1
|
Reychler G, Audag N, Prieur G, Poncin W, Contal O. [Guidelines for the management of airway mucus secretions by airway clearance techniques]. Rev Mal Respir 2024; 41:512-537. [PMID: 39025771 DOI: 10.1016/j.rmr.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 05/23/2024] [Indexed: 07/20/2024]
Affiliation(s)
- G Reychler
- Institut de recherche expérimentale et clinique (IREC), pôle de pneumologie, ORL et dermatologie, université catholique de Louvain, Brussels, Belgique; Service de pneumologie, cliniques universitaires Saint-Luc, avenue Hippocrate 10, 1200 Brussels, Belgique; Secteur de kinésithérapie et ergothérapie, cliniques universitaires Saint-Luc, Brussels, Belgique.
| | - N Audag
- Institut de recherche expérimentale et clinique (IREC), pôle de pneumologie, ORL et dermatologie, université catholique de Louvain, Brussels, Belgique; Service de pneumologie, cliniques universitaires Saint-Luc, avenue Hippocrate 10, 1200 Brussels, Belgique; Secteur de kinésithérapie et ergothérapie, cliniques universitaires Saint-Luc, Brussels, Belgique
| | - G Prieur
- Physiotherapy Department, Le Havre Hospital, 76600 Le Havre, France
| | - W Poncin
- Institut de recherche expérimentale et clinique (IREC), pôle de pneumologie, ORL et dermatologie, université catholique de Louvain, Brussels, Belgique; Service de pneumologie, cliniques universitaires Saint-Luc, avenue Hippocrate 10, 1200 Brussels, Belgique; Secteur de kinésithérapie et ergothérapie, cliniques universitaires Saint-Luc, Brussels, Belgique
| | - O Contal
- School of Health Sciences (HESAV), HES-SO University of Applied Sciences and Arts of Western Switzerland, 1005 Lausanne, Suisse
| |
Collapse
|
2
|
Hyun SE, Hwang W, Ji HM, Shin HI. Effect of body position on peak expiratory flow during mechanical insufflation-exsufflation in people with cervical spinal cord injury: a pilot study. Sci Rep 2023; 13:16548. [PMID: 37783754 PMCID: PMC10545699 DOI: 10.1038/s41598-023-43256-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 09/21/2023] [Indexed: 10/04/2023] Open
Abstract
This prospective pilot study investigated the influence of body position on peak cough flow (PCF) during mechanical insufflation-exsufflation (MI-E) treatment in people with tetraplegia. Fifteen participants with cervical spinal cord injury (C-SCI) were randomized into two groups, which differed in the starting position, that is, the patients were either supine or reclined. Four sessions of MI-E in alternating positions with each session comprising three different maneuvers: five voluntary coughs, five MI-E-assisted coughs, and five MI-E-assisted with manual thrusts were performed with continuous airflow measurement reporting PCF from every cough. PCF was associated with the application maneuvers, total insufflation volume (TIV), and interaction between position and maneuvers but not with the application position. The estimated mean PCF was 1.808, 3.529, and 3.925 L/s when supine and 1.672, 3.598, and 3.909 L/s when reclined from voluntary cough, MI-E, and MI-E with manual thrust, respectively. The estimated PCF change compared to voluntary cough was 1.721 (95% CI, 1.603-1.838) L/s from the combined MI-E and 2.116 (95% CI, 2.005-2.228) L/s from the MI-E with manual thrust, calculated from the linear mixed-model analysis. PCF moderately correlated with TIV (R2 = 0.64). Therefore, either position can be used for C-SCI patients as long as MI-E can be performed with manual thrust and sufficient TIV is provided.
Collapse
Affiliation(s)
- Sung Eun Hyun
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Wonjae Hwang
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hye Min Ji
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Veterans Medical Research Institute, Veterans Health Service Medical Center, Seoul, Korea
| | - Hyung-Ik Shin
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
| |
Collapse
|
3
|
Khan A, Frazer-Green L, Amin R, Wolfe L, Faulkner G, Casey K, Sharma G, Selim B, Zielinski D, Aboussouan LS, McKim D, Gay P. Respiratory Management of Patients With Neuromuscular Weakness: An American College of Chest Physicians Clinical Practice Guideline and Expert Panel Report. Chest 2023; 164:394-413. [PMID: 36921894 DOI: 10.1016/j.chest.2023.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/27/2023] [Accepted: 03/05/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Respiratory failure is a significant concern in neuromuscular diseases (NMDs). This CHEST guideline examines the literature on the respiratory management of patients with NMD to provide evidence-based recommendations. STUDY DESIGN AND METHODS An expert panel conducted a systematic review addressing the respiratory management of NMD and applied the Grading of Recommendations, Assessment, Development, and Evaluations approach for assessing the certainty of the evidence and formulating and grading recommendations. A modified Delphi technique was used to reach a consensus on the recommendations. RESULTS Based on 128 studies, the panel generated 15 graded recommendations, one good practice statement, and one consensus-based statement. INTERPRETATION Evidence of best practices for respiratory management in NMD is limited and is based primarily on observational data in amyotrophic lateral sclerosis. The panel found that pulmonary function testing every 6 months may be beneficial and may be used to initiate noninvasive ventilation (NIV) when clinically indicated. An individualized approach to NIV settings may benefit patients with chronic respiratory failure and sleep-disordered breathing related to NMD. When resources allow, polysomnography or overnight oximetry can help to guide the initiation of NIV. The panel provided guidelines for mouthpiece ventilation, transition to home mechanical ventilation, salivary secretion management, and airway clearance therapies. The guideline panel emphasizes that NMD pathologic characteristics represent a diverse group of disorders with differing rates of decline in lung function. The clinician's role is to add evaluation at the bedside to shared decision-making with patients and families, including respect for patient preferences and treatment goals, considerations of quality of life, and appropriate use of available resources in decision-making.
Collapse
Affiliation(s)
- Akram Khan
- Division of Pulmonary Allergy and Critical Care Medicine, Oregon Health and Science University, Portland, OR.
| | | | - Reshma Amin
- Department of Respiratory Medicine, The Hospital for Sick Kids, Toronto
| | - Lisa Wolfe
- Department of Medicine, Northwestern University, Chicago, IL
| | | | - Kenneth Casey
- Department of Sleep Medicine, William S. Middleton Memorial Veterans Hospital, Shorewood Hills, WI
| | - Girish Sharma
- Department of Pediatrics, Rush University Medical Center, Chicago, IL
| | - Bernardo Selim
- Department of Pulmonary Medicine, Mayo Clinic, Rochester, MN
| | - David Zielinski
- Department of Pediatrics, McGill University, Montreal, QC, Canada
| | | | - Douglas McKim
- Department of Medicine, The Ottawa Hospital Research Institute, Ottawa, ON
| | - Peter Gay
- Department of Pulmonary Medicine, Mayo Clinic, Rochester, MN
| |
Collapse
|
4
|
Sheers NL, O’Sullivan R, Howard ME, Berlowitz DJ. The role of lung volume recruitment therapy in neuromuscular disease: a narrative review. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1164628. [PMID: 37565183 PMCID: PMC10410160 DOI: 10.3389/fresc.2023.1164628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/16/2023] [Indexed: 08/12/2023]
Abstract
Respiratory muscle weakness results in substantial discomfort, disability, and ultimately death in many neuromuscular diseases. Respiratory system impairment manifests as shallow breathing, poor cough and associated difficulty clearing mucus, respiratory tract infections, hypoventilation, sleep-disordered breathing, and chronic ventilatory failure. Ventilatory support (i.e., non-invasive ventilation) is an established and key treatment for the latter. As survival outcomes improve for people living with many neuromuscular diseases, there is a shift towards more proactive and preventative chronic disease multidisciplinary care models that aim to manage symptoms, improve morbidity, and reduce mortality. Clinical care guidelines typically recommend therapies to improve cough effectiveness and mobilise mucus, with the aim of averting acute respiratory compromise or respiratory tract infections. Moreover, preventing recurrent infective episodes may prevent secondary parenchymal pathology and further lung function decline. Regular use of techniques that augment lung volume has similarly been recommended (volume recruitment). It has been speculated that enhancing lung inflation in people with respiratory muscle weakness when well may improve respiratory system "flexibility", mitigate restrictive chest wall disease, and slow lung volume decline. Unfortunately, clinical care guidelines are based largely on clinical rationale and consensus opinion rather than level A evidence. This narrative review outlines the physiological changes that occur in people with neuromuscular disease and how these changes impact on breathing, cough, and respiratory tract infections. The biological rationale for lung volume recruitment is provided, and the clinical trials that examine the immediate, short-term, and longer-term outcomes of lung volume recruitment in paediatric and adult neuromuscular diseases are presented and the results synthesised.
Collapse
Affiliation(s)
- Nicole L. Sheers
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, VIC, Australia
- Institute for Breathing and Sleep, Heidelberg, VIC, Australia
- Department of Physiotherapy, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Rachel O’Sullivan
- Department of Physiotherapy, Christchurch Hospital, Canterbury, New Zealand
| | - Mark E. Howard
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, VIC, Australia
- Institute for Breathing and Sleep, Heidelberg, VIC, Australia
- Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia
- Turner Institute of Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - David J. Berlowitz
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, VIC, Australia
- Institute for Breathing and Sleep, Heidelberg, VIC, Australia
- Department of Physiotherapy, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia
- Department of Physiotherapy, Austin Health, Heidelberg, VIC, Australia
| |
Collapse
|
5
|
Hadda V, Suri TM, Pahuja S, El-Khatib M, Ciobanu LD, Cabrita B, Karim HMR, Barjaktarevic I, Crimi C, Garuti G, Mittal S, Tiwari P, Madan K, Mohan A, Karakurt Z, Esquinas A. Secretion management in patients with ineffective airway clearance with non-invasive mechanical ventilation use: Expert guidance for clinical practice. Monaldi Arch Chest Dis 2021; 91. [PMID: 34121373 DOI: 10.4081/monaldi.2021.1499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 04/17/2021] [Indexed: 11/23/2022] Open
Abstract
Non-invasive ventilation (NIV) is a mainstay of management of chronic respiratory failure in many disorders which are known to cause abnormal airway secretion clearance. Currently, there is no guidance regarding either the secretion handling during NIV use or the role of NIV in secretion management in these patients. The aim of this document was to provide an overview of the various techniques available in the management of respiratory secretions and their use in conjunction with NIV. Literature search was performed using the keywords, "(secretion OR secretions) AND (noninvasive ventilation OR NIV)" on PubMed and EMBASE. The search yielded 1681 and 509 titles from PubMed and EMBASE, respectively. After screening, 19 articles were included in this review. Suggestions of the expert panel were formulated by mutual consensus after reviewing the relevant literature. The draft of the expert panel's suggestions was circulated among all authors via electronic mail for comments. Any conflicts were resolved by mutual discussion to achieve agreement. The final document was approved by all. This document by the International Network for Airway Secretions Management in NIV describes various airway secretion clearance techniques. It provides the expert panel's suggestions for the use of these techniques in conjunction with NIV for patients with muco-obstructive and neuromuscular disorders.
Collapse
Affiliation(s)
- Vijay Hadda
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute Of Medical Sciences, New Delhi.
| | - Tejas Menon Suri
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute Of Medical Sciences, New Delhi.
| | - Sourabh Pahuja
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute Of Medical Sciences, New Delhi.
| | - Mohamad El-Khatib
- Department of Respiratory Therapy, American University of Beirut Medical Center, Beirut.
| | - Laura D Ciobanu
- Department of Internal Medicine, University of Medicine and Pharmacy "Grigore T. Popa", Iasi.
| | - Bruno Cabrita
- Pulmonology Department, Hospital Pedro Hispano, Matosinhos.
| | - Habib Md Reazaul Karim
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Raipur.
| | - Igor Barjaktarevic
- Division of Pulmonary and Critical Care, David Geffen School of Medicine at University of California, Los Angeles, CA.
| | - Claudia Crimi
- Respiratory Medicine Unit, A.O.U. "Policlinico-Vittorio Emanuele", Catania.
| | | | - Saurabh Mittal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute Of Medical Sciences, New Delhi.
| | - Pawan Tiwari
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute Of Medical Sciences, New Delhi.
| | - Karan Madan
- All India Institute of Medical Sciences, New Delhi.
| | - Anant Mohan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute Of Medical Sciences, New Delhi.
| | - Zuhal Karakurt
- Respiratory Intensive Care Unit, Sureyyapasa Chest Diseases and Surgery Hospital, Istanbul.
| | | |
Collapse
|
6
|
Human A, Corten L, Morrow BM. The role of physiotherapy in the respiratory management of children with neuromuscular diseases: A South African perspective. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2021; 77:1527. [PMID: 34131595 PMCID: PMC8186372 DOI: 10.4102/sajp.v77i1.1527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 02/08/2021] [Indexed: 12/05/2022] Open
Abstract
Background Respiratory morbidity is common in children with neuromuscular diseases (NMD) owing to chronic hypoventilation and impaired cough. Optimal, cost-effective respiratory management requires implementation of clinical practice guidelines and a coordinated multidisciplinary team approach. Objectives To explore South African physiotherapists’ knowledge, perception and implementation of respiratory clinical practice guidelines for non-ventilated children with NMD. Methods An online survey was conducted amongst members of the South African Society of Physiotherapy’s Cardiopulmonary Rehabilitation (CPRG) and Paediatric special interest groups and purposive sampling of non-member South African physiotherapists with respiratory paediatrics expertise (N= 481). Results Most respondents worked in private healthcare, with 1–10 years’ experience treating patients with NMD. For acute and chronic management, most participants recommended nebulisation and 24-h postural management for general respiratory care. Percussions, vibrations, positioning, adapted postural drainage, breathing exercises and manually assisted cough were favoured as airway clearance techniques. In addition, participants supported non-invasive ventilation, oscillatory devices and respiratory muscle training for chronic management. Conclusion Respondents seemed aware of internationally-endorsed NMD clinical practice guidelines and recommendations, but traditional manual airway clearance techniques were favoured. This survey provided novel insight into the knowledge, perspectives and implementation of NMD clinical practice guidelines amongst South African physiotherapists. Clinical implications There is an urgent need to increase the abilities of South African physiotherapists who manage children with NMD, as well as the establishment of specialised centres with the relevant equipment, ventilatory support and expertise in order to provide safe, cost-effective and individualised patient care.
Collapse
Affiliation(s)
- Anri Human
- Department of Physiotherapy, Faculty of Healthcare Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Lieselotte Corten
- Department of Physiotherapy, School of Health Sciences, University of Brighton, Eastbourne, United Kingdom
| | - Brenda M Morrow
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
7
|
Morrow B, Argent A, Zampoli M, Human A, Corten L, Toussaint M. Cough augmentation techniques for people with chronic neuromuscular disorders. Cochrane Database Syst Rev 2021; 4:CD013170. [PMID: 33887060 PMCID: PMC8092569 DOI: 10.1002/14651858.cd013170.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND People with neuromuscular disorders may have a weak, ineffective cough predisposing them to respiratory complications. Cough augmentation techniques aim to improve cough effectiveness and mucous clearance, reduce the frequency and duration of respiratory infections requiring hospital admission, and improve quality of life. OBJECTIVES To determine the efficacy and safety of cough augmentation techniques in adults and children with chronic neuromuscular disorders. SEARCH METHODS On 13 April 2020, we searched the Cochrane Neuromuscular Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL, and ClinicalTrials.gov for randomised controlled trials (RCTs), quasi-RCTs, and randomised cross-over trials. SELECTION CRITERIA We included trials of cough augmentation techniques compared to no treatment, alternative techniques, or combinations thereof, in adults and children with chronic neuromuscular disorders. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial eligibility, extracted data, and assessed risk of bias. The primary outcomes were the number and duration of unscheduled hospitalisations for acute respiratory exacerbations. We assessed the certainty of evidence using GRADE. MAIN RESULTS The review included 11 studies involving 287 adults and children, aged three to 73 years. Inadequately reported cross-over studies and the limited additional information provided by authors severely restricted the number of analyses that could be performed. Studies compared manually assisted cough, mechanical insufflation, manual and mechanical breathstacking, mechanical insufflation-exsufflation, glossopharyngeal breathing, and combination techniques to unassisted cough and alternative or sham interventions. None of the included studies reported on the primary outcomes of this review (number and duration of unscheduled hospital admissions) or listed 'adverse events' as primary or secondary outcome measures. The evidence suggests that a range of cough augmentation techniques may increase peak cough flow compared to unassisted cough (199 participants, 8 RCTs), but the evidence is very uncertain. There may be little to no difference in peak cough flow outcomes between alternative cough augmentation techniques (216 participants, 9 RCTs). There was insufficient evidence to determine the effect of interventions on measures of gaseous exchange, pulmonary function, quality of life, general function, or participant preference and satisfaction. AUTHORS' CONCLUSIONS We are very uncertain about the safety and efficacy of cough augmentation techniques in adults and children with chronic neuromuscular disorders and further studies are needed.
Collapse
Affiliation(s)
- Brenda Morrow
- Department of Paediatrics, University of Cape Town, Cape Town, South Africa
| | - Andrew Argent
- Pediatric Intensive Care, Division of Pediatric Critical Care and Children's Heart Disease, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa
| | - Marco Zampoli
- Pulmonology, and Paediatric Medicine, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa
| | - Anri Human
- Physiotherapy Department, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Garankuwa, South Africa
| | | | - Michel Toussaint
- Centre for Home Mechanical Ventilation and Specialized Centre for Neuromuscular Diseases, Inkendaal Rehabilitation Hospital, Vlezenbeek, Belgium
| |
Collapse
|
8
|
Sharma A, Mitra S, Dutta V, Moiz JA. Effects of glossopharyngeal insufflation on pulmonary function in cervical cord injury patients. Spinal Cord Ser Cases 2021; 7:15. [PMID: 33674558 DOI: 10.1038/s41394-021-00390-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 02/10/2021] [Indexed: 11/09/2022] Open
Abstract
STUDY DESIGN Quasi experimental. OBJECTIVE To evaluate the effect of glossopharyngeal insufflation on pulmonary function in cervical cord injury. SETTING Indian Spinal Injuries Centre, Vasant Kunj, Delhi, India. METHODS Thirty-one cervical cord injured (ISNCSCI A and B) subjects received respiratory rehabilitation for 4 weeks, with the experimental group performing glossopharyngeal insufflation along with respiratory rehabilitation. The groups were assessed at baseline and after 4 weeks for pulmonary function test, chest expansion, dyspnea, and chest tightness. RESULTS Significant differences were observed in IVC, IC, FVC, FEV1, MEF 75%, PEF, tidal volume, chest expansion, dyspnea, and chest tightness (p < 0.05). CONCLUSION Glossopharyngeal insufflation is a technique that can be used to improve the respiratory function after cervical cord injury.
Collapse
Affiliation(s)
- Akanksha Sharma
- ISIC Institute of Rehabilitation Sciences, Vasant Kunj, Delhi, India.
| | - Shambhovi Mitra
- ISIC Institute of Rehabilitation Sciences, Vasant Kunj, Delhi, India
| | - Vijay Dutta
- Indian Spinal Injuries Centre, Vasant Kunj, Delhi, India
| | - Jamal Ali Moiz
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, Delhi, India
| |
Collapse
|
9
|
Spinou A. A Review on Cough Augmentation Techniques: Assisted Inspiration, Assisted Expiration and Their Combination. Physiol Res 2020; 69:S93-S103. [DOI: 10.33549/physiolres.934407] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Cough is an important mechanism of airway clearance. In patients who present weak and ineffective cough, augmentation techniques aim to assist or simulate the maneuver. These techniques target different phases of the cough cycle, mainly the inspiratory and expiratory phases, through assisted inspiration, assisted expiration and their combination. They include the manual hyperinflation, ventilator hyperinflation, glossopharyngeal breathing, manually assisted cough and mechanical insufflator-exsufflator, each applied individually or in different combinations. The aim of this review is to investigate the effectiveness and safety of cough augmentation techniques. Findings support that all commonly used techniques can theoretically improve airway clearance, as they generate higher cough peak flows compared to unassisted cough. Still, the studies assessing cough augmentation present considerable limitations and the direct comparison of different techniques is challenging. Current evidence indicate that cough peak flow shows higher increase with the combination of assisted inspiration and expiration, and improvement is greater in patients with lower unassisted values. Associated adverse events are infrequent.
Collapse
Affiliation(s)
- A. Spinou
- Population Health Sciences, Faculty of Life Sciences and Medicine, King’s College London, United Kingdom.
| |
Collapse
|
10
|
Banfi P, Pierucci P, Volpato E, Nicolini A, Lax A, Robert D, Bach J. Daytime noninvasive ventilatory support for patients with ventilatory pump failure: a narrative review. Multidiscip Respir Med 2019; 14:38. [PMID: 31798866 PMCID: PMC6884796 DOI: 10.1186/s40248-019-0202-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 10/31/2019] [Indexed: 12/12/2022] Open
Abstract
Over the past three decades, the use of noninvasive ventilation or "NIV" to assuage symptoms of hypoventilation for patients with early onset or mild ventilatory pump failure has been extended to up to the use of continuous noninvasive ventilatory support (CNVS) at full ventilatory support settings as a definitive alternative to tracheostomy mechanical ventilation. NVS, along with mechanical insufflation-exsufflation, now provides a noninvasive option for the management of both chronic and acute respiratory failure for these patients. The most common diagnoses for which these methods are useful include chest wall deformities, neuromuscular diseases, morbid obesity, high level spinal cord injury and idiopathic, primary or secondary disorders of the ventilatory control. Thus, NVS is being used in diverse settings: critical care units, medical wards, at home, and in extended care. The aim of this review is to examine the techniques used for daytime support.
Collapse
Affiliation(s)
- Paolo Banfi
- IRCCS Fondazione Don Carlo Gnocchi, via Capecelatro, 66 20148 Milan, Italy
| | - Paola Pierucci
- Cardio Thoracic Department, Respiratory and Sleep Disorders Unit, Bari Policlinic, Bari, Italy
| | - Eleonora Volpato
- IRCCS Fondazione Don Carlo Gnocchi, via Capecelatro, 66 20148 Milan, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Antonello Nicolini
- Respiratory Rehabilitation Unit, ASL 4 Chiavarese, Hospital of Sestri Levante, Sestri Levante, Italy
| | - Agata Lax
- IRCCS Fondazione Don Carlo Gnocchi, via Capecelatro, 66 20148 Milan, Italy
| | - Dominique Robert
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Réanimation Médicale, Lyon, France
- Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - John Bach
- Department of Physical Medicine and Rehabilitation, Rutgers University New Jersey Medical School, Newark, USA
| |
Collapse
|
11
|
Camela F, Gallucci M, Ricci G. Cough and airway clearance in Duchenne muscular dystrophy. Paediatr Respir Rev 2019; 31:35-39. [PMID: 30553655 DOI: 10.1016/j.prrv.2018.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 08/26/2018] [Accepted: 11/16/2018] [Indexed: 01/14/2023]
Abstract
People with Duchenne muscular dystrophy (DMD), develop a respiratory muscle weakness that results in weakened cough, airway clearance impairment and over time respiratory failure and death. Assessment of cough effectiveness through vital capacity, peak cough flow and maximal inspiratory and expiratory pressures has been used to identify the optimal timing of cough augmentation techniques initiation. The choice of therapies depends on physician knowledge, and patient/care giver abilities. The purpose of this review is to clarify mechanisms of action, benefits and disadvantages of available techniques, such as manual cough-assisting manoeuvres, glossopharyngeal breathing, air stacking by resuscitator bag or by volume-cycle ventilator, and mechanical insufflator-exsufflator. Mechanisms of mucus mobilization, like intrapulmonary percussive ventilation, may have a therapeutic role in the case of persistent atelectasis. It is also crucial to recognize the initial phase of an acute respiratory exacerbation, increase the use of these techniques which may reduce morbidity and mortality.
Collapse
Affiliation(s)
- F Camela
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 11, 40138 Bologna, Italy
| | - M Gallucci
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 11, 40138 Bologna, Italy
| | - G Ricci
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 11, 40138 Bologna, Italy.
| |
Collapse
|
12
|
|
13
|
Chatwin M, Toussaint M, Gonçalves MR, Sheers N, Mellies U, Gonzales-Bermejo J, Sancho J, Fauroux B, Andersen T, Hov B, Nygren-Bonnier M, Lacombe M, Pernet K, Kampelmacher M, Devaux C, Kinnett K, Sheehan D, Rao F, Villanova M, Berlowitz D, Morrow BM. Airway clearance techniques in neuromuscular disorders: A state of the art review. Respir Med 2018; 136:98-110. [PMID: 29501255 DOI: 10.1016/j.rmed.2018.01.012] [Citation(s) in RCA: 121] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 01/20/2018] [Accepted: 01/22/2018] [Indexed: 12/13/2022]
Abstract
This is a unique state of the art review written by a group of 21 international recognized experts in the field that gathered during a meeting organized by the European Neuromuscular Centre (ENMC) in Naarden, March 2017. It systematically reports the entire evidence base for airway clearance techniques (ACTs) in both adults and children with neuromuscular disorders (NMD). We not only report randomised controlled trials, which in other systematic reviews conclude that there is a lack of evidence base to give an opinion, but also include case series and retrospective reviews of practice. For this review, we have classified ACTs as either proximal (cough augmentation) or peripheral (secretion mobilization). The review presents descriptions; standard definitions; the supporting evidence for and limitations of proximal and peripheral ACTs that are used in patients with NMD; as well as providing recommendations for objective measurements of efficacy, specifically for proximal ACTs. This state of the art review also highlights how ACTs may be adapted or modified for specific contexts (e.g. in people with bulbar insufficiency; children and infants) and recommends when and how each technique should be applied.
Collapse
Affiliation(s)
- Michelle Chatwin
- Academic and Clinical Department of Sleep and Breathing and NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, Sydney Street, London, UK.
| | - Michel Toussaint
- Centre for Home Mechanical Ventilation and Specialized Centre for Neuromuscular Diseases, Inkendaal Rehabilitation Hospital, Vlezenbeek, Belgium
| | - Miguel R Gonçalves
- Noninvasive Ventilatory Support Unit, Pulmonology Department, Emergency and Intensive Care Medicine Department, São João University Hospital, Faculty of Medicine, University of Porto, Portugal
| | - Nicole Sheers
- Institute for Breathing and Sleep and Victorian Respiratory Support Service, Austin Health, Melbourne, Australia
| | - Uwe Mellies
- Departement of Pediatric Pulmonology and Sleep Medicine, Cystic Fibrosis Center Essen, University of Essen, Germany
| | - Jesus Gonzales-Bermejo
- Sorbonne Université, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département "R3S"), Paris, France
| | - Jesus Sancho
- Respiratory Care Unit, Respiratory Medicine Department, Hospital Clinico Universitario, Valencia, Institute of Health Research INCLIVA, Valencia, Spain
| | - Brigitte Fauroux
- Pediatric Noninvasive Ventilation and Sleep Unit, Necker University Hospital, Paris, Paris Descartes University, Paris Research Unit INSERM U 955, Team 13, Creteil, France
| | - Tiina Andersen
- Norwegian Centre of Excellence for Home Mechanical Ventilation, Thoracic Department and Department of Physiotherapy, Haukeland University Hospital, Bergen Norway, Department of Clinical Science, Medical Faculty, University of Bergen, Bergen, Norway
| | - Brit Hov
- Dept of Peadiatric Medicine, Oslo University Hospital, Oslo, Norway and Norwegian Centre of Excellence for Home Mechanical Ventilation, Haukeland University Hospital, Bergen, Norway
| | - Malin Nygren-Bonnier
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Functional Area Occupational Therapy and Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden
| | - Matthieu Lacombe
- Adult Intensive Care Unit, Raymond Poincaré Hospital (AP-HP) Garches, France
| | - Kurt Pernet
- Centre for Home Mechanical Ventilation and Specialized Centre for Neuromuscular Diseases, Inkendaal Rehabilitation Hospital, Vlezenbeek, Belgium
| | - Mike Kampelmacher
- Home Ventilation Service, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Christian Devaux
- Direction des Actions Médicales, Paramédicales et Psychologiques, Association Française Contre Les Myopathies-Téléthon, 91000 EVRY, France
| | - Kathy Kinnett
- Parent Project Muscular Dystrophy, 401 Hackensack Ave 9th Floor, Hackensack, NJ 07601, United States
| | - Daniel Sheehan
- Assisted Breathing Center, Women and Children's Hospital of Buffalo Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, United States
| | - Fabrizio Rao
- Respiratory Unit, Neuromuscular OmniCentre (NeMO), Neurorehabilitation, University of Milan, Niguarda Hospital, Milan, Italy
| | - Marcello Villanova
- Neuromuscular Rehabilitation Unit, Nigrisoli Hospital, Viale Ercolani 7/b - 40125, Bologna, Italy
| | - David Berlowitz
- Institute for Breathing and Sleep and Victorian Respiratory Support Service, Austin Health, Melbourne, Australia
| | - Brenda M Morrow
- Department of Paediatrics and Child Health, University of Cape Town, Klipfontein Rd, Rondebosch, Cape Town, South Africa
| |
Collapse
|
14
|
Lee SY, Cho KJ. A study on the cough augmentation using a belt-driven assistive. IEEE Int Conf Rehabil Robot 2017; 2017:1654-1659. [PMID: 28814057 DOI: 10.1109/icorr.2017.8009485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Coughing is one of the most important mechanisms performed in human body in that it removes mucus. The absence of enough ability to remove mucus leads to accumulation of the mucus on the airway, followed by possible complications such as pneumonia and atelectasis. Patients with diseases or disorders such as spinal cord injury have weakened ability in coughing. So far, there have been various treatments such as intubation surgery, mechanical insufflation-exsufflation or manual assistance provided by paramedic. But those treatments are mainly focusing on hospitalized patients. Patients showing better abilities in breathing are rarely and sporadically cared. We found that our prior research to assist breathing of these patients could also assist cough. Also, with our mechanism, now it is available that patients can care about themselves without on by own and more frequently if they needed assistance or treatment. To assist coughing, a belt-driven assistive robot are developed and effectiveness is investigated. With three healthy subjects, general breathing and coughing ability was monitored while using the robot. The result showed about 1.59 times better inhalation and exhalation. Also 1.52 times better coughing ability was measured.
Collapse
|