title: Effects of mechanical insufflation-exsufflation on respiratory parameters for patients with chronic airway secretion encumbrance.
abstract: OBJECTIVE
  To analyze the physiologic effects and tolerance of mechanical insufflation-exsufflation (MI-E) for patients with chronic ventilatory failure of various etiologies.
  
  
  METHODS
  Prospective clinical trial.
  
  
  METHODS
  Rehabilitation unit of a university hospital.
  
  
  METHODS
  Thirteen patients with amyotrophic lateral sclerosis (ALS), 9 patients with severe COPD, and 7 patients with other neuromuscular disorders (oNMDs) with chronic airway secretion encumbrance and decreases in oxyhemoglobin saturation (Spo(2)).
  
  
  METHODS
  Pressures of MI-E of 15 cm H(2)O, 30 cm H(2)O, and 40 cm H(2)O were cycled to each patient, with 3 s for insufflation and 4 s for exsufflation. One application was six cycles at each pressure for a total of three applications.
  
  
  RESULTS
  We continuously evaluated respiratory inductance plethysmography (RIP) and Spo(2) during every application. Peak cough flow (PCF) and dyspnea (Borg Scale) were also measured before the first and after the last application. The technique was well tolerated in all patient groups. Median Spo(2) improved significantly (p < 0.005) in all patient groups. Median PCF improved significantly (p < 0.005) in the ALS and oNMD groups from 170 to 200 L/min and from 180 to 220 L/min, respectively, and dyspnea improved significantly in the patients with oNMDs and patients with COPD from 3 to 1 and from 2 to 0.75, respectively. Breathing pattern characteristics (RIP) did not deteriorate after MI-E in any patient groups. Inspiratory flow limitation significantly decreased at the highest MI-E pressures for the ALS group.
  
  
  CONCLUSIONS
  Our results confirm good tolerance and physiologic improvement in patients with restrictive disease and in patients with obstructive disease, suggesting that MI-E may be a potential complement to noninvasive ventilation for a wide variety of patient groups.
authors.affiliation: Pneumology Department, Hospital São João, Faculdade de Medicina, Universidade do Porto-Porto, Portugal. jwinck@hsjoao.min-saude.pt
authors.forename: João C
authors.initials: JC
authors.lastname: Winck
authors.forename: Miguel R
authors.initials: MR
authors.lastname: Gonçalves
authors.forename: Cristina
authors.initials: C
authors.lastname: Lourenço
authors.forename: Paulo
authors.initials: P
authors.lastname: Viana
authors.forename: João
authors.initials: J
authors.lastname: Almeida
authors.forename: John R
authors.initials: JR
authors.lastname: Bach
mesh_terms: D000328:Adult; D000368:Aged; D000402:Airway Obstruction / Q000503:physiopathology / Q000534:rehabilitation*; D003131:Combined Modality Therapy; D045422:Continuous Positive Airway Pressure; D003371:Cough / Q000503:physiopathology; D004867:Equipment Design; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007327:Insufflation / Q000295:instrumentation*; D008176:Lung Volume Measurements; D008297:Male; D008875:Middle Aged; D016472:Motor Neuron Disease / Q000503:physiopathology / Q000534:rehabilitation*; D009136:Muscular Dystrophies / Q000503:physiopathology / Q000534:rehabilitation*; D010100:Oxygen / Q000097:blood; D010102:Oxygen Inhalation Therapy; D010108:Oxyhemoglobins / Q000378:metabolism; D010993:Plethysmography, Whole Body; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology / Q000534:rehabilitation*; D012131:Respiratory Insufficiency / Q000503:physiopathology / Q000534:rehabilitation*; D020545:Respiratory Mucosa / Q000378:metabolism*; D012132:Respiratory Muscles / Q000503:physiopathology; D013147:Spirometry
chemical_list: D010108:Oxyhemoglobins; D010100:Oxygen