title: Clinical Implications of Assisted Peak Cough Flow Measured With an External Glottic Control Device for Tracheostomy Decannulation in Patients With Neuromuscular Diseases and Cervical Spinal Cord Injuries: A Pilot Study.
abstract: To investigate the clinical usefulness and significance of an external control device substituting for glottic function in determining the feasibility of decannulation in tracheostomized patients with neuromuscular diseases and cervical spinal cord injuries whose assisted peak cough flow (APCF) was unmeasurable or <160L/min.
  
  
  
  Before-after trial.
  
  
  
  Inpatient setting in a university hospital.
  
  
  
  Tracheostomized patients (N=16; 11 with neuromuscular diseases and 5 with cervical spinal cord injuries) were recruited.
  
  
  
  Unassisted peak cough flow (UPCF) and APCF were measured with and without an external glottic control device. Among patients whose APCF without the device was <160L/min, if their APCF with the device was measured as ≥160L/min, they were decannulated. After decannulation, UPCF and APCF were measured again.
  
  
  
  APCF with and without an external glottic control device as well as APCF after decannulation.
  
  
  
  After successful decannulation, APCFs were greater than or equal to those measured with the device before decannulation. No patients underwent intubation or retracheostomy, and there were no respiratory complications.
  
  
  
  The external glottic control device substituting for innate glottic function is beneficial for determining tracheostomy decannulation. It provides an objective and accurate APCF. It is particularly helpful for patients whose APCF is ≥160L/min while using the device, even if APCF is <160L/min without this device.
authors.affiliation: Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea. Electronic address: kswoong@yuhs.ac.
authors.forename: Seong-Woong
authors.initials: SW
authors.lastname: Kang
authors.affiliation: Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Won Ah
authors.initials: WA
authors.lastname: Choi
authors.affiliation: Research Institute of Clinical Medicine of Chonbuk National University, Biomechanical Research Institute of Chonbuk National University Hospital, Jeonju-si, Jeollabuk-do, Korea.
authors.forename: Yu Hui
authors.initials: YH
authors.lastname: Won
authors.affiliation: Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jang Woo
authors.initials: JW
authors.lastname: Lee
authors.affiliation: Catholic University of Korea Catholic Medical Center National Traffic Injury Rehabilitation Hospital, Yangpyeong-gun, Gyeonggi-do, Korea.
authors.forename: Hoo Young
authors.initials: HY
authors.lastname: Lee
authors.affiliation: Department of Rehabilitation Medicine, SRC Rehabilitation Hospital, Gwangju-si, Gyeonggi-do, Korea.
authors.forename: Dong Jin
authors.initials: DJ
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D066193:Cervical Cord; D003371:Cough / Q000503:physiopathology*; D020878:Device Removal / Q000379:methods*; D019937:Diagnostic Techniques and Procedures / Q000295:instrumentation*; D005260:Female; D005931:Glottis; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D009468:Neuromuscular Diseases / Q000534:rehabilitation*; D010865:Pilot Projects; D013119:Spinal Cord Injuries / Q000534:rehabilitation*; D014139:Tracheostomy / Q000379:methods*; D055815:Young Adult
keywords: Cough; Glottis; Neuromuscular diseases; Rehabilitation; Spinal cord injuries; Tracheostomy