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This Article Full Text (PDF) All Versions of this Article: chest.07-1615v1 133/1/161    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Fauroux, B. Articles by Lofaso, F. Search for Related Content PubMed PubMed Citation Articles by Fauroux, B. Articles by Lofaso, F.

Physiological benefits of mechanical insufflation-exsufflation in children with neuromuscular diseases

¹AP-HP, Hôpital Armand Trousseau, Pediatric Pulmonary Department, Paris, France ²Université Pierre et Marie Curie-Paris6, INSERM UMR S-719, Paris. France ³AP-HP, Hôpital Raymond Poincaré, Université de Versailles Saint Quentin en Yvelines, Department of Clinical Physiology, Garches, France and INSERM U 851, Créteil, France

brigitte.fauroux{at}trs.aphp.fr

Abstract

Study objectives: To analyze the physiological effects and tolerance of mechanical insufflation-exsufflation (MI-E) by means of the Cough Assist^TM for children with neuromuscular disease.

Design: Prospective clinical trial.

Setting: Physiology laboratory of a pediatric pulmonary department of a university hospital.

Patients: Seventeen children with Duchenne muscular dystrophy (n=4), spinal muscular atrophy (n=4), or other congenital myopathy (n=9) in a stable state.

Interventions: Pressures of 15 cm H₂O, 30 cm H₂O, and 40 cm H₂O were cycled to each patient, with 2 seconds for insufflation and 3 seconds for exsufflation. One application was 6 cycles at each pressure for a total of 3 applications.

Measurements and results: Airway pressure and airflow were measured during every application. Breathing pattern, vital capacity (VC), sniff nasal inspiratory pressure (SNIP), peak expiratory flow (PEF) and respiratory comfort were evaluated at baseline and after each application. The tolerance of the patients was excellent with a significant increase in the respiratory comfort score in all the patients (p=0.02). Expired volume during the MI-E application increased significantly to reach twice the VC at 40 cm H₂O. Mean and maximal inspiratory and expiratory flows increased in a pressure-dependent manner. Breathing pattern did not change after the MI-E applications, SaO₂ remained stable within normal values but mean PetCO₂ decreased significantly. VC did not change but mean SNIP and PEF improved significantly after the MI-E applications.

Conclusions: Our results confirm the good tolerance and physiological short term benefit of the MI-E in children with neuromuscular disease in a stable state.