Titration of Mechanical Insufflation-Exsufflation Optimal Pressure Combinations in Neuromuscular Diseases by Flow/Pressure Waveform Analysis

Arch Bronconeumol (Engl Ed). 2019 May;55(5):246-251. doi: 10.1016/j.arbres.2018.10.011. Epub 2018 Dec 28.
[Article in English, Spanish]

Abstract

Introduction: The aim of this study was to assess several air-pressure settings for MI-E to determine their effect on peak cough flow (PCF), and to compare the best pressures with those are more common used in the literature (±40cmH2O) in patients with neuromuscular disorders (NMD).

Methods: Adults with NMD in whom MI-E was indicated were recruited. Assisted PCF was measured by an external pneumotachograph. The protocol included 9 PCF measures per patient: 1 baseline (non-assisted), 4 with increasing inspiratory pressures without negative pressure (10, 20, 30 and 40cmH2O or maximum tolerated), and then 4 adding expiratory pressures (-10, -20, -30 and -40cmH2O or maximum tolerated) with maximum inspiratory pressure previously achieved.

Results: Twenty one patients were included, 61% with amyotrophic lateral sclerosis (ALS). Mean PCFs with recommended pressures (±40cmH2O) were lower than the scored in the individualized steps of the titration protocol (197.7±67l/min vs 214.2±60l/min, p<0.05). Regarding subgroups, mean PCFmax values in ALS patients with bulbar symptoms were significantly higher than those achieved with recommended pressures (163.6±80 vs 189±66l/min, p<0.05).

Conclusion: The PCFmax obtained with the protocol did not always match the recommended settings. It may be advisable to perform MI-E titration assessed by non-invasive PCF monitoring in patients with NMD, especially in ALS with bulbar involvement to improve the therapy detecting airway collapse induced by high pressures.

Keywords: Curvas flujo/presión tiempo; Enfermedades neuromusculares; Flow/pressure waveforms; Mechanical assisted cough; Monitor; Monitorización; Neuromuscular disorders; Tos asistida mecánica.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Amyotrophic Lateral Sclerosis / complications
  • Amyotrophic Lateral Sclerosis / physiopathology
  • Cough / etiology
  • Cough / physiopathology*
  • Female
  • Heart Rate
  • Humans
  • Inhalation
  • Insufflation
  • Male
  • Middle Aged
  • Neuromuscular Diseases / complications*
  • Neuromuscular Diseases / physiopathology
  • Oxygen / blood
  • Partial Pressure
  • Pressure*
  • Prospective Studies
  • Respiration, Artificial / instrumentation
  • Respiration, Artificial / methods*
  • Respiratory Insufficiency / etiology
  • Respiratory Insufficiency / physiopathology
  • Respiratory Insufficiency / therapy*
  • Respiratory Muscles / physiopathology
  • Respiratory Therapy / instrumentation
  • Respiratory Therapy / methods*
  • Rheology

Substances

  • Oxygen