Comparison of Three Cough-Augmentation Techniques in Neuromuscular Patients: Mechanical Insufflation Combined with Manually Assisted Cough, Insufflation-Exsufflation Alone and Insufflation-Exsufflation Combined with Manually Assisted Cough
| العنوان: | Comparison of Three Cough-Augmentation Techniques in Neuromuscular Patients: Mechanical Insufflation Combined with Manually Assisted Cough, Insufflation-Exsufflation Alone and Insufflation-Exsufflation Combined with Manually Assisted Cough |
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| المؤلفون: | Michelle Lejaille, Hélène Prigent, Aurélien Boré, Lorena Del Amo Castrillo, David Orlikowski, Matthieu Lacombe, Isabelle Vaugier, Frédéric Lofaso, David Chapeau, Eric Horvat |
| المصدر: | Respiration. 88:215-222 |
| بيانات النشر: | S. Karger AG, 2014. |
| سنة النشر: | 2014 |
| مصطلحات موضوعية: | Adult, Male, Pulmonary and Respiratory Medicine, Insufflation, Respiratory Therapy, Muscular Dystrophies, Muscular Atrophy, Spinal, Random order, Young Adult, Respiratory muscle, Humans, Medicine, In patient, Intermittent Positive-Pressure Breathing, Aged, Cross-Over Studies, business.industry, Neuromuscular Diseases, Middle Aged, Respiratory Paralysis, Treatment Outcome, Cough, Respiratory failure, Intermittent positive pressure breathing, Anesthesia, Breathing, Female, Exsufflation, Respiratory Insufficiency, business, Metabolism, Inborn Errors |
| الوصف: | Background: Mechanical insufflation-exsufflation (MI-E), more commonly known as ‘cough assist therapy', is a method which produces inspiratory and expiratory assistance to improve cough performances. However, other alternatives or combinations are possible. Objective: The objective was to compare the effects of mechanical insufflation combined with manually assisted coughing (MAC), insufflation-exsufflation alone and insufflation-exsufflation combined with MAC in neuromuscular patients requiring cough assistance. Methods: Eighteen neuromuscular patients with severe respiratory muscle dysfunction and peak cough flow (PCF) lower than 3 liters/s or maximal expiratory pressure (MEP) lower than +45 cm H2O were studied. Patients were studied under three cough-assisted conditions, which were used in random order: insufflation by intermittent positive-pressure breathing (IPPB) combined with MAC, MI-E and MI-E + MAC. Results: Overall, PCF was higher with IPPB + MAC than with MI-E + MAC or MI-E alone. Among the 12 patients who had higher PCF values with IPPB + MAC than with the two other techniques, 9 exhibited mask pressure swings during MI-E exsufflation, with a transient positive-pressure value due to the expiratory flow produced by the combined patient cough effort and MAC. Each of these 9 patients had higher PCF values (>5 liters/s) than did the other 9 patients when using IPPB + MAC. Conclusion: Our results indicate that adding the MI-E device to MAC is unhelpful in patients whose PCF with an insufflation technique and MAC exceeds 5 liters/s. This is because the expiratory flow produced by the patient's effort and MAC transitorily exceeds the vacuum capacity of the MI-E device, which therefore becomes a transient load against the PCF. |
| تدمد: | 1423-0356 0025-7931 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::02f29f66c7a6df04fdd9daa4143e4394Test https://doi.org/10.1159/000364911Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....02f29f66c7a6df04fdd9daa4143e4394 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 14230356 00257931 |
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