title: Mechanical insufflation-exsufflation improves outcomes for neuromuscular disease patients with respiratory tract infections.
abstract: OBJECTIVE
  The efficacy of mechanical insufflation-exsufflation, in addition to standard chest physical treatments, was investigated as a first-line intervention for patients with neuromuscular diseases with respiratory tract infections and airway mucous encumbrance.
  
  
  METHODS
  The short-term outcomes of 11 consecutive neuromuscular disease patients with respiratory tract infections and tracheobronchial mucous encumbrance who were administered mechanical insufflation-exsufflation and conventional chest physical treatments in an intensive care unit were compared with the outcomes of 16 historical matched controls who had received chest physical treatments alone. Treatment failure was defined as the need for cricothyroid "minitracheostomy" or endotracheal intubation, despite treatment. The number of subjects administered bronchoscopy-assisted aspiration during the hospital stay was also compared.
  
  
  RESULTS
  Treatment failure was significantly lower (P < 0.05) in the mechanical insufflation-exsufflation group than in the conventional chest physical treatments group (2/11 vs. 10/16 cases). The use of bronchoscopy-assisted aspiration was similar in the two groups (5/11 vs. 6/16 cases). Mechanical insufflation-exsufflation did not produce serious side effects and was well tolerated by all subjects.
  
  
  CONCLUSIONS
  Provision of mechanical insufflation-exsufflation in combination with standard chest physical treatments may improve the management of airway mucous encumbrance in neuromyopathic patients; its use should be included in the noninvasive approach to treatment of respiratory tract infections with impaired mucous clearance.
authors.affiliation: Unità di Terapia Semi-Intensiva Respiratoria, Azienda Ospedaliera di Padova, Padova, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Vianello
authors.forename: Antonio
authors.initials: A
authors.lastname: Corrado
authors.forename: Giovanna
authors.initials: G
authors.lastname: Arcaro
authors.forename: Federico
authors.initials: F
authors.lastname: Gallan
authors.forename: Carlo
authors.initials: C
authors.lastname: Ori
authors.forename: Michele
authors.initials: M
authors.lastname: Minuzzo
authors.forename: Matteo
authors.initials: M
authors.lastname: Bevilacqua
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000403:Airway Resistance; D016022:Case-Control Studies; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D007327:Insufflation / Q000379:methods*; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D009468:Neuromuscular Diseases / Q000150:complications*; D026741:Physical Therapy Modalities; D011175:Positive-Pressure Respiration / Q000379:methods*; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy; D012141:Respiratory Tract Infections / Q000150:complications / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome