Pneumothorax in neuromuscular disease associated with lung volume recruitment and mechanical insufflation‐exsufflation

McDonald, Luke A; Berlowitz, David J; Rautela, Linda; Chao, Caroline; Sheers, Nicole

doi:10.1002/rcr2.447

Cited by 14 publications

(5 citation statements)

References 9 publications

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“…Second, HRV analysis, which evaluates autonomic nervous system function based on changes in ECG RR intervals, showed significantly decreased SDNN, LF, and HF. Previous reports of adverse events with MI‐E use include pneumothorax as a serious adverse event, 2 and other mild adverse events including dynamic collapse of the upper airways during the exsufflation cycle, gastric distention, premature ventricular contractions, and fatigue. However, the present report is clinically important because there have been no previous reports of autonomic dysfunction associated with the use of MI‐E.…”

Section: Discussionmentioning

confidence: 99%

“…MI‐E devices are useful for respiratory management in GBS. Risks of MI‐E include mechanical injury in the respiratory system, such as pneumothorax, 2 but to date, there are no reported effects of MI‐E on the autonomic nervous system. This report describes two cases of GBS with severe autonomic dysfunction presumably facilitated by MI‐E.…”

Section: Introductionmentioning

confidence: 99%

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Cardiovascular autonomic dysfunction induced by mechanical insufflation‐exsufflation in Guillain–Barré syndrome

Kuroiwa

Tateishi

Oshima

et al. 2023

Respirology Case Reports

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Mechanical insufflation‐exsufflation (MI‐E) is an effective airway clearance device for impaired cough associated with respiratory muscle weakness caused by neuromuscular disease. Its complications on the respiratory system, such as pneumothorax, are well‐recognized, but the association of the autonomic nervous system dysfunction with MI‐E has never been reported. We herein describe two cases of Guillain–Barré syndrome with cardiovascular autonomic dysfunction during MI‐E: a 22‐year‐old man who developed transient asystole and an 83‐year‐old man who presented with prominent fluctuation of blood pressure. These episodes occurred during the use of MI‐E with abnormal cardiac autonomic testing, such as heart rate variability in both patients. While Guillain–Barré syndrome itself may cause cardiac autonomic dysfunction, MI‐E possibly caused or enhanced the autonomic dysfunction by an alternation of thoracic cavity pressure. The possibility of MI‐E‐related cardiovascular complications should be recognized, and its appropriate monitoring and management are necessary, particularly when used for Guillain–Barré syndrome patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cardiovascular autonomic dysfunction induced by mechanical insufflation‐exsufflation in Guillain–Barré syndrome

Kuroiwa

Tateishi

Oshima

et al. 2023

Respirology Case Reports

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“…The possibility to lower the P i without compromising high expiratory flows may have several clinical benefits. First, some may be reluctant to use high P i due to the potential risk of lung tissue damage and pneumothorax, as reported in some adult MI‐E users . Further, using high P i may lead to adverse events such as abdominal distention and suggested from clinical experience especially in this age group, the use of high P i may induce air leaks, which require a firmer grip to secure mask fit.…”

Section: Discussionmentioning

confidence: 99%

Optimizing expiratory flows during mechanical cough in a pediatric neuromuscular lung model

Hov

Andersen

Toussaint

et al. 2019

Pediatric Pulmonology

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Mechanical insufflation‐exsufflation (MI‐E) is recommended for subjects of all ages with neuromuscular disorders (NMDs) and weak cough. There is a lack of knowledge on the optimal treatment settings for young children. This study aims to determine the MI‐E settings providing high expiratory airflow while using safe inspiratory volumes, and to identify possible limits where the benefit of incrementing the MI‐E settings to achieve a higher expiratory airflow, decreased. Using an MI‐E device and a lung model imitating a 1‐year‐old child with NMD, we explored the impact of 120 combinations of MI‐E pressure and time settings on maximal expiratory airflow and inspiratory volume. High expiratory airflows were achieved with several pressure and time combinations where the exsufflation pressure, followed by insufflation pressure and time, had the greatest impact. The benefit of incrementing the settings to increase the expiratory airflow leveled off for the insufflation pressure and time, but not for the exsufflation pressure. Given exsufflation pressure of −40 or −50 cmH2O and insufflation time longer than 1 second, a plateau in the expiratory airflow curve was present at insufflation pressures from 25 cmH2O, whereas a plateau in the inspired volume curve occurred at insufflation pressures from 35 cmH2O. The present neuromuscular pediatric lung model study showed that expiratory pressure impacts expiratory airflow more than inspiratory pressure and time. An inspiratory and expiratory pressure set between 20 to 30 and −40 cmH2O, respectively, and an inspiratory time longer than 1 second may be considered as a basis when titrating MI‐E settings in young children with NMD. The findings must be confirmed in clinical trials.

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“…Stehling et al 3 could demonstrate an increase in vital capacity within one year after the introduction of the therapy and its stabilisation in the second year. In the mentioned studies, no barotrauma such as air leaks have been reported, although there are some case reports in adult patients 19 , 20 .…”

Section: Introductionmentioning

confidence: 97%

Changes in ventilation distribution in children with neuromuscular disease using the insufflator/exsufflator technique: an observational study

Casaulta

Messerli

Rodriguez

et al. 2022

Sci Rep

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Patients with neuromuscular disease often suffer from weak and ineffective cough resulting in mucus retention and increased risk for chest infections. Different airway clearance techniques have been proposed, one of them being the insufflator/exsufflator technique. So far, the immediate physiological effects of the insufflator/exsufflator technique on ventilation distribution and lung volumes are not known. We aimed to describe the immediate effects of the insufflator/exsufflator technique on different lung volumes, forced flows and ventilation distribution. Eight subjects (age 5.8–15.2 years) performed lung function tests including spirometry, multiple breath washout and electrical impedance tomography before and after a regular a chest physiotherapy session with an insufflator/exsufflator device. Forced lung volumes and flows as well as parameters of ventilation distribution derived from multiple breath washout and electrical impedance tomography were compared to assess the short-term effect of the therapy. In this small group of stable paediatric subjects with neuromuscular disease we could not demonstrate any short-term effects of insufflation/exsufflation manoeuvres on lung volumes, expiratory flows and ventilation distribution. With the currently used protocol of the insufflation/exsufflation manoeuvre, we cannot demonstrate any immediate changes in lung function.

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Pneumothorax in neuromuscular disease associated with lung volume recruitment and mechanical insufflation‐exsufflation

Cited by 14 publications

References 9 publications

Cardiovascular autonomic dysfunction induced by mechanical insufflation‐exsufflation in Guillain–Barré syndrome

Cardiovascular autonomic dysfunction induced by mechanical insufflation‐exsufflation in Guillain–Barré syndrome

Optimizing expiratory flows during mechanical cough in a pediatric neuromuscular lung model

Changes in ventilation distribution in children with neuromuscular disease using the insufflator/exsufflator technique: an observational study

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