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.

Abstract

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.

• Authors: Matthieu Lacombe, Lorena Del Amo Castrillo, Aurélien Boré, David Chapeau, Eric Horvat, Isabelle Vaugier, Michelle Lejaille, David Orlikowski, Hélène Prigent, Frédéric Lofaso
• Journal: Respiration; international review of thoracic diseases (Respiration) Vol. 88 Issue 3 Pg. 215-22 ( 2014) ISSN: 1423-0356 [Electronic] Switzerland
• PMID: 25171575 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial)

Topics

• Adult
• Aged
• Cough
• Cross-Over Studies
• Female
• Humans
• Insufflation (methods)
• Intermittent Positive-Pressure Breathing (methods)
• Male
• Metabolism, Inborn Errors (complications)
• Middle Aged
• Muscular Atrophy, Spinal (complications)
• Muscular Dystrophies (complications)
• Neuromuscular Diseases (complications)
• Respiratory Insufficiency (etiology, therapy)
• Respiratory Paralysis (etiology, therapy)
• Respiratory Therapy (methods)
• Treatment Outcome
• Young Adult