Chest
Clinical InvestigationsCOPDEffects of Mechanical Insufflation-Exsufflation on Respiratory Parameters for Patients With Chronic Airway Secretion Encumbrance
Section snippets
Patients
Patients with severe COPD or NMDs were referred to our rehabilitation unit after at least one episode of acute respiratory failure. All who complained of chronic airway congestion and difficulty clearing airway secretions, had decreases in baseline oxyhemoglobin saturation (Spo2), and provided consent satisfied the criteria for inclusion in this study. Exclusion criteria were medical instability, any changes in respiratory management during the 3 prior months, or need for any antibiotic therapy
Results
The oNMD patient group was significantly younger than the ALS and COPD groups (p = 0.024 and p = 0.004, respectively) [Table 1]. Pao2 was significantly lower in the COPD group compared to the oNMD and ALS groups (p = 0.016 and p = 0.001, respectively). Paco2 values were significantly higher and the FEV1 significantly lower in the COPD group compared to the ALS group (p = 0.003 and p = 0.0023, respectively). PCF at baseline was not significantly different between patient groups. In the ALS
Discussion
MI-E was well tolerated, and it significantly improved PCF and Spo2 for patients with NMD and COPD with airway secretion encumbrance, especially when used at pressures of 40 to − 40 cm H2O. It has been demonstrated in Rhesus monkeys that these pressures result in the greatest expiratory flows and result in no airway damage.21 While some patients find MI-E to be most effective at pressures of ≥ 60 cm H2O, the great majority of patients in clinical practice receive it at 40 to − 40 cm H2O. Thus,
Conclusion
This prospective study confirms that MI-E can improve PCF and oxygenation in ALS and other NMDs. In patients with COPD, it improved oxygenation and breathlessness without a significant improvement in PCF, but also without any deterioration in breathing pattern or pulmonary parameters. Taken together, these findings suggest that MI-E may be a potential complement to noninvasive ventilation for a wide variety of patient groups, and may help to reduce the frequency of pulmonary complications
ACKNOWLEDGMENT
The authors thank JH Emerson Company (Cambridge, MA) and Medipro (Grupo Eucon; Madrid, Spain) for supplying the Cough-Assist unit for the study and all the technical support provided.
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