Cough peak flow with different mechanically assisted coughing approaches under different conditions in patients with neuromuscular disorders

Kikuchi, Kazuto; Satake, Masahiro; Terui, Yoshino; Kimoto, Yusuke; Iwasawa, Satomi; Furukawa, Yutaka

doi:10.1298/ptr.e9978

Cited by 3 publications

(11 citation statements)

References 34 publications

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“…¼ 19) including observational cohort studies (no. ¼ 7), [29][30][31][32][33][34][35] surveys (no. ¼ 6), 8,10,11,[36][37][38] and case study/series reports (no.…”

Section: Resultsmentioning

confidence: 99%

“…A pressure setting combination of 6 40 cm H 2 O was most commonly used across reporting studies (10/20, 50%). [21][22][23][24]26,[28][29][30]39,44 Time settings were reported in 11/20 (55%) studies. [21][22][23][24]29,30,34,[39][40][41]44 Most commonly used time settings were inspiratory time 3 s, expiratory time 2 s, and 1 s pause.…”

Section: Clinical Studiesmentioning

confidence: 99%

“…[21][22][23][24]26,[28][29][30]39,44 Time settings were reported in 11/20 (55%) studies. [21][22][23][24]29,30,34,[39][40][41]44 Most commonly used time settings were inspiratory time 3 s, expiratory time 2 s, and 1 s pause. A pause duration was reported in 8/20 (40%) studies.…”

Section: Clinical Studiesmentioning

confidence: 99%

“…A pause duration was reported in 8/20 (40%) studies. [20][21][22][23][24]30,34,44 Five studies (25%) reported use of one insufflation prior to an exsufflation breath (not reported in the remaining studies). Flow profile was specified in only 3 (15%) studies and was set at medium (no.…”

Section: Clinical Studiesmentioning

confidence: 99%

“…One study applied an oscillation amplitude of 10 and frequency of 20 Hz, 20 whereas only oscillation frequency was reported in the remaining 2 studies as high 33 regimens varied across studies, with MI-E cycles being repeated up to every 20 min, 29 hourly, 32 1-2 times per day, 34 3 times a day, 22 4 times a day, 43 and most commonly up to once per day. 20,21,23,24,30,31,33,39,44 Five studies (25%) reported the inclusion of other treatment adjuncts alongside MI-E including side positioning, 43 manual assisted cough, 34 and suction. 24,41,44 Table 3 provides an overview of described settings of MI-E use in invasively ventilated critically ill participants.…”

Section: Clinical Studiesmentioning

confidence: 99%

See 4 more Smart Citations

The Use of Mechanical Insufflation-Exsufflation in Invasively Ventilated Critically Ill Adults

et al. 2022

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Mechanical insufflation-exsufflation (MI-E) is traditionally used in the neuromuscular population. There is growing interest of MI-E use in invasively ventilated critically ill adults. We aimed to map current evidence on MI-E use in invasively ventilated critically ill adults. Two authors independently searched electronic databases MEDLINE, Embase, and CINAHL via the Ovid platform; PROSPERO; Cochrane Library; ISI Web of Science; and International Clinical Trials Registry Platform between January 1990-April 2021. Inclusion criteria were (1) adult critically ill invasively ventilated subjects, (2) use of MI-E, (3) study design with original data, and (4) published from 1990 onward. Data were extracted by 2 authors independently using a bespoke extraction form. We used Mixed Methods Appraisal Tool to appraise risk of bias. Theoretical Domains Framework was used to interpret qualitative data. Of 3,090 citations identified, 28 citations were taken forward for data extraction. Main indications for MI-E use during invasive ventilation were presence of secretions and mucus plugging (13/28, 46%). Perceived contraindications related to use of high levels of positive pressure (18/28, 68%). Protocolized MI-E settings with a pressure of 640 cm H 2 O were most commonly used, with detail on timing, flow, and frequency of prescription infrequently reported. Various outcomes were re-intubation rate, wet sputum weight, and pulmonary mechanics. Only 3 studies reported the occurrence of adverse events. From qualitative data, the main barrier to MI-E use in this subject group was lack of knowledge and skills. We concluded that there is little consistency in how MI-E is used and reported, and therefore, recommendations about best practices are not possible.

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“…¼ 19) including observational cohort studies (no. ¼ 7), [29][30][31][32][33][34][35] surveys (no. ¼ 6), 8,10,11,[36][37][38] and case study/series reports (no.…”

Section: Resultsmentioning

confidence: 99%

Section: Clinical Studiesmentioning

confidence: 99%

Section: Clinical Studiesmentioning

confidence: 99%

Section: Clinical Studiesmentioning

confidence: 99%

Section: Clinical Studiesmentioning

confidence: 99%

See 3 more Smart Citations

The Use of Mechanical Insufflation-Exsufflation in Invasively Ventilated Critically Ill Adults

et al. 2022

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Respiratory Management of Patients With Neuromuscular Weakness

Khan¹,

Frazer-Green²,

Amin³

et al. 2023

CHEST

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Effects of Rehabilitative Intervention for Augmenting Cough Function in Patients with Multiple System Atrophy

Asakawa,

Ogino,

Tominaga

et al. 2023

PRM

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Objectives: One of the causes of death in patients with multiple system atrophy (MSA) is aspiration pneumonia caused by cough dysfunction. This study aimed to identify an effective approach to improve coughing and to explore the establishment of criteria for the use of gastrostomy based on cough and respiratory dysfunctions. Methods: Eighteen probable MSA patients participated in the study. They were categorized into air stacking and non-air stacking groups. First, we investigated how the inspiration volume changes by applying maximum insufflation capacity (MIC). Second, peak cough flow (PCF) was measured by different cough augmentation methods: 1) spontaneous coughing (SpC); 2) SpC with MIC (SpC + MIC); 3) SpC with manually assisted cough (MAC) (SpC + MAC); and 4) SpC with MIC and MAC (SpC + MIC + MAC). Among these four conditions, PCF values were compared to determine the most effective approach for cough augmentation. Receiver operating characteristic analysis was performed on percent forced vital capacity (%FVC) to determine an index for discriminating PCF below160 L/min, which indicates a high risk of suffocation, involving SpC and SpC + MIC. Results: Inspiration volume increased significantly with MIC in both groups (P < 0.05), and PCF increased significantly with MIC in the air stacking group (P < 0.01). PCF could not be maintained at 160 L/min when %FVC fell below 59%, even when MIC was applied. Conclusions: PCF increases with MIC in patients with MSA. It may be meaningful to consider the timing of gastrostomy introduction based on the severity of cough and respiratory dysfunction.

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Cough peak flow with different mechanically assisted coughing approaches under different conditions in patients with neuromuscular disorders

Cited by 3 publications

References 34 publications

The Use of Mechanical Insufflation-Exsufflation in Invasively Ventilated Critically Ill Adults

The Use of Mechanical Insufflation-Exsufflation in Invasively Ventilated Critically Ill Adults

Respiratory Management of Patients With Neuromuscular Weakness

Effects of Rehabilitative Intervention for Augmenting Cough Function in Patients with Multiple System Atrophy

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