The Use of Mechanical Insufflation-Exsufflation Via Artificial Airways

Toussaint, Michel

doi:10.4187/respcare.01448

Cited by 23 publications

(18 citation statements)

References 23 publications

(28 reference statements)

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“…A similar study was conducted by Sancho et al 16 They found that S pO 2 , peak inspiratory pressure, mean airway pressure, and work of breathing performed by the ventilator were improved after using MI-E via a tracheostomy tube compared with conventional tracheal suctioning. 10,16 All of the subjects in our study were discharged home without any severe complications from either therapy. In previous reports, complications of MI-E use in adults were rare.…”

Section: Discussionmentioning

confidence: 99%

“…8 MI-E works by regularly administering positive pressure to augment inspiration and then negative pressure to enhance expiratory flow. 9,10 The device is effective at increasing cough peak flow for patients with reduced or no capacity to cough and expectorate. 11 Early experiences with MI-E have been effective in adults with neuromuscular weakness, 12 including Duchenne muscular dystrophy 13 and amyotrophic lateral sclerosis.…”

Section: Introductionmentioning

confidence: 99%

“…For example, Sancho et al 16 established beneficial use of MI-E in unconscious or sedated subjects with less irritation, less pain, less tiring, and more comfort than conventional suctioning via tracheostomy tube. 10 Since its introduction to pediatric practice, MI-E studies have been limited. In 2000, Bach et al 17 found that using MI-E for airway clearance in spinal muscular atrophy type 1 can avoid tracheostomy throughout early childhood.…”

Section: Introductionmentioning

confidence: 99%

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Mechanical Insufflation-Exsufflation Versus Conventional Chest Physiotherapy in Children With Cerebral Palsy

et al. 2017

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Mechanical Insufflation-Exsufflation Versus Conventional Chest Physiotherapy in Children With Cerebral Palsy

et al. 2017

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“…The availability of MI-E devices in Europe since 2002 has increased the number of studies initiated. 25,26 The first team that performed a systematic review on MI-E was Anderson et al 27 in 2005. Their systematic review included 4 controlled trials, with a total of 98 subjects with neuromuscular disease.…”

Section: Introductionmentioning

confidence: 99%

Use of Mechanical Insufflation-Exsufflation Devices for Airway Clearance in Subjects With Neuromuscular Disease

Auger¹,

Hernando²,

Galmiche³

2017

Respir Care

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The aim of this systematic review is to examine the benefit/risk ratio of the use of mechanical insufflation-exsufflation (MI-E) devices for airway clearance in patients with neuromuscular diseases. A search was conducted for relevant studies in MEDLINE, the Cochrane Library, and the Health Technology Assessment Database using the main key words: cough, airway clearance, in-exsufflation. The search limits were studies published in English and French between 1970 and 2014 (literature watch until December 2015). The methodological quality of the studies was assessed using (1) the Cochrane Collaboration's risk of bias tool for randomized controlled trials and (2) the Institute of Health Economics' 20-item checklist for comparative and observational studies. Data were extracted into an evidence table according to (1) study design, (2) population characteristics (including age and type of diseases) and intervention (MI-E associated or not with other interventions), (3) outcome measures, and (4) key findings. Twelve studies met the inclusion criteria (4 randomized controlled trials, 3 comparative studies, and 5 observational studies). The quality of the selected studies was poor. None of the studies reported survival outcome. All studies evaluated change of pulmonary function parameters, such as peak expiratory flow. This review underlines the lack of robust data on mechanical medical devices used for airway clearance. The current scientific evidence does not support the use of MI-E for cough augmentation in patients with neuromuscular diseases, but health-care professionals are faced with the reality of medical practice and the absence of alternatives. Most European and American guidelines recommend the use of MI-E despite low-level evidence. However, even if performing comparative trials in a specific population is difficult, the medical device industry should provide reliable data to assist health-care professionals, providers, and payers in the decision-making process. This is the only way to ensure the best treatment for patients.

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“…2,3 Cough assistance is traditionally based on inspiratory volume increase and manual abdominal thrust and/or chest compression. Mechanically assisted cough devices can also be used for this purpose, with either an endotracheal artificial airway 4 or a mask. 5 These devices sequentially apply positive and negative (subatmospheric) pressure to the airway, creating a pressure gradient to promote a peak expiratory flow (PEF) sufficient to remove secretions from the large airways.…”

Section: Introductionmentioning

confidence: 99%

Bench Comparative Assessment of Mechanically Assisted Cough Devices

Frigerio

Longhini

Sommariva³

et al. 2015

Respir Care

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BACKGROUND: Mechanically assisted cough devices are used in patients with impaired cough to avoid secretion accumulation. We compared 5 mechanically assisted cough devices by bench testing using a breathing simulator and assessed their user-friendliness. METHODS: We measured inspiratory and expiratory airway pressures and peak expiratory flow, the strongest indicator of cough efficacy. We performed 2 bench tests: 1) to ascertain the differences between preset and actual settings in 3 different machines of each mechanically assisted cough device and 2) to assess the effects of varying respiratory impedance and air leaks on performance of the devices. We also evaluated the user-friendliness of the devices by measuring the time required and errors in accomplishing 4 tasks by 10 physicians unfamiliar with mechanically assisted cough devices compared with product specialists from the distributing companies. Physicians also scored the ease of use. RESULTS: Four mechanically assisted cough devices during insufflation and all 5 during exsufflation showed differences between preset and actual airway pressures. All but one device showed uneven actual pressure values between models of the same type. Peak expiratory flow was significantly influenced by the mechanical properties in 2 devices and by air leaks in 4 devices. The median time to accomplish all tasks by the product specialist (10 [interquartile range of 2-29] s) was overall significantly shorter compared with all physicians (from 19 [14 -65] to 36 [19 -116] s). The number of procedural errors, but not the perceived ease of use, differed significantly between the devices. CONCLUSIONS: The performance of different mechanically assisted cough devices was erratic and included variance between models from the same manufacturer; it was affected by respiratory system impedance and air leaks. Time and rate of errors for performing procedures were elevated. These findings indicate that the devices are not interchangeable and that the settings should be targeted for each patient with the specific machine being used. Improvements in reliability, performance, and user-friendliness are advisable.

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The Use of Mechanical Insufflation-Exsufflation Via Artificial Airways

Cited by 23 publications

References 23 publications

Mechanical Insufflation-Exsufflation Versus Conventional Chest Physiotherapy in Children With Cerebral Palsy

Mechanical Insufflation-Exsufflation Versus Conventional Chest Physiotherapy in Children With Cerebral Palsy

Use of Mechanical Insufflation-Exsufflation Devices for Airway Clearance in Subjects With Neuromuscular Disease

Bench Comparative Assessment of Mechanically Assisted Cough Devices

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