title: Pneumothorax associated with mechanical insufflation-exsufflation and related factors.
abstract: Impaired cough that results in ineffective airway secretion clearance is an important contributor to pulmonary complications in patients with neuromuscular weakness including spinal cord injury. Mechanical insufflation-exsufflation (MI-E) is a respiratory aid used by patients with weak respiratory muscles to increase cough peak flows and improve cough effectiveness. Relative contraindications to MI-E are said to include susceptibility to pneumothorax, but the association of pneumothorax with MI-E use has never before been described. We report two cases of pneumothorax in patients with respiratory muscle weakness associated with daily use of MI-E: one was a 58-yr-old male with C4 ASIA C tetraplegia, and the other was a 26-yr-old male with Duchenne muscular dystrophy. Both patients also used positive-pressure ventilatory assistance. Although seemingly rare in this patient population, ventilator users also using MI-E who have increasing dyspnea or who require increasing positive inspiratory pressures when using noninvasive ventilation should be evaluated for pneumothorax.
authors.affiliation: Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA.
authors.forename: Pradeep
authors.initials: P
authors.lastname: Suri
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Burns
authors.forename: John R
authors.initials: JR
authors.lastname: Bach
mesh_terms: D000328:Adult; D003371:Cough; D006801:Humans; D007327:Insufflation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D018908:Muscle Weakness / Q000209:etiology / Q000628:therapy; D020388:Muscular Dystrophy, Duchenne / Q000150:complications; D011030:Pneumothorax / Q000209:etiology*; D011782:Quadriplegia / Q000150:complications; D012120:Respiration Disorders / Q000209:etiology / Q000628:therapy*