title: Mechanical insufflation-exsufflation device prescription for outpatients with tetraplegia.
abstract: BACKGROUND
  Mechanical insufflation-exsufflation (MIE) is an option for secretion mobilization in outpatients with spinal cord injury (SCI) who lack an effective cough and are at high risk for developing pneumonia.
  
  
  OBJECTIVE
  To describe characteristics of persons with SCI who received MIE devices for outpatient use and compare respiratory hospitalizations before and after MIE prescription.
  
  
  METHODS
  Retrospective cohort study of all persons who were prescribed MIE devices for outpatient use during 2000 to 2006 by a Veterans Affairs SCI service.
  
  
  RESULTS
  We identified 40 patients with tetraplegia (4.5% of population followed by the SCI service) who were prescribed MIE devices. Of these, 30 (75%) had neurologic levels of C5 or rostral, and 33 (83%) had motor-complete injuries. For chronically injured patients who were prescribed MIE for home use, there was a nonsignificant reduction in respiratory hospitalization rates by 34% (0.314/y before MIE vs 0.208/y after MIE; P = 0.21). A posthoc subgroup analysis showed a significant decline in respiratory hospitalizations for patients with significant tobacco smoking histories.
  
  
  CONCLUSIONS
  Mechanical insufflation-exsufflation was typically prescribed for people with motor-complete tetraplegia. Outpatient MIE usage may reduce respiratory hospitalizations in smokers with SCI. Further research of this alternative, noninvasive method is warranted in the outpatient SCI population.
authors.affiliation: Spinal Cord Injury Service, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA. jdcrew@gmail.com
authors.forename: James D
authors.initials: JD
authors.lastname: Crew
authors.forename: Jelena N
authors.initials: JN
authors.lastname: Svircev
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Burns
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007327:Insufflation; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011782:Quadriplegia / Q000150:complications*; D012131:Respiratory Insufficiency / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D012138:Respiratory Therapy / Q000379:methods*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D014728:Veterans