in some patient populations given the positive pressure associated with the insufflation phase of MIE.…”

Section: Introductionmentioning

confidence: 87%

“…Preliminary results from a survey indicate that most SCI specialists had some inpatient experience with its use; however, only 28% had ever prescribed MIE for outpatient use (11). A more recent study indicated comparable inpatient usage experience (51%) and somewhat more prevalent (42%) experience using it with outpatients, although the low response rate in that survey (16%) may have biased those findings (12). Patients typically prefer MIE over suctioning (13), and in outpatient settings the treatments are most commonly administered by family members or other caregivers, not nurses (12).…”

Section: Introductionmentioning

confidence: 96%

Mechanical Insufflation-Exsufflation Device Prescription for Outpatients With Tetraplegia

Crew

Svircev

Burns

2010

The Journal of Spinal Cord Medicine

View full text Add to dashboard Cite

Background: Mechanical insufflation-exsufflation (MIE) is an option for secretion mobilization in outpatients with spinal cord injury (SCI) who lack an effective cough and are at high risk for developing pneumonia. Objective: To describe characteristics of persons with SCI who received MIE devices for outpatient use and compare respiratory hospitalizations before and after MIE prescription. Design: Retrospective cohort study of all persons who were prescribed MIE devices for outpatient use during 2000 to 2006 by a Veterans Affairs SCI service. Results: We identified 40 patients with tetraplegia (4.5% of population followed by the SCI service) who were prescribed MIE devices. Of these, 30 (75%) had neurologic levels of C5 or rostral, and 33 (83%) had motor-complete injuries. For chronically injured patients who were prescribed MIE for home use, there was a nonsignificant reduction in respiratory hospitalization rates by 34% (0.314/y before MIE vs 0.208/y after MIE; P 5 0.21). A posthoc subgroup analysis showed a significant decline in respiratory hospitalizations for patients with significant tobacco smoking histories. Conclusions: Mechanical insufflation-exsufflation was typically prescribed for people with motor-complete tetraplegia. Outpatient MIE usage may reduce respiratory hospitalizations in smokers with SCI. Further research of this alternative, noninvasive method is warranted in the outpatient SCI population.

show abstract

Survey of Use of the Insufflator-Exsufflator in Patients With Spinal Cord injury

Cited by 14 publications

References 14 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

Mechanical Insufflation-Exsufflation Device Prescription for Outpatients With Tetraplegia

Contact Info

Product

Resources

About