title: Mechanical insufflation-exsufflation: pressure, volume, and flow relationships and the adequacy of the manufacturer's guidelines.
abstract: OBJECTIVE
  Pulmonary complications of neuromuscular disease can be averted by increasing peak cough flows with the use of a forced exsufflation device. The purpose of this study was to examine the pressure, volume, and flow relationships for a range of settings generated by this device, and compare them with clinically efficacious values and the manufacturer's guidelines.
  
  
  METHODS
  The In-exsufflator was connected to a standard lung model. The resulting forced deflation volumes, flows, and pressures were averaged over 10 cycles at each setting.
  
  
  RESULTS
  The set insufflation pressures significantly correlated with the generated insufflation pressures and volumes and the exsufflation volumes and flows. Increasing set insufflation time significantly increased generated insufflation pressures, flows, and volumes and exsufflation volumes. Increasing set exsufflation time did not significantly increase generated exsufflation flows. At set pressures of 40 to -40 cm H2O, insufflation time of 3 sec, and exsufflation time of 2 sec, the exsufflation flow was 4.09 l/sec. A plateau insufflation volume of 3.8 l was reached after 4.9 sec of insufflation.
  
  
  CONCLUSIONS
  In-exsufflator performance was very consistent. Its clinical effectiveness can be explained by its generation of exsufflation flows >2.7 l/sec. Increasing insufflation times more than exsufflation times is more important for optimal function. Current manufacturer use guidelines may not yield optimal exsufflation flows.
authors.affiliation: Pneumology Department, Hospital Clínico Universitario Sant Joan d'Alacant, Alicante, Spain.
authors.forename: Elia
authors.initials: E
authors.lastname: Gómez-Merino
authors.forename: Jesús
authors.initials: J
authors.lastname: Sancho
authors.forename: Julio
authors.initials: J
authors.lastname: Marín
authors.forename: Emilio
authors.initials: E
authors.lastname: Servera
authors.forename: M Luisa
authors.initials: ML
authors.lastname: Blasco
authors.forename: F Javier
authors.initials: FJ
authors.lastname: Belda
authors.forename: Christopher
authors.initials: C
authors.lastname: Castro
authors.forename: John R
authors.initials: JR
authors.lastname: Bach
mesh_terms: D003371:Cough; D017408:Guidelines as Topic / Q000592:standards; D006801:Humans; D007327:Insufflation / Q000295:instrumentation*; D008168:Lung / Q000502:physiology; D008171:Lung Diseases / Q000209:etiology / Q000517:prevention & control; D008953:Models, Anatomic; D009468:Neuromuscular Diseases / Q000150:complications; D012123:Pulmonary Ventilation / Q000502:physiology; D015656:Respiratory Mechanics / Q000502:physiology*; D012122:Ventilators, Mechanical / Q000592:standards*