• Lorena Del Amo Castrillo, Matthieu Lacombe, Aurélien Boré, Isabelle Vaugier, Line Falaize, David Orlikowski, Hélène Prigent, and Frédéric Lofaso.
• Intensive Care Unit at Hôpital Raymond Poincaré, AP-HP, Garches, France.
• Respir Care. 2019 Mar 1; 64 (3): 255-261.

BackgroundBreath-stacking, which consists of taking 2 or more consecutive ventilator insufflations without exhaling, is a noninvasive and inexpensive cough-assistance technique for patients with neuromuscular disease. Volumetric cough mode (VCM) is a recently introduced ventilator mode consisting of a programmable intermittent deep breath equal to a set percentage of the baseline tidal volume. Here, our objective was to compare VCM to breath-stacking during volume-control continuous mandatory ventilation in subjects on long-term noninvasive mechanical ventilation at home.MethodsWe included 20 subjects with neuromuscular disease causing severe respiratory muscle dysfunction with a cough peak flow (CPF) < 270 L/min or maximum expiratory pressure < 45 cm H2O. Each subject tested breath-stacking and VCM in random order.ResultsCPF increased with both techniques but was higher with VCM than with breath-stacking in 16 subjects. In 17 subjects, CPF was highest with the technique that produced the greatest inspiratory capacity.ConclusionOur results indicate that both breath-stacking and VCM are useful cough-augmentation techniques. Displaying insufflated volumes on the ventilator screen is a simple and accessible method for selecting the most efficient cough-augmentation technique delivered by a home ventilator.Copyright © 2019 by Daedalus Enterprises.

38 keywords...

hide…