Review
The clinical use of mechanical insufflation-exsufflation in children with neuromuscular disorders in Europe

https://doi.org/10.1016/j.prrv.2017.08.003Get rights and content
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Abstract

Mechanical insufflation-exsufflation (MI-E) is a strategy to treat pulmonary exacerbations in neuromuscular disorders (NMDs). Pediatric guidelines for optimal setting titration of MI-E are lacking and the settings used in studies vary. Our objective was to assess the actual MI-E settings being used in current clinical treatment of children with NMDs and a survey was sent in July 2016 to European expertise centers. Ten centers from seven countries gave information on MI-E settings for 240 children aged 4 months to 17.8 years (mean 10.5). Settings varied greatly between the centers. Auto mode was used in 71%, triggering of insufflation in 21% and manual mode in 8% of the cases. Mean (SD) time for insufflation (Ti) and exsufflation (Te) were 1.9 (0.5) and 1.8 (0.6) s respectively, both ranging from 1 to 4 s. Asymmetric time settings were common (65%). Mean (SD) insufflation (Pi) and exsufflation (Pe) pressures were 32.4 (7.8) and −36.9 (7.4), ranging 10 to 50 and −10 to −60 cmH2O, respectively. Asymmetric pressures were as common as symmetric. Both Ti, Te, Pi and Pe increased with age (p < 0.001). In conclusion, pediatric MI-E settings in clinical use varied greatly and altered with age, highlighting the need of more studies to improve our knowledge of optimal settings in MI-E in children with NMDs.

Abbreviations

NMD
neuromuscular diseases
MI-E
mechanical insufflation-exsufflation
PCF
peak cough flow
Ti
insufflation time
Te
exsufflation time
Tp
pause time
Pi
insufflation pressure
Pe
exsufflation pressure

Keywords

Airway management
Cough
Neuromuscular diseases
Pediatrics
Respiratory therapy
Mechanical insufflation-exsufflation

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