• Matthieu Lacombe, Lorena Del Amo Castrillo, Aurélien Boré, David Chapeau, Eric Horvat, Isabelle Vaugier, Michelle Lejaille, David Orlikowski, Hélène Prigent, and Frédéric Lofaso.
• Réanimation Médicale, Physiologie - Explorations Fonctionnelles, Centre d'Innovations Technologiques UMR 805, Hôpital Raymond Poincaré, AP-HP, Garches, and EA 4497, Université de Versailles Saint-Quentin-en-Yvelines, Versailles, France.
• Respiration. 2014 Jan 1;88(3):215-22.

BackgroundMechanical insufflation-exsufflation (MI-E), more commonly known as 'cough assist therapy', is a method which produces inspiratory and expiratory assistance to improve cough performances. However, other alternatives or combinations are possible.ObjectiveThe objective was to compare the effects of mechanical insufflation combined with manually assisted coughing (MAC), insufflation-exsufflation alone and insufflation-exsufflation combined with MAC in neuromuscular patients requiring cough assistance.MethodsEighteen neuromuscular patients with severe respiratory muscle dysfunction and peak cough flow (PCF) lower than 3 liters/s or maximal expiratory pressure (MEP) lower than +45 cm H2O were studied. Patients were studied under three cough-assisted conditions, which were used in random order: insufflation by intermittent positive-pressure breathing (IPPB) combined with MAC, MI-E and MI-E + MAC.ResultsOverall, PCF was higher with IPPB + MAC than with MI-E + MAC or MI-E alone. Among the 12 patients who had higher PCF values with IPPB + MAC than with the two other techniques, 9 exhibited mask pressure swings during MI-E exsufflation, with a transient positive-pressure value due to the expiratory flow produced by the combined patient cough effort and MAC. Each of these 9 patients had higher PCF values (>5 liters/s) than did the other 9 patients when using IPPB + MAC.ConclusionOur results indicate that adding the MI-E device to MAC is unhelpful in patients whose PCF with an insufflation technique and MAC exceeds 5 liters/s. This is because the expiratory flow produced by the patient's effort and MAC transitorily exceeds the vacuum capacity of the MI-E device, which therefore becomes a transient load against the PCF.

32 keywords...

hide…