The Effect of Pressure Changes During Mechanical Insufflation-Exsufflation on Respiratory and Airway Physiology

Shah, Neeraj M.; Apps, Chloe; Kaltsakas, Georgios; Madden-Scott, Sophie; Suh, Eui-Sik; D’Cruz, Rebecca F.; Arbane, Gill; Patout, Maxime; Lhuillier, Elodie; Hart, Nicholas; Murphy, Patrick B.

doi:10.1016/j.chest.2023.10.015

Cited by 6 publications

(1 citation statement)

References 44 publications

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“…Different measures can be generated from EIT patient examinations allowing the assessment of ventilation distribution, regional lung volume changes and respiratory mechanics, as well as lung perfusion, stroke volume or regional oxygen uptake. EIT has been used to detect changes in ventilation and lung recruitment after MI-E in spinal muscular atrophy type I [40] and DMD [41]. However, if a change (improvement) in ventilation is detected, it can be presumed that the airway is open.…”

Section: Other Options To Evaluate Mi-e Efficacymentioning

confidence: 99%

Waves of Precision: A Practical Guide for Reviewing New Tools to Evaluate Mechanical In-Exsufflation Efficacy in Neuromuscular Disorders

Chatwin,

Sancho,

Lujan

et al. 2024

JCM

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Mechanical insufflation-exsufflation (MI-E) is essential for secretion clearance, especially in neuromuscular disorders. For the best outcomes, initiation of MI-E should be started at the correct time with regular evaluation to the response to treatment. Typically, cough peak flow has been used to evaluate cough effectiveness with and without MI-E. This review highlights the limitations of this and discussed other tools to evaluate MI-E efficacy in this rapidly developing field. Such tools include the interpretation of parameters (like pressure, flow and volumes) that derive from the MI-E device and external methods to evaluate upper airway closure. In this review we pinpoint the differences between different devices in the market and discuss new tools to better titrate MI-E and detect pathological responses of the upper airway. We discuss the importance of point of care ultrasound (POCUS), transnasal fiberoptic laryngoscopy and wave form analysis in this setting. To improve clinical practice newer generation MI-E devices should allow real-time evaluation of waveforms and standardize some of the derived parameters.

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Section: Other Options To Evaluate Mi-e Efficacymentioning

confidence: 99%