Mechanical insufflation-exsufflation vs. tracheal suctioning via tracheostomy tubes for patients with amyotrophic lateral sclerosis: a pilot study.
OBJECTIVE
To compare the effects of mechanical insufflation-exsufflation vs. suctioning via tracheostomy tubes on respiratory variables for six amyotrophic lateral sclerosis patients.


METHODS
In this prospective crossover study, six consecutive patients with amyotrophic lateral sclerosis who required continuous mechanical ventilation via tracheostomy tubes and developed chest infections underwent measurement of pulse oxyhemoglobin saturation (SpO2), peak inspiratory pressure (PIP), mean airway pressure (Pawm), and work of breathing performed by the ventilator (WOBv) at baseline and 5 and 30 min after tracheal suctioning and 5 min after mechanical insufflation-exsufflation.


RESULTS
The baseline values were 93.50 +/- 2.26% for SpO2 in ambient air, 18.50 +/- 4.23 cm H2O for PIP, 4.67 +/- 1.37 cm H2O for Pawm, and 1.03 +/- 0.25 J/liters for WOBv. Only WOBv changed significantly, decreasing after tracheal suctioning (P < 0.05), whereas all variables improved significantly after mechanical insufflation-exsufflation.


CONCLUSIONS
For ventilator-dependent patients with amyotrophic lateral sclerosis, mechanical insufflation-exsufflation via a tracheostomy tube with an inflated cuff may be more effective in eliminating airway secretions than conventional tracheal suctioning.
D000690:Amyotrophic Lateral Sclerosis / Q000150:complications / Q000628:therapy*; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D007327:Insufflation / Q000379:methods*; D007442:Intubation, Intratracheal / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010092:Oximetry; D010865:Pilot Projects; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods*; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy*; D013396:Suction / Q000295:instrumentation; D014139:Tracheostomy / Q000295:instrumentation; D016896:Treatment Outcome; D014939:Work of Breathing / Q000502:physiology