Chest
Clinical Investigations in Critical Care: Comparative Study: Journal Article: Research Support, U.S. Gov't, P.H.S.Mechanical Insufflation-Exsufflation: Comparison of Peak Expiratory Flows With Manually Assisted and Unassisted Coughing Techniques
Section snippets
Patients and Methods
Forty-six ventilator-dependent individuals who used noninvasive IPPV techniques and relied on MI-E for airway secretion clearance were surveyed for the frequency of MI-E utilization, difficulties encountered, and intercurrent episodes of pneumonia, and hospitalizations. These 46 patients had the following diagnoses: postpoliomyelitis, 24; pseudohypertrophic muscular dystrophy, 9; spinal cord injury, 5; non-pseudohypertrophic muscular dystrophy myopathies, 5; spinal muscular atrophy,
Results
Of the 46 patients studied, 33 used MI-E as necessary on about 10 to 35 separate occasions, 11 stated that manually assisted coughing was usually adequate so they had used MI-E on several occasions, and two with severely impaired oropharyngeal musculature and a tendency to aspirate used MI-E on a daily basis to clear aspirated food and secretions. None of the patients reported episodes of air collection under the skin of the neck or chest (mediastinal emphysema), lung collapse (pneumothorax),
Discussion
The small physiologic volume of respiratory mucus can normally be easily transported by the mucociliary elevator.40 During RTIs, however, the elevator is overwhelmed and effective PCEF must be generated to avoid mucus plugging and pulmonary complications. Although mucus plugging41, 42 and other difficulties may be associated with long-term tracheostomy,8, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53 resorting to strictly noninvasive ventilatory support methods with removal of the tube eliminates
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This work was funded by the Department of Health and Human Services, Food and Drug Administration, Orphan Products Development grant FD-R-000649-01.