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Wahlgren L, Kroksmark AK, Lindblad A, Tulinius M, Sofou K. Respiratory comorbidities and treatments in Duchenne muscular dystrophy: impact on life expectancy and causes of death. J Neurol 2024; 271:4300-4309. [PMID: 38630313 PMCID: PMC11233294 DOI: 10.1007/s00415-024-12372-7] [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: 02/26/2024] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND Duchenne muscular dystrophy (DMD) is a neuromuscular disorder with progressive decline of pulmonary function increasing the risk of early mortality. The aim of this study was to explore the respiratory-related comorbidities, and the effect of these comorbidities and treatments on life expectancy and causes of death. METHODS All male patients living in Sweden with DMD, born and deceased 1970-2019, were included. Data regarding causes of death were collected from the Cause of Death Registry and cross-checked with the medical records along with diagnostics and relevant clinical features. RESULTS Hundred and twenty nine patients were included with a median lifespan of 24.3 years. Acute respiratory failure accounted for 63.3% of respiratory-related causes of death. 70.1% suffered at least one pneumonia, with first episode at a median age of 17.8 years. Hypoventilation was found in 73.0% with onset at 18.1 years. 60.5% had their first pneumonia before established hypoventilation. Age at onset of hypoventilation showed a strong correlation with age at first pneumonia. First pneumonia and scoliosis non-treated with scoliosis surgery increased the risk of dying of respiratory-related causes. In 10% of the patients, first pneumonia resulted in acute tracheostomy or early death. Patients treated with assisted ventilation had higher life expectancy compared to untreated patients. CONCLUSIONS Our results highlight the importance of identifying subclinical hypoventilation in a timely manner and the importance of an active treatment regime upon clinical signs of pneumonia.
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Affiliation(s)
- Lisa Wahlgren
- The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.
- Department of Pediatrics, Lnstitute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Anna-Karin Kroksmark
- Department for Health and Rehabilitation/Physiotherapy, University of Gothenburg, Gothenburg, Sweden
| | - Anders Lindblad
- The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Pediatrics, Lnstitute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mar Tulinius
- Department of Pediatrics, Lnstitute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kalliopi Sofou
- The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Pediatrics, Lnstitute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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2
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Chatwin M, Sancho J, Lujan M, Andersen T, Winck JC. Waves of Precision: A Practical Guide for Reviewing New Tools to Evaluate Mechanical In-Exsufflation Efficacy in Neuromuscular Disorders. J Clin Med 2024; 13:2643. [PMID: 38731172 PMCID: PMC11084470 DOI: 10.3390/jcm13092643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/15/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
Mechanical insufflation-exsufflation (MI-E) is essential for secretion clearance, especially in neuromuscular disorders. For the best outcomes, initiation of MI-E should be started at the correct time with regular evaluation to the response to treatment. Typically, cough peak flow has been used to evaluate cough effectiveness with and without MI-E. This review highlights the limitations of this and discussed other tools to evaluate MI-E efficacy in this rapidly developing field. Such tools include the interpretation of parameters (like pressure, flow and volumes) that derive from the MI-E device and external methods to evaluate upper airway closure. In this review we pinpoint the differences between different devices in the market and discuss new tools to better titrate MI-E and detect pathological responses of the upper airway. We discuss the importance of point of care ultrasound (POCUS), transnasal fiberoptic laryngoscopy and wave form analysis in this setting. To improve clinical practice newer generation MI-E devices should allow real-time evaluation of waveforms and standardize some of the derived parameters.
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Affiliation(s)
- Michelle Chatwin
- Neuromuscular Complex Care Centre, The National Hospital for Neurology and Neurosurgery, University College London Hospitals Foundation Trust, London WC1N 3BG, UK;
- Clinical and Academic Department of Sleep and Breathing, Royal Brompton Hospital, Part of Guys and St Thomas’ NHS Foundation Trust, London SW3 6NP, UK
| | - Jesus Sancho
- Respiratory Medicine Department, Hospital Clínico Universitario, 46010 Valencia, Spain;
- Institute of Health Research INCLIVA, 46010 Valencia, Spain
| | - Manel Lujan
- Servei de Pneumologia, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, 08208 Sabadell, Spain;
- Centro de Investigación Biomédica en Red (CIBERES), 28029 Madrid, Spain
| | - Tiina Andersen
- Norwegian Advisory Unit on Home Mechanical Ventilation, Thoracic Department, Haukeland University Hospital, 5021 Bergen, Norway;
- The Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, 5063 Bergen, Norway
| | - Joao-Carlos Winck
- Cardiovascular R&D Centre (UniC), Faculdade de Medicina da Universidade do Porto, 4200-319 Porto, Portugal
- Pulmonology Unit, Instituto CUF, 4460-188 Porto, Portugal
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3
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Recasens BB, Balañá Corberó A, Llorens JMM, Guillen-Sola A, Moreno MV, Escobar GG, Umayahara Y, Soh Z, Tsuji T, Rubio MÁ. Sound-based cough peak flow estimation in patients with neuromuscular disorders. Muscle Nerve 2024; 69:213-217. [PMID: 37860934 DOI: 10.1002/mus.27987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 10/01/2023] [Accepted: 10/04/2023] [Indexed: 10/21/2023]
Abstract
INTRODUCTION/AIMS Cough impairment is common in individuals with neuromuscular disorders and is associated with respiratory infections and shorter survival. Cough strength is assessed by measuring cough peak flow (CPF) using a flow meter, but this method requires a complex device setup and trained staff. The aim of the study is to evaluate the reliability of a smartphone app to estimate CPF based on cough sounds in a cohort of individuals with neuromuscular disorders. METHODS Individuals with neuromuscular disorders underwent CPF measurement with a flow meter and a smartphone app. A CPF <270 L/min was considered abnormal. RESULTS Of the 50 patients studied, 26 had amyotrophic lateral sclerosis (52%), 15 had hereditary myopathies (30%), and 9 had myasthenia gravis (18%). The intraclass correlation coefficient (ICC) between the CPF measured with a flow meter and CPF estimated with cough sounds was 0.774 (p < .001) even if the patients had orofacial weakness (ICC = 0.806, p < .001). The smartphone app had 94.4% sensitivity and 100% specificity to detect patients with CPF of less than 270 L/min. DISCUSSION Our findings suggest that sounds measured with a smartphone app provide a reliable estimate of CPF in patients with neuromuscular disorders, even in the presence of with orofacial weakness. This may be a convenient way to monitor respiratory involvement in patients with neuromuscular disorders, but larger studies of more diverse patient cohorts are needed.
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Affiliation(s)
| | - Ana Balañá Corberó
- ALS/Motor Neuron Diseases Unit, Pneumology Department, Hospital del Mar, Barcelona, Spain
| | - Juana María Martínez Llorens
- ALS/Motor Neuron Diseases Unit, Pneumology Department, Hospital del Mar, Barcelona, Spain
- Hospital del Mar - Medical Research Institute (IMIM), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), ISC III, Madrid, Spain
| | - Anna Guillen-Sola
- ALS/Motor Neuron Diseases Unit, Physical Medicine and Rehabilitation Department, Hospital del Mar, Barcelona, Spain
- Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | | | - Greta García Escobar
- ALS/Motor Neuron Diseases Unit, Neurology Department, Hospital del Mar, Barcelona, Spain
| | - Yasutaka Umayahara
- Graduate School of Health Sciences, Hiroshima Cosmopolitan University, Hiroshima, Japan
| | - Zu Soh
- Graduate School of Advanced Science and Engineering, Hiroshima University, Hiroshima, Japan
| | - Toshio Tsuji
- Graduate School of Advanced Science and Engineering, Hiroshima University, Hiroshima, Japan
| | - Miguel Ángel Rubio
- ALS/Motor Neuron Diseases Unit, Neurology Department, Hospital del Mar, Barcelona, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, Instituto de Salud Carlos III, Bellaterra, Spain
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4
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Hu J, Guo R, Li H, Wen H, Wang Y. Perioperative Diaphragm Dysfunction. J Clin Med 2024; 13:519. [PMID: 38256653 PMCID: PMC10816119 DOI: 10.3390/jcm13020519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/07/2024] [Accepted: 01/15/2024] [Indexed: 01/24/2024] Open
Abstract
Diaphragm Dysfunction (DD) is a respiratory disorder with multiple causes. Although both unilateral and bilateral DD could ultimately lead to respiratory failure, the former is more common. Increasing research has recently delved into perioperative diaphragm protection. It has been established that DD promotes atelectasis development by affecting lung and chest wall mechanics. Diaphragm function must be specifically assessed for clinicians to optimally select an anesthetic approach, prepare for adequate monitoring, and implement the perioperative plan. Recent technological advancements, including dynamic MRI, ultrasound, and esophageal manometry, have critically aided disease diagnosis and management. In this context, it is noteworthy that therapeutic approaches for DD vary depending on its etiology and include various interventions, either noninvasive or invasive, aimed at promoting diaphragm recruitment. This review aims to unravel alternative anesthetic and operative strategies that minimize postoperative dysfunction by elucidating the identification of patients at a higher risk of DD and procedures that could cause postoperative DD, facilitating the recognition and avoidance of anesthetic and surgical interventions likely to impair diaphragmatic function.
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Affiliation(s)
- Jinge Hu
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China; (J.H.); (R.G.); (H.L.)
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China;
| | - Ruijuan Guo
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China; (J.H.); (R.G.); (H.L.)
| | - Huili Li
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China; (J.H.); (R.G.); (H.L.)
| | - Hong Wen
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China;
| | - Yun Wang
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China; (J.H.); (R.G.); (H.L.)
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5
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Sciurello SA, Graziano F, Laganà MM, Compalati E, Pappacoda G, Gambazza S, Navarro J, Cecconi P, Baglio F, Banfi P. Feasibility of high-frequency percussions in people with severe acquired brain injury and tracheostomy: an observational study. Monaldi Arch Chest Dis 2024. [PMID: 38247397 DOI: 10.4081/monaldi.2024.2734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/02/2024] [Indexed: 01/23/2024] Open
Abstract
People with severe acquired brain injury (pwSABI) frequently experience pulmonary complications. Among these, atelectasis can occur as a result of pneumonia, thus increasing the chance of developing acute respiratory failure. Respiratory physiotherapy contribution to the management of atelectasis in pwSABI is yet poorly understood. We conducted a retrospective analysis on 15 non-cooperative pwSABI with tracheostomy and spontaneously breathing, hospitalized and treated with high-frequency percussion physiotherapy between September 2018 and February 2021 at the Neurological Rehabilitation Unit of the IRCCS "S.Maria Nascente - Fondazione Don Gnocchi", Milan. Our primary aim was to investigate the feasibility of such a physiotherapy intervention method. Then, we assessed changes in respiratory measures (arterial blood gas analysis and peripheral night-time oxygen saturation) and high-resolution computed tomography lung images, evaluated before and after the physiotherapy treatment. The radiological measures were a modified radiological atelectasis score (mRAS) assigned by two radiologists, and an opacity score automatically provided by the software CT Pneumonia Analysis® that identifies the regions of abnormal lung patterns. Treatment diaries showed that all treatments were completed, and no adverse events during treatment were registered. Among the 15 pwSABI analyzed, 8 were treated with IPV® and 7 with MetaNeb®. After a median of 14 (I-III quartile=12.5-14.5) days of treatment, we observed a statistical improvement in various arterial blood gas measures and peripheral night-time oxygen saturation measures. We also found radiological improvement or stability in more than 80% of pwSABI. In conclusion, our physiotherapy approach was feasible, and we observed respiratory parameters and radiological improvements. Using technology to assess abnormal tomographic patterns could be of interest to disentangle the short-term effects of respiratory physiotherapy on non-collaborating people.
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Affiliation(s)
| | - Francesca Graziano
- Bicocca Bioinformatics Biostatistics and Bioimaging Center B4, School of Medicine and Surgery, University of Milano Bicocca; Biostatistics and Clinical Epidemiology, Fondazione IRCCS San Gerardo dei Tintori, Monza.
| | | | | | | | - Simone Gambazza
- Healthcare Professions Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan.
| | | | | | | | - Paolo Banfi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan.
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Duprez F, Crombin M, Daubechies I, Devries N, Durant V, El Khalil M, Audag N. [Update on manual bronchial clearance techniques (adults and adolescents)]. Rev Mal Respir 2024; 41:43-50. [PMID: 38057240 DOI: 10.1016/j.rmr.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/07/2023] [Indexed: 12/08/2023]
Abstract
In adults and teenagers, airway clearance physiotherapy techniques (ACPT) are various and numerous. However, they for still awaiting scientific validation. Among ACPTs, Slow Expiration with the Glottis Opened in the Lateral Posture (ELTGOL), Autogenic Drainage (DA), and Active Cycling Breathing Technique (ACBT) present a Grade B level of evidence with weak recommendations. Even though these maneuvers are widely applied, precise description of chest physiotherapy (CP) is largely absent from the scientific literature; it is difficult to standardize its implementation and reproduce the results; scientific validation and faithful execution of the techniques are consequently problematic. In this paper, the authors aim to depict each of the three CP techniques as precisely as possible; with this in mind, graphic modeling of the different respiratory exercises is presented in such a way that they can be easily learned, applied and reproduced by physiotherapists.
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Affiliation(s)
- F Duprez
- Unité de recherche et d'innovation Condorcet-Epicura (URICE), hôpital Epicura, 63, rue de Mons, 7301 Tournai-Hornu, Belgique; Haute école master en sciences de la motricité, groupe kinésithérapie respiratoire, Condorcet, Tournai, Belgique.
| | - M Crombin
- Haute école master en sciences de la motricité, groupe kinésithérapie respiratoire, Condorcet, Tournai, Belgique
| | - I Daubechies
- Haute école master en sciences de la motricité, groupe kinésithérapie respiratoire, Condorcet, Tournai, Belgique
| | - N Devries
- Haute école master en sciences de la motricité, groupe kinésithérapie respiratoire, Condorcet, Tournai, Belgique
| | - V Durant
- Haute école master en sciences de la motricité, groupe kinésithérapie respiratoire, Condorcet, Tournai, Belgique
| | - M El Khalil
- Haute école master en sciences de la motricité, groupe kinésithérapie respiratoire, Condorcet, Tournai, Belgique
| | - N Audag
- Service de kinésithérapie et ergothérapie, cliniques universitaires Saint-Luc. Bruxelles, Belgique; Institut de recherche expérimentale et clinique (IREC), pôle de pneumologie, ORL et dermatologie, groupe de recherche en kinésithérapie respiratoire, université catholique de Louvain, Bruxelles, Belgique
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7
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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.
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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
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8
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Chatwin M, Wakeman RH. Mechanical Insufflation-Exsufflation: Considerations for Improving Clinical Practice. J Clin Med 2023; 12:jcm12072626. [PMID: 37048708 PMCID: PMC10095394 DOI: 10.3390/jcm12072626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/14/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
The provision of mechanical insufflation-exsufflation (MI-E) devices to enhance cough efficacy is increasing. Typically, MI-E devices are used to augment cough in patients with neuromuscular disorders but also in patients who are weak in an acute care setting. Despite a growing evidence base for the use of these devices, there are barriers to the provision of MI-E, including clinician lack of knowledge and confidence. Enhancing clinician education and confidence is key. Individualized or protocolized approaches can be used to initiate MI-E. Evaluation of MI-E efficacy is critical. One method to evaluate effectiveness of MI-E is the MI-E-assisted cough peak flow (CPF). However, this should always be considered alongside other factors discussed in this review. The purpose of this review is to increase the theoretical understanding of the provision and evaluation of MI-E and provide insight into how this knowledge can be applied into clinical practice. Approaches to initiation and titration can be selected based on the clinical situation, patient diagnosis (including and beyond neuromuscular disorders), and clinician’s confidence.
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9
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Hov B, Andersen T, Toussaint M, Mikalsen IB, Vollsaeter M, Markussen H, Indrekvam S, Hovland V. User-perceived impact of long-term mechanical assisted cough in paediatric neurodisability. Dev Med Child Neurol 2023; 65:655-663. [PMID: 36787316 DOI: 10.1111/dmcn.15543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 01/07/2023] [Accepted: 01/11/2023] [Indexed: 02/15/2023]
Abstract
AIM To (1) compare the perceived benefit of long-term mechanical insufflation-exsufflation (MI-E) of children with neuromuscular disorders (NMDs) and central nervous system (CNS) disorders, including health care needs and treatment routines and (2) describe the children's health-related quality of life (HRQoL). METHOD This cross-sectional study used a questionnaire and memory card data to assess the perceived benefit of MI-E via the Visual Analogue Scale (VAS; 10 maximum), willingness to pause treatment, level of health care needs before and after MI-E initiation, and the children's treatment routines. A DISABKIDS questionnaire assessed HRQoL (100 maximum). RESULTS Seventy-three children using MI-E participated (42 males, median [interquartile range {IQR}] age 10 years 2 months [6 years 3 months-14 years 1 month]), 47 with NMDs (such as spinal muscular atrophy and Duchenne muscular dystrophy) and 26 with CNS disorders (such as cerebral palsy, encephalitis, neurometabolic and other diseases). The median (IQR) VAS score for the perceived benefit of MI-E therapy at stable state and respiratory tract infection were 9 (6-10) and 10 (8.5-10) respectively. Sixty-two per cent were reluctant or unwilling to pause MI-E therapy, with no NMD versus CNS disorder group difference. After MI-E initiation, fewer physician consultations and hospitalizations were reported by the group with NMDs. The MI-E routine was similar in both groups. The mean (SD) HRQoL score for 26 of 51 eligible children was 71 (16.7). INTERPRETATION MI-E treatment was generally perceived as beneficial and performed equally in both diagnostic groups. HRQoL was in line with children with a moderate-to-severe chronic condition.
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Affiliation(s)
- Brit Hov
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Tiina Andersen
- Norwegian Advisory Unit on Long-term Mechanical Ventilation, Thoracic Department, Haukeland University Hospital, Bergen, Norway.,Faculty of Health and Social Sciences, Western Norway University of Applied Science, Bergen, Norway
| | - Michel Toussaint
- Centre de Référence Neuromusculaire, Département de Neurologie, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Ingvild B Mikalsen
- Department of Paediatrics, Stavanger University Hospital HF, Stavanger, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Maria Vollsaeter
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Paediatrics, Haukeland University Hospital, Bergen, Norway
| | - Heidi Markussen
- Norwegian Advisory Unit on Long-term Mechanical Ventilation, Thoracic Department, Haukeland University Hospital, Bergen, Norway.,Faculty of Health and Social Sciences, Western Norway University of Applied Science, Bergen, Norway
| | - Solfrid Indrekvam
- Norwegian Advisory Unit on Long-term Mechanical Ventilation, Thoracic Department, Haukeland University Hospital, Bergen, Norway.,Norwegian National Register for Long-Term Mechanical Ventilation, Thoracic Department, Haukeland University Hospital, Bergen, Norway
| | - Vegard Hovland
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
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10
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Watson K, Egerton T, Sheers N, Retica S, McGaw R, Clohessy T, Webster P, Berlowitz DJ. Respiratory muscle training in neuromuscular disease: a systematic review and meta-analysis. Eur Respir Rev 2022; 31:31/166/220065. [DOI: 10.1183/16000617.0065-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 09/01/2022] [Indexed: 12/03/2022] Open
Abstract
BackgroundNeuromuscular disease causes a progressive decline in ventilatory function which respiratory muscle training may address. Previous systematic reviews have focussed on single diseases, whereas this study systematically reviewed the collective evidence for respiratory muscle training in children and adults with any neuromuscular disease.MethodsSeven databases were searched for randomised controlled trials. Three reviewers independently reviewed eligibility, extracted characteristics, results, determined risk of bias and combined results using narrative synthesis and meta-analysis.Results37 studies (40 publications from 1986–2021, n=951 participants) were included. Respiratory muscle training improved forced vital capacity (standardised mean difference (SMD) 0.40 (95% confidence interval 0.12–0.69)), maximal inspiratory (SMD 0.53 (0.21–0.85)) and maximal expiratory pressure (SMD 0.70 (0.35–1.04)) compared to control (usual care, sham or alternative treatment). No impact on cough, dyspnoea, voice, physical capacity or quality of life was detected. There was high degree of variability between studies.DiscussionStudy heterogeneity (children and adults, different diseases, interventions, dosage and comparators) suggests that the results should be interpreted with caution. Including all neuromuscular diseases increased the evidence pool and tested the intervention overall.ConclusionsRespiratory muscle training improves lung volumes and respiratory muscle strength in neuromuscular disease, but confidence is tempered by limitations in the underlying research.
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11
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Perez G, Young L, Kravitz R, Sheehan D, Adang L, Van Haren K, Lin JL, Jaffe NN, Kuo D, Ball L, Keller J, Sank J, DiVito D, Naime S. Pulmonological issues. Curr Probl Pediatr Adolesc Health Care 2022; 52:101313. [PMID: 36470809 PMCID: PMC11348663 DOI: 10.1016/j.cppeds.2022.101313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Pediatric leukodystrophies are rare neurodegenerative diseases involving multiple systems. Each form has unique neurologic features but are characterized by encephalopathy with accompanying impairments evidenced in reflexes, muscle tone and movement control. Weakness of expiratory, inspiratory, and upper airway muscles may lead to impaired airway secretion clearance resulting in recurrent respiratory infections, dysphagia, sleep-disordered breathing, restrictive lung disease, and ultimately chronic respiratory insufficiency.
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Affiliation(s)
| | - Lisa Young
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | - Laura Adang
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Jody L Lin
- Universty of Utah, Salt Lake City, UT, USA
| | | | - Dennis Kuo
- Strong Memorial Hospital, Rochester, NY, USA
| | - Laura Ball
- Children's National Medical Center, Washington DC, USA
| | | | | | - Donna DiVito
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
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12
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Cho HE, Choi WA, Lee SY, Kang SW. Standardization of Air Stacking as Lung Expansion Therapy for Patients With Restrictive Lung Disease: A Pilot Study. Phys Ther 2022; 102:6649712. [PMID: 35913796 DOI: 10.1093/ptj/pzac092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 03/02/2022] [Accepted: 05/06/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Although air stacking is a widely used lung expansion therapy essential for restrictive lung diseases, important details such as peak insufflation pressure (PIP) and number of squeezes have not been investigated. The purpose of this study was to standardize a method of air stacking to minimize problems with its application by identifying the optimal pressure and number of squeezes performed by professional physicians and investigating the current status of routine air stacking implementation in patients. METHODS This prospective cross-sectional test-retest study involved individuals who had neuromuscular disorders and had performed air stacking exercise for longer than 1 year. PIP and number of squeezes were measured to identify the differences between caregivers and physicians. Cases of incorrectly performed air stacking were investigated and categorized. The problems associated with air stacking were evaluated. RESULTS A total of 45 participants were included. PIP was 41.4 (SD = 4.2; range = 34.8-50.0) cm H2O, and optimal number of squeezes was 3.1 (SD = 0.5; range = 2-4). When the air stacking methods used by caregivers were evaluated, 19 of 45 caregivers (42.2%) used methods inappropriately. Higher PIP and larger number of squeezes were observed with caregiver implementation. Thirty caregivers (66.7%) experienced finger or wrist pain; this problem was observed especially in female caregivers, who tended to incorrectly perform air stacking. CONCLUSIONS This pilot study showed that the optimal pressure of air stacking was 35 to 50 cm H2O. Caregivers often perform air stacking inappropriately, leading to complications without achieving the purpose of air stacking. The introduction of a new method, such as manometry, can be helpful for achieving optimal air stacking. IMPACT Optimal pressure of air stacking can be measured with inexpensive, simple, and commercially available digital manometry. This approach enables air stacking to be performed and taught more accurately and efficiently and reduces complications in both patients and caregivers.
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Affiliation(s)
- Han Eol Cho
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Won Ah Choi
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang-Yoep Lee
- Biorobotics Laboratory, Department of Mechanical Engineering, Seoul National University, Seoul, Republic of Korea
| | - Seong-Woong Kang
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Republic of Korea
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13
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Pascoal A, Lourenço C, Pires C, Paiva A, Vaz IM. Good Bronchial Hygiene Reaches the Left Lung: Successful Extubation in a Tetraplegic Patient With Spinal Cord Injury. Cureus 2022; 14:e28732. [PMID: 36211093 PMCID: PMC9531700 DOI: 10.7759/cureus.28732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2022] [Indexed: 11/05/2022] Open
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14
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Yoon JA, Park HE, Kim J, Son J, Shin YB. Cardiac and Pulmonary Management Status of Duchenne Muscular Dystrophy in South Korea Based on Data From the National Health Insurance Database. J Clin Neurol 2022; 18:522-528. [PMID: 36062769 PMCID: PMC9444560 DOI: 10.3988/jcn.2022.18.5.522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/14/2022] [Accepted: 02/14/2022] [Indexed: 11/18/2022] Open
Abstract
Background and Purpose The purpose of this study was to determine the cardiac and pulmonary management status of patients with Duchenne muscular dystrophy (DMD) in South Korea based on the Korean National Health Insurance database. Methods This study used data of patients with code G71.0 in the National Health Information database, and also those with the special case of code V012. Cardiac function was assessed based on whether echocardiography and 24-h electrocardiography were performed, as well as the frequency of these investigations. Furthermore, information on the use of angiotensin-converting enzyme inhibitors (ACEi), angiotensin II receptor blockers (ARB), and beta blockers (BB) in the drug benefit list was checked. Medical charge records were also checked regarding the prescription of respiratory functional assessments and treatments. Results The diagnostic criteria were met by 479 patients, with 41% of these patients receiving a cardiac evaluation, 29.8% being prescribed ACEi at 14.4±3.7 years of age, 59.5% undergoing pulmonary function tests, and 42.1% received pulmonary rehabilitation. The age at receiving ventilator support was 19.4±2.7 years. The frequency of cardiac and respiratory function tests increased with age, but the interval between tests was longer than the recent DMD care recommendations. The trend of taking ACEi, ARB, and BB for cardiac management in South Korea did not change during the study analysis period. Conclusions The findings of this study will contribute to recognizing the current status and the importance of applying an anticipatory approach to cardiopulmonary function in DMD patients.
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Affiliation(s)
- Jin A Yoon
- Department of Rehabilitation Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Ho Eun Park
- Department of Rehabilitation Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Jinmi Kim
- Department of Biostatistics, Clinical Trial Center, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Jungmin Son
- Department of Biostatistics, Clinical Trial Center, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Yong Beom Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
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15
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Jia YX, Dong CL, Xue JW, Duan XQ, Xu MY, Su XM, Li P. Myotonic dystrophy type 1 presenting with dyspnea: A case report. World J Clin Cases 2022; 10:7060-7067. [PMID: 36051128 PMCID: PMC9297391 DOI: 10.12998/wjcc.v10.i20.7060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 04/04/2022] [Accepted: 05/22/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Myotonic dystrophy type 1 (DM1) is a genetic neuromuscular disease involving multiple systems, especially the cardiopulmonary system. The clinical phenotype of DM1 patients is highly variable, which limits early diagnosis and treatment. In the present study, we reported a 35-year-old female DM1 patient with dyspnea as the primary onset clinical manifestation, analyzed her family's medical history, and reviewed related literature.
CASE SUMMARY A 35-year-old woman was admitted to the hospital with dyspnea of 1 mo duration, and sleep apnea for 3 d. Her respiratory pattern and effort were normal, but limb muscle tension was low. Investigation into the patient's medical history revealed that she might have hereditary neuromuscular disease. Electromyography showed that her myotonia potentials were visible in the resting state of the examined muscles, with decreased motor unit potential time limit and amplitude. Genetic testing for DM1 revealed that the cytosine-thymine-guanine (CTG) repeat number of the DMPK gene exceeded 50, while cytosine-CTG expansion in intron 1 of ZNF9 gene was < 30 repeats. The patient was diagnosed with DM1.
CONCLUSION DM1 is a genetic neuromuscular disease involving multiple systems, and the clinical phenotype in DM1 is extremely variable. Some patients with DM1 may be presented at the respiratory department because of dyspnea, which should be cautioned by the pulmonologists. There may be no obvious or specific symptoms in the early stage of disease, and clinicians should improve their understanding of DM1 and make an early diagnosis, which will improve patients’ quality of life.
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Affiliation(s)
- Yu-Xi Jia
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
- Application Demonstration Center of Precision Medicine Molecular Diagnosis, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
| | - Chun-Ling Dong
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
| | - Jia-Wei Xue
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
| | - Xiao-Qin Duan
- Department of Rehabilitation Medicine, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
| | - Ming-Yu Xu
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
| | - Xiao-Min Su
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
| | - Ping Li
- Department of Developmental Pediatrics, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
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16
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Birnkrant DJ, Carter JC. Back to basics: the respiratory management of Duchenne muscular dystrophy. Thorax 2022; 77:743-744. [PMID: 35470244 DOI: 10.1136/thoraxjnl-2022-218798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2022] [Indexed: 11/04/2022]
Affiliation(s)
- David J Birnkrant
- Pediatrics, MetroHealth Medical Center, Cleveland, Ohio, USA .,Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - John C Carter
- Division of Pulmonary, Critical Care, and Sleep Medicine, MetroHealth Medical Center, Cleveland, Ohio, USA.,Department of Medicine, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
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17
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Narayan S, Pietrusz A, Allen J, Docherty K, Emery N, Ennis M, Flesher R, Foo W, Freebody J, Gallagher E, Grose N, Harris D, Hewamadduma C, Holmes S, James M, Maidment L, Mayhew A, Moat D, Moorcroft N, Muni-Lofra R, Nevin K, Quinlivan R, Sodhi J, Stuart D, White N, Yvonne J. Adult North Star Network (ANSN): Consensus Document for Therapists Working with Adults with Duchenne Muscular Dystrophy (DMD) - Therapy Guidelines. J Neuromuscul Dis 2022; 9:365-381. [PMID: 35124658 DOI: 10.3233/jnd-210707] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- S Narayan
- University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - A Pietrusz
- UCL Queen Square Institute of Neurology, MRC Centre for Neuromuscular Diseases, UK
| | - J Allen
- Neuromuscular Complex Care Centre (NMCCC), National Hospital for Neurology and Neurosurgery, UK
| | - K Docherty
- University Hospitals Dorset NHS Foundation Trust, UK
| | - N Emery
- The Robert Jones and Agnes Hunt Orthopaedic Hospital, UK
| | - M Ennis
- The Walton Centre NHS Foundation Trust, UK
| | - R Flesher
- The Walton Centre NHS Foundation Trust, UK
| | - W Foo
- Manchester University NHS Foundation Trust, UK
| | - J Freebody
- John Radcliffe Hospital -OxfordUniversity Hospitals NHS Foundation Trust, UK
| | | | - N Grose
- North Bristol NHS Foundation Trust, The South West Neuromuscular Operational Delivery Network (SWNODN), UK
| | - D Harris
- West Midlands Rehabilitation Centre, Birmingham Community Healthcare NHS Foundation Trust, UK
| | - C Hewamadduma
- Sheffield Teaching Hospitals NHS Foundation Trust, UK.,Sheffield Institute for Translational Neurosciences (SITRAN), University of Sheffield, UK
| | - S Holmes
- MRC Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, UK
| | - M James
- The John Walton Muscular Dystrophy Research Centre, Newcastle, UK
| | - L Maidment
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - A Mayhew
- The John Walton Muscular Dystrophy Research Centre, Newcastle, UK
| | - D Moat
- The John Walton Muscular Dystrophy Research Centre, Newcastle, UK
| | - N Moorcroft
- West Midlands Rehabilitation Centre, Birmingham Community Healthcare NHS Foundation Trust, UK
| | - R Muni-Lofra
- The John Walton Muscular Dystrophy Research Centre, Newcastle, UK
| | - K Nevin
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - R Quinlivan
- UCL Queen Square Institute of Neurology, MRC Centre for Neuromuscular Diseases, UK
| | - J Sodhi
- The John Walton Muscular Dystrophy Research Centre, Newcastle, UK
| | | | - N White
- The Robert Jones and Agnes Hunt Orthopaedic Hospital, UK
| | - J Yvonne
- University Hospitals of Leicester Emergency and Specialist Medicine, UK
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18
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Veldhoen ES, Vercoelen F, Ros L, Verweij-van den Oudenrijn LP, Wösten-van Asperen RM, Hulzebos EH, Bartels B, Gaytant MA, van der Ent K, Ludo van der Pol W. Short-term effect of air stacking and mechanical insufflation-exsufflation on lung function in patients with neuromuscular diseases. Chron Respir Dis 2022; 19:14799731221094619. [PMID: 35442817 PMCID: PMC9024083 DOI: 10.1177/14799731221094619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Air stacking (AS) and mechanical insufflation-exsufflation (MI-E) aim to increase cough efficacy by augmenting inspiratory lung volumes in patients with neuromuscular diseases (NMDs). We studied the short-term effect of AS and MI-E on lung function. We prospectively included NMD patients familiar with daily AS or MI-E use. Studied outcomes were forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and peak expiratory flow (PEF) prior to, immediately after, and up to 2 h after treatment. Paired sample T-test and Wilcoxon signed-rank test was used. Sixty-seven patients participated. We observed increased FVC and FEV1 immediately after AS with a mean difference of respectively 0.090 L (95% CI 0.045; 0.135, p < .001) and 0.073 L (95% CI 0.017; 0.128, p = .012). Increased FVC immediately after MI-E (mean difference 0.059 L (95% CI 0.010; 0.109, p = .021) persisted 1 hour (mean difference 0.079 L (95% CI 0.034; 0.125, p = .003). The effect of treatment was more pronounced in patients diagnosed with Spinal Muscular Atrophy, compared to patients with Duchenne muscular dystrophy. AS and MI-E improved FVC immediately after treatment, which persisted 1 h after MI-E. There is insufficient evidence that short-lasting increases in FVC would explain the possible beneficial effect of AS and MI-E.
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Affiliation(s)
- Esther S Veldhoen
- Pediatric Intensive Care Unit and Center of Home Mechanical Ventilation, Wilhelmina Children's Hospital
- 89098University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Femke Vercoelen
- Pediatric Intensive Care Unit and Center of Home Mechanical Ventilation, Wilhelmina Children's Hospital
- 89098University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Leandra Ros
- Department of Neurology, Brain Centre Rudolf Magnus, 89098University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Laura P Verweij-van den Oudenrijn
- Pediatric Intensive Care Unit and Center of Home Mechanical Ventilation, Wilhelmina Children's Hospital
- 89098University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Roelie M Wösten-van Asperen
- Pediatric Intensive Care Unit, Wilhelmina Children's Hospital, 89098University Medical Center Utrecht, Utrecht, The Netherlands
| | - Erik Hj Hulzebos
- Child Development and Exercise Center, Wilhelmina Children's Hospital, 89098University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Bart Bartels
- Child Development and Exercise Center, Wilhelmina Children's Hospital, 89098University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Michael A Gaytant
- Center of Home Mechanical Ventilation, Department of Pulmonology, 89098University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Kors van der Ent
- Department of Pediatric Pulmonology, Wilhelmina Children's Hospital, 89098University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - W Ludo van der Pol
- Department of Neurology, Brain Centre Rudolf Magnus, 89098University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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19
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Vianello A, Racca F, Vita GL, Pierucci P, Vita G. Motor neuron, peripheral nerve, and neuromuscular junction disorders. HANDBOOK OF CLINICAL NEUROLOGY 2022; 189:259-270. [PMID: 36031308 DOI: 10.1016/b978-0-323-91532-8.00014-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In amyotrophic lateral sclerosis (ALS), Guillain-Barré syndrome (GBS), and neuromuscular junction disorders, three mechanisms may lead, singly or together, to respiratory emergencies and increase the disease burden and mortality: (i) reduced strength of diaphragm and accessory muscles; (ii) oropharyngeal dysfunction with possible aspiration of saliva/bronchial secretions/drink/food; and (iii) inefficient cough due to weakness of abdominal muscles. Breathing deficits may occur at onset or more often along the chronic course of the disease. Symptoms and signs are dyspnea on minor exertion, orthopnea, nocturnal awakenings, excessive daytime sleepiness, fatigue, morning headache, poor concentration, and difficulty in clearing bronchial secretions. The "20/30/40 rule" has been proposed to early identify GBS patients at risk for respiratory failure. The mechanical in-exsufflator is a device that assists ALS patients in clearing bronchial secretions. Noninvasive ventilation is a safe and helpful support, especially in ALS, but has some contraindications. Myasthenic crisis is a clinical challenge and is associated with substantial morbidity including prolonged mechanical ventilation and 5%-12% mortality. Emergency room physicians and consultant pulmonologists and neurologists must know such respiratory risks, be able to recognize early signs, and treat properly.
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Affiliation(s)
- Andrea Vianello
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Fabrizio Racca
- Department of Anaesthesiology and Intensive Care, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Gian Luca Vita
- Unit of Neurology, Emergency Department, P.O. Piemonte, IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - Paola Pierucci
- Cardiothoracic Department, Respiratory and Critical Care Unit, "Aldo Moro" Bari University School of Medicine, Bari, Italy
| | - Giuseppe Vita
- Unit of Neurology and Neuromuscular Diseases, Department of Clinical and Experimental Medicine, Messina University Hospital, Messina, Italy.
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20
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Yoshinaga R, Futsuhara H. Inter-rater reliability of a wright respirometer to measure vital capacity in neuromuscular disorders. J Phys Ther Sci 2021; 33:818-822. [PMID: 34776615 PMCID: PMC8575478 DOI: 10.1589/jpts.33.818] [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: 06/09/2021] [Accepted: 08/02/2021] [Indexed: 11/24/2022] Open
Abstract
[Purpose] We examined the inter-rater reliability of the Wright respirometer between
therapists who assessed the vital capacity of patients with neuromuscular disorders.
[Participants and Methods] We examined 18 patients with neuromuscular disorders. We
performed a test-retest method after measuring their vital capacities. Two physical
therapists experienced in the use of the Wright respirometer, specifically, therapist A
with six years of clinical experience and therapist B with one, each took one measurement
of the vital capacity of the same patients. The measurements between the therapists were
taken at intervals of 3–7 days. We made a manual to standardize the measurements between
the therapists. [Results] The vital capacities were 905 ± 490 mL for therapist A and 897 ±
483 mL for therapist B. The inter-rater reliability of ICC2,1 was 0.96 (95% CI:
0.89–0.98). Bland-Altman analyses revealed neither a fixed nor proportional bias.
[Conclusion] These results demonstrated good to excellent inter-rater reliability of the
Wright respirometer for patients with neuromuscular disorders using a manual and
instructions.
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Affiliation(s)
- Ryuji Yoshinaga
- Department of Rehabilitation, National Hospital Organization Miyazaki Higashi Hospital, Japan.,Department of Rehabilitation, National Hospital Organization Nagasaki Medical Center: 2-1001-1 Kubara, Omura-city, Nagasaki 856-8562, Japan.,Department of Cardiopulmonary Rehabilitation Science, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Haruki Futsuhara
- Department of Rehabilitation, National Hospital Organization Miyazaki Higashi Hospital, Japan
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21
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Cleary S, Misiaszek JE, Wheeler S, Kalra S, Genuis SK, Johnston WS. Lung volume recruitment improves volitional airway clearance in amyotrophic lateral sclerosis. Muscle Nerve 2021; 64:676-682. [PMID: 34505708 PMCID: PMC9293446 DOI: 10.1002/mus.27417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/01/2021] [Accepted: 09/03/2021] [Indexed: 11/11/2022]
Abstract
Introduction/Aims In this study we evaluated the effects of lung volume recruitment treatment (LVR), a low‐tech, low‐cost, manual “breath‐stacking” technique used to help people cough with enough force to clear their airways, thereby reducing the risk of aspiration and choking, on five volitional airway clearance and protection behaviors used by people living with amyotrophic lateral sclerosis (PwALS). Methods Using a repeated‐measures cross‐over design, 29 PwALS performed five volitional airway clearance and protection behaviors in LVR treatment and in no‐treatment, control conditions. Peak cough flow (PCF) was used to measure maximum expiratory rate during forced expiration, throat clearing, hawking, post‐swallow coughing, and the supraglottic swallowing maneuver. Comparisons were made as a function of condition (treatment or control) and three time‐points (pretreatment, and 15 and 30 minutes posttreatment). Results LVR treatment had a significant positive effect on maximum expiratory rates during all tested airway clearance and protection behaviors. Increased PCF values lasted for up to 30 minutes post‐LVR for all tested behaviors in the treatment condition. Discussion We found that LVR treatment could increase control over airway clearance in PwALS, as well as provide improved airway protection for up to 30 minutes, the duration of a typical meal. This study has implications for patient care. These include offering patients control over some of the most feared symptoms of ALS, particularly choking during activities of daily living, and enhanced ALS respiratory care in low‐resource settings. Findings may have implications for other neurodegenerative disorders in which dysphagia occurs with retained sensory function.
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Affiliation(s)
- Stuart Cleary
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - John E Misiaszek
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Sonya Wheeler
- Misericordia Hospital, Covenant Health Group, Edmonton, Alberta, Canada
| | - Sanjay Kalra
- Division of Neurology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Shelagh K Genuis
- Division of Neurology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Wendy S Johnston
- Division of Neurology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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22
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Hov B, Andersen T, Toussaint M, Vollsæter M, Mikalsen IB, Indrekvam S, Hovland V. Prevalence of long-term mechanical insufflation-exsufflation in children with neurological conditions: a population-based study. Dev Med Child Neurol 2021; 63:537-544. [PMID: 33393110 PMCID: PMC8048789 DOI: 10.1111/dmcn.14797] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/25/2020] [Indexed: 01/04/2023]
Abstract
AIM To determine the prevalence of long-term mechanical insufflation-exsufflation (MI-E) and concomitant mechanical ventilation in children with neurological conditions, with reported reasons behind the initiation of treatment. METHOD This was a population-based, cross-sectional study using Norwegian national registries and a questionnaire. RESULTS In total, 114 of 19 264 children with a neurological condition had an MI-E device. Seventy-three of 103 eligible children (31 females, 42 males), median (min-max) age of 10 years 1 month (1y 5mo-17y 10mo), reported their MI-E treatment initiation. Overall, 76% reported airway clearance as the main reason to start long-term MI-E. A prophylactic use was mainly reported by children with neuromuscular disorders (NMDs). Prevalence and age at initiation differed by diagnosis. In spinal muscular atrophy and muscular dystrophies, MI-E use was reported in 34% and 7% of children, of whom 83% and 57% respectively received ventilator support. One-third of the MI-E users were children with central nervous system (CNS) conditions, such as cerebral palsy and degenerative disorders, and ventilator support was provided in 31%. The overall use of concomitant ventilatory support among the long-term MI-E users was 56%. INTERPRETATION The prevalence of MI-E in a neuropaediatric population was 6 per 1000, with two-thirds having NMDs and one-third having conditions of the CNS. The decision to initiate MI-E in children with neurological conditions relies on clinical judgment. WHAT THIS PAPER ADDS The prevalence and age at initiation of mechanical insufflation/exsufflation (MI-E) differed between diagnoses. MI-E was most commonly used in spinal muscular atrophy, where it generally coincided with ventilatory support. One-third of MI-E devices were given to children with central nervous system conditions, and one-third also received ventilatory support.
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Affiliation(s)
- Brit Hov
- Division of Paediatric and Adolescent MedicineOslo University HospitalOsloNorway,Institute of Clinical MedicineUniversity of OsloOsloNorway
| | - Tiina Andersen
- Norwegian Advisory Unit on Long‐term Mechanical VentilationThoracic DepartmentHaukeland University HospitalBergenNorway,Physiotherapy DepartmentHaukeland University HospitalBergenNorway
| | - Michel Toussaint
- Centre for Neuromuscular Disorders and Home Mechanical VentilationUZ Brussel‐InkendaalVlezenbeekBelgium
| | - Maria Vollsæter
- Norwegian Advisory Unit on Long‐term Mechanical VentilationThoracic DepartmentHaukeland University HospitalBergenNorway,Department of PaediatricsHaukeland University HospitalsBergenNorway,Department of Clinical ScienceUniversity of BergenBergenNorway
| | - Ingvild B Mikalsen
- Department of Clinical ScienceUniversity of BergenBergenNorway,Department of Paediatric MedicineStavanger University Hospital HFStavangerNorway
| | - Solfrid Indrekvam
- Norwegian Advisory Unit on Long‐term Mechanical VentilationThoracic DepartmentHaukeland University HospitalBergenNorway
| | - Vegard Hovland
- Division of Paediatric and Adolescent MedicineOslo University HospitalOsloNorway
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23
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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.
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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
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24
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Sedra F, Shafafy R, Sadek AR, Aftab S, Montgomery A, Nadarajah R. Perioperative Optimization of Patients With Neuromuscular Disorders Undergoing Scoliosis Corrective Surgery: A Multidisciplinary Team Approach. Global Spine J 2021; 11:240-248. [PMID: 32875888 PMCID: PMC7882827 DOI: 10.1177/2192568220901692] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
STUDY DESIGN Narrative review. OBJECTIVE The high rate of complications associated with the surgical management of neuromuscular spinal deformities is well documented in the literature. This is attributed to attenuated protective physiological responses in multiple organ systems. METHODS Review and synthesis of the literature pertaining to optimization of patients with neuromuscular scoliosis undergoing surgery. Our institutional practice in the perioperative assessment and management of neuromuscular scoliosis is also described along with a clinical vignette. RESULTS Respiratory complications are the most common to occur following surgery for neuromuscular disorders. Other categories include gastrointestinal, cardiac, genitourinary, blood loss, and wound complications. A multidisciplinary approach is required for perioperative optimization of these patients and numerous strategies are described, including respiratory management. CONCLUSION Perioperative optimization for patients with neuromuscular disorders undergoing corrective surgery for spinal deformity is multifaceted and complex. It requires a multidisciplinary evidence-based approach. Preadmission of patients in advance of surgery for assessment and optimization may be required in certain instances to identify key concerns and formulate a tailored treatment plan.
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Affiliation(s)
- Fady Sedra
- Royal London Hospital, Barts Health NHS Trust, London, UK,Cairo University Hospitals, Cairo, Egypt,Fady Sedra, Department of Spinal Surgery, Royal London Hospital, Barts Health NHS Trust, Whitechapel Rd, Whitechapel, London E1 1FR, UK.
| | | | | | - Syed Aftab
- Royal London Hospital, Barts Health NHS Trust, London, UK
| | | | - Ramesh Nadarajah
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
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25
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Abstract
Respiration is an event of oxygen consumption and carbon dioxide production. Respiratory failure is common in pediatric neuromuscular diseases and the main cause of morbidity and mortality. It is a consequence of lung failure, ventilatory pump failure, or their combination. Lung failure often is due to chronic aspiration either from above or from below. It may lead to end-stage lung disease. Ventilatory pump failure is caused by increased respiratory load and progressive respiratory muscles weakness. This article reviews the normal function of the respiratory pump, general pathophysiology issues, abnormalities in the more common neuromuscular conditions and noninvasive interventions.
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26
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Cherchi C, Chiarini Testa MB, Deriu D, Schiavino A, Petreschi F, Ullmann N, Paglietti MG, Cutrera R. All You Need Is Evidence: What We Know About Pneumonia in Children With Neuromuscular Diseases. Front Pediatr 2021; 9:625751. [PMID: 34540761 PMCID: PMC8441014 DOI: 10.3389/fped.2021.625751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 08/04/2021] [Indexed: 11/13/2022] Open
Abstract
Neuromuscular diseases may involve all major respiratory muscles groups including inspiratory, expiratory, and bulbar muscles. Respiratory complications are the major cause of morbidity and mortality. Pneumonia represents a frequent cause of morbidity in children with neuromuscular disease. The aim of this review is to collect knowledge about pneumonia in children with neuromuscular diseases. Pneumonia usually follows viral respiratory infections of the upper respiratory tract, due to the combination of an increased amount of nasal and oral secretions and an impairment of the cough efficiency and of the clearance of secretions due to the muscle weakness, further compromised by the infection itself. The accumulation of bronchial secretions leads to atelectasis and promote bacterial infection. Moreover, dysfunction of swallowing mechanism exposes these children to the risk of developing aspiration pneumonia. However, etiology of viral and bacterial respiratory infection in these patients is still poorly studied.
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Affiliation(s)
- Claudio Cherchi
- Pediatric Pulmonology and Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Pediatric Hospital "Bambino Gesù" Research Institute, Rome, Italy.,Rare Diseases and Medical Genetics Unit, Bambino Gesù Children Hospital (IRCCS), Rome, Italy
| | - Maria B Chiarini Testa
- Pediatric Pulmonology and Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Pediatric Hospital "Bambino Gesù" Research Institute, Rome, Italy.,Rare Diseases and Medical Genetics Unit, Bambino Gesù Children Hospital (IRCCS), Rome, Italy
| | - Daniele Deriu
- Department of Pediatrics, University of Rome Tor Vergata, Rome, Italy
| | - Alessandra Schiavino
- Pediatric Pulmonology and Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Pediatric Hospital "Bambino Gesù" Research Institute, Rome, Italy.,Rare Diseases and Medical Genetics Unit, Bambino Gesù Children Hospital (IRCCS), Rome, Italy
| | - Francesca Petreschi
- Pediatric Pulmonology and Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Pediatric Hospital "Bambino Gesù" Research Institute, Rome, Italy.,Rare Diseases and Medical Genetics Unit, Bambino Gesù Children Hospital (IRCCS), Rome, Italy
| | - Nicola Ullmann
- Pediatric Pulmonology and Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Pediatric Hospital "Bambino Gesù" Research Institute, Rome, Italy.,Rare Diseases and Medical Genetics Unit, Bambino Gesù Children Hospital (IRCCS), Rome, Italy
| | - Maria G Paglietti
- Pediatric Pulmonology and Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Pediatric Hospital "Bambino Gesù" Research Institute, Rome, Italy.,Rare Diseases and Medical Genetics Unit, Bambino Gesù Children Hospital (IRCCS), Rome, Italy
| | - Renato Cutrera
- Pediatric Pulmonology and Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Pediatric Hospital "Bambino Gesù" Research Institute, Rome, Italy.,Rare Diseases and Medical Genetics Unit, Bambino Gesù Children Hospital (IRCCS), Rome, Italy
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27
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Janssens JP, Michel F, Schwarz EI, Prella M, Bloch K, Adler D, Brill AK, Geenens A, Karrer W, Ogna A, Ott S, Rüdiger J, Schoch OD, Soler M, Strobel W, Uldry C, Gex G. Long-Term Mechanical Ventilation: Recommendations of the Swiss Society of Pulmonology. Respiration 2020; 99:1-36. [PMID: 33302274 DOI: 10.1159/000510086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 12/12/2022] Open
Abstract
Long-term mechanical ventilation is a well-established treatment for chronic hypercapnic respiratory failure (CHRF). It is aimed at improving CHRF-related symptoms, health-related quality of life, survival, and decreasing hospital admissions. In Switzerland, long-term mechanical ventilation has been increasingly used since the 1980s in hospital and home care settings. Over the years, its application has considerably expanded with accumulating evidence of beneficial effects in a broad range of conditions associated with CHRF. Most frequent indications for long-term mechanical ventilation are chronic obstructive pulmonary disease, obesity hypoventilation syndrome, neuromuscular and chest wall diseases. In the current consensus document, the Special Interest Group of the Swiss Society of Pulmonology reviews the most recent scientific literature on long-term mechanical ventilation and provides recommendations adapted to the particular setting of the Swiss healthcare system with a focus on the practice of non-invasive and invasive home ventilation in adults.
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Affiliation(s)
- Jean-Paul Janssens
- Division of Pulmonary Diseases, Geneva University Hospitals, Geneva, Switzerland,
| | - Franz Michel
- Klinik für Neurorehabilitation und Paraplegiologie, Basel, Switzerland
| | - Esther Irene Schwarz
- Department of Pulmonology and Sleep Disorders Centre, University Hospital of Zurich, Zurich, Switzerland
| | - Maura Prella
- Division of Pulmonary Diseases, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Konrad Bloch
- Department of Pulmonology and Sleep Disorders Centre, University Hospital of Zurich, Zurich, Switzerland
| | - Dan Adler
- Division of Pulmonary Diseases, Geneva University Hospitals, Geneva, Switzerland
| | | | - Aurore Geenens
- Pulmonary League of the Canton of Vaud, Lausanne, Switzerland
| | | | - Adam Ogna
- Respiratory Medicine Service, Locarno Regional Hospital, Locarno, Switzerland
| | - Sebastien Ott
- Universitätsklinik für Pneumologie, Universitätsspital (Inselspital) und Universität, Bern, Switzerland
- Division of Pulmonary Diseases, St. Claraspital, Basel, Switzerland
| | - Jochen Rüdiger
- Division of Pulmonary and Sleep Medicine, Medizin Stollturm, Münchenstein, Switzerland
| | - Otto D Schoch
- Division of Pulmonary Diseases, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Markus Soler
- Division of Pulmonary Diseases, St. Claraspital, Basel, Switzerland
| | - Werner Strobel
- Division of Pulmonary Diseases, Universitätsspital Basel, Basel, Switzerland
| | - Christophe Uldry
- Division of Pulmonary Diseases and Pulmonary Rehabilitation Center, Rolle Hospital, Rolle, Switzerland
| | - Grégoire Gex
- Division of Pulmonary Diseases, Geneva University Hospitals, Geneva, Switzerland
- Division of Pulmonary Diseases, Hôpital du Valais, Sion, Switzerland
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28
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Abstract
Many neuromuscular disorders (NMD) are complicated by respiratory failure. These patients are best managed in a multidisciplinary outpatient clinic to provide timely access to the various disciplines they require. The key mainstay of treatment of respiratory failure in patients with NMD is noninvasive ventilation, supported by secretion clearance, speech and language therapy, optimisation of nutrition and the maintenance of mobility. Patients with specific conditions may also require cardiology, neurology, orthopaedics, urology and psychological services. The respiratory NMD multidisciplinary team should also provide access to palliative care, and caregiver health and wellbeing should also be reviewed at clinical reviews. The future of care for the respiratory NMD patient will increasingly involve home services and telehealth and the clinic should be equipped and resourced to deliver these. Although not all health systems will be able to provide all elements of the multidisciplinary team discussed here, this review provides the “ideal” recipe for the adult multidisciplinary team and the evidence base underpinning this from which a clinic can be developed. Care for neuromuscular-related respiratory failure is complex and is best delivered in a multidisciplinary context. The future will increasingly involve home services and telehealth, and their burden needs to be considered when establishing this service.https://bit.ly/33fNsMT
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Affiliation(s)
- Neeraj M Shah
- Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
| | - Patrick B Murphy
- Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
| | - Georgios Kaltsakas
- Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
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29
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Affiliation(s)
- Erin W MacKintosh
- Department of Pediatrics, University of Washington, Box 359300, Seattle, WA 98195, USA; Division of Pulmonary and Sleep Medicine, Seattle Children's Hospital, 4800 Sand Point Way Northeast, M/S OC.7.720, Seattle, WA 98115, USA.
| | - Maida L Chen
- Department of Pediatrics, University of Washington, Box 359300, Seattle, WA 98195, USA; Division of Pulmonary and Sleep Medicine, Seattle Children's Hospital, 4800 Sand Point Way Northeast, M/S OC.7.720, Seattle, WA 98115, USA
| | - Joshua O Benditt
- Respiratory Care Services and General Pulmonary Clinic, Department of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, UW Medical Center, 1959 Northeast Pacific Street, Seattle, WA 98195, USA
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30
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Complete Restoration of Respiratory Muscle Function in Subjects With Spinal Cord Injury: Interventional Clinical Trial. Am J Phys Med Rehabil 2020; 99:e91-e92. [PMID: 31688014 DOI: 10.1097/phm.0000000000001338] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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31
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Egea-Santaolalla CJ, Chiner Vives E, Díaz Lobato S, Mangado NG, Lujan Tomé M, Mediano San Andrés O. Ventilación mecánica a domicilio. OPEN RESPIRATORY ARCHIVES 2020. [DOI: 10.1016/j.opresp.2020.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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32
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Racca F, Vianello A, Mongini T, Ruggeri P, Versaci A, Vita GL, Vita G. Practical approach to respiratory emergencies in neurological diseases. Neurol Sci 2020; 41:497-508. [PMID: 31792719 PMCID: PMC7224095 DOI: 10.1007/s10072-019-04163-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 11/15/2019] [Indexed: 02/06/2023]
Abstract
Many neurological diseases may cause acute respiratory failure (ARF) due to involvement of bulbar respiratory center, spinal cord, motoneurons, peripheral nerves, neuromuscular junction, or skeletal muscles. In this context, respiratory emergencies are often a challenge at home, in a neurology ward, or even in an intensive care unit, influencing morbidity and mortality. More commonly, patients develop primarily ventilatory impairment causing hypercapnia. Moreover, inadequate bulbar and expiratory muscle function may cause retained secretions, frequently complicated by pneumonia, atelectasis, and, ultimately, hypoxemic ARF. On the basis of the clinical onset, two main categories of ARF can be identified: (i) acute exacerbation of chronic respiratory failure, which is common in slowly progressive neurological diseases, such as movement disorders and most neuromuscular diseases, and (ii) sudden-onset respiratory failure which may develop in rapidly progressive neurological disorders including stroke, convulsive status epilepticus, traumatic brain injury, spinal cord injury, phrenic neuropathy, myasthenia gravis, and Guillain-Barré syndrome. A tailored assistance may include manual and mechanical cough assistance, noninvasive ventilation, endotracheal intubation, invasive mechanical ventilation, or tracheotomy. This review provides practical recommendations for prevention, recognition, management, and treatment of respiratory emergencies in neurological diseases, mostly in teenagers and adults, according to type and severity of baseline disease.
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Affiliation(s)
- Fabrizio Racca
- Department of Anaesthesia and Intensive Care, Sant'Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Andrea Vianello
- Respiratory Pathophysiology Division, University of Padua, Padua, Italy
| | - Tiziana Mongini
- Neuromuscular Center, Department of Neurosciences, University of Turin, Turin, Italy
| | - Paolo Ruggeri
- Unit of Pneumology, Department BIOMORF, University of Messina, Messina, Italy
| | - Antonio Versaci
- Intensive Care Unit, AOU Policlinico "G. Martino", Messina, Italy
| | - Gian Luca Vita
- Nemo Sud Clinical Centre for Neuromuscular Disorders, Messina, Italy
| | - Giuseppe Vita
- Nemo Sud Clinical Centre for Neuromuscular Disorders, Messina, Italy.
- Unit of Neurology and Neuromuscular Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
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33
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Peak Cough Flow in Children with Neuromuscular Disorders. Lung 2020; 198:371-375. [DOI: 10.1007/s00408-020-00340-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 02/15/2020] [Indexed: 10/24/2022]
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34
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Hov B, Andersen T, Toussaint M, Fondenes O, Carlsen KCL, Hovland V. Optimizing expiratory flows during mechanical cough in a pediatric neuromuscular lung model. Pediatr Pulmonol 2020; 55:433-440. [PMID: 31856413 DOI: 10.1002/ppul.24606] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 12/04/2019] [Indexed: 12/14/2022]
Abstract
Mechanical insufflation-exsufflation (MI-E) is recommended for subjects of all ages with neuromuscular disorders (NMDs) and weak cough. There is a lack of knowledge on the optimal treatment settings for young children. This study aims to determine the MI-E settings providing high expiratory airflow while using safe inspiratory volumes, and to identify possible limits where the benefit of incrementing the MI-E settings to achieve a higher expiratory airflow, decreased. Using an MI-E device and a lung model imitating a 1-year-old child with NMD, we explored the impact of 120 combinations of MI-E pressure and time settings on maximal expiratory airflow and inspiratory volume. High expiratory airflows were achieved with several pressure and time combinations where the exsufflation pressure, followed by insufflation pressure and time, had the greatest impact. The benefit of incrementing the settings to increase the expiratory airflow leveled off for the insufflation pressure and time, but not for the exsufflation pressure. Given exsufflation pressure of -40 or -50 cmH2 O and insufflation time longer than 1 second, a plateau in the expiratory airflow curve was present at insufflation pressures from 25 cmH2 O, whereas a plateau in the inspired volume curve occurred at insufflation pressures from 35 cmH2 O. The present neuromuscular pediatric lung model study showed that expiratory pressure impacts expiratory airflow more than inspiratory pressure and time. An inspiratory and expiratory pressure set between 20 to 30 and -40 cmH2 O, respectively, and an inspiratory time longer than 1 second may be considered as a basis when titrating MI-E settings in young children with NMD. The findings must be confirmed in clinical trials.
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Affiliation(s)
- Brit Hov
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslðo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Tiina Andersen
- Norwegian Advisory Unit on Long Term Mechanical Ventilation, Thoracic Department, Haukeland University Hospital, Bergen, Norway.,Physiotherapy Department, Haukeland University Hospital, Bergen, Norway
| | - Michel Toussaint
- Centre for Neuromuscular Disorders and Home Mechanical Ventilation, UZ Brussel-Inkendaal, Vlezenbeek, Belgium
| | - Ove Fondenes
- Norwegian Advisory Unit on Long Term Mechanical Ventilation, Thoracic Department, Haukeland University Hospital, Bergen, Norway
| | - Karin C L Carlsen
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslðo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Vegard Hovland
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslðo, Norway
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35
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Chen TH, Hsu JH. Noninvasive Ventilation and Mechanical Insufflator-Exsufflator for Acute Respiratory Failure in Children With Neuromuscular Disorders. Front Pediatr 2020; 8:593282. [PMID: 33194926 PMCID: PMC7661489 DOI: 10.3389/fped.2020.593282] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/12/2020] [Indexed: 02/04/2023] Open
Abstract
Children with neuromuscular disorder (NMD) usually have pulmonary involvement characterized by weakened respiratory muscles, insufficient coughing, and inability to clear airway secretions. When suffering from community-acquired pneumonia, these patients are more likely to develop acute respiratory failure (ARF). Therefore, recurrent pneumonias leading to acute on chronic respiratory failure accounts for a common cause of mortality in children with NMD. For many years, noninvasive ventilation (NIV) has been regarded as a life-prolonging tool and has been used as the preferred intervention for treating chronic hypoventilation in patients with advanced NMD. However, an increasing number of studies have proposed the utility of NIV as first-line management for acute on chronic respiratory failure in NMD patients. The benefits of NIV support in acute settings include avoiding invasive mechanical ventilation, shorter intensive care unit or hospital stays, facilitation of extubation, and improved overall survival. As the difficulty in clearing respiratory secretions is considered a significant risk factor attributing to NIV failure, combined coughing assistance of mechanical insufflator-exsufflator (MI-E) with NIV has been recommended the treatment of acute neuromuscular respiratory failure. Several recent studies have demonstrated the feasibility and effectiveness of combined NIV and MI-E in treating ARF of children with NMD in acute care settings. However, to date, only one randomized controlled study has investigated the efficacy of NIV in childhood ARF, but subjects with underlying NMD were excluded. It reflects the need for more studies to elaborate evidence-based practice, especially the combined NIV and MI-E use in children with acute neuromuscular respiratory failure. In this article, we will review the feasibility, effectiveness, predictors of outcome, and perspectives of novel applications of combined NIV and MI-E in the treatment of ARF in NMD children.
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Affiliation(s)
- Tai-Heng Chen
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Emergency, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Biological Sciences, University of Southern California, Los Angeles, CA, United States
| | - Jong-Hau Hsu
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Pediatrics, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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36
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Stratton AT, Roberts Iii RO, Kupfer O, Carry T, Parsons J, Apkon S. Pediatric neuromuscular disorders: Care considerations during the COVID-19 pandemic. J Pediatr Rehabil Med 2020; 13:405-414. [PMID: 33185615 DOI: 10.3233/prm-200768] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
COVID-19, the respiratory and frequently systemic disease caused by the novel SARS-COV-2 virus, was first recognized in December 2019 and quickly spread to become a pandemic and world-wide public health emergency over the subsequent 3-4 months. While COVID-19 has a very low morbidity rate across approximately 80% of the population, it has a high morbidity and mortality rate in the remaining 20% of the population.1 These numbers have put a significant strain on medical systems around the world. Patients with neuromuscular diseases such as those with Duchenne muscular dystrophy (DMD) and spinal muscular atrophy (SMA), tend to be more medically fragile and have higher health care needs than the general population. Respiratory insufficiency, cardiac disease, obesity, and immunocompromised status due to chronic steroid treatments in certain patient populations with neuromuscular conditions are specific risk factors for severe COVID-19 disease. In general, the pediatric population has shown to be less severely impacted with lower infection rates and lower morbidity and mortality rates than the adult population, however, as expected, children with underlying medical conditions are at higher risk of morbidity from COVID-19 than their peers.2 Many patients with neuromuscular disease also rely heavily on caregiver support through their lifetime and thus maintaining the health of their primary caregivers is also a significant consideration in the health and well-being of the patients. This paper will address routine and emergency medical care, rehabilitation services, and other considerations for the pediatric patient with a neuromuscular condition during the COVID-19 pandemic.
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Affiliation(s)
- Anne Troike Stratton
- Department of Physical Medicine and Rehabilitation, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Richard Ogden Roberts Iii
- Department of Pediatrics, Section of Diabetes and Endocrinology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Oren Kupfer
- Department of Pediatrics, Section of Pulmonary Medicine, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Terri Carry
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Julie Parsons
- Department of Pediatrics, Section of Neurology, Haberfeld Family Endowed Chair in Pediatric Neuromuscular Disorders, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Susan Apkon
- Department of Physical Medicine and Rehabilitation, Fischahs Chair in Pediatric Rehabilitation, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
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37
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Respiratory Involvement in Patients with Neuromuscular Diseases: A Narrative Review. Pulm Med 2019; 2019:2734054. [PMID: 31949952 PMCID: PMC6944960 DOI: 10.1155/2019/2734054] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 04/08/2019] [Accepted: 11/20/2019] [Indexed: 12/11/2022] Open
Abstract
Respiratory muscle weakness is a major cause of morbidity and mortality in patients with neuromuscular diseases (NMDs). Respiratory involvement in NMDs can manifest broadly, ranging from milder insufficiency that may affect only sleep initially to severe insufficiency that can be life threatening. Patients with neuromuscular diseases exhibit very often sleep-disordered breathing, which is frequently overlooked until symptoms become more severe leading to irreversible respiratory failure necessitating noninvasive ventilation (NIV) or even tracheostomy. Close monitoring of respiratory function and sleep evaluation is currently the standard of care. Early recognition of sleep disturbances and initiation of NIV can improve the quality of life and prolong survival. This review discusses the respiratory impairment during sleep in patients with NMDs, the diagnostic tools available for early recognition of sleep-disordered breathing and the therapeutic options available for overall respiratory management of patients with NMDs.
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Consensus on the diagnosis, treatment and follow-up of patients with Duchenne muscular dystrophy. NEUROLOGÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.nrleng.2018.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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Guo J, Gao C, Xin H, Li J, Li B, Wei Z, Yue Y. The application of "upper-body yoga" in elderly patients with acute hip fracture: a prospective, randomized, and single-blind study. J Orthop Surg Res 2019; 14:250. [PMID: 31387629 PMCID: PMC6685250 DOI: 10.1186/s13018-019-1295-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 07/25/2019] [Indexed: 12/05/2022] Open
Abstract
Purposes Hip fracture leads to decreased activity and an increased risk of pulmonary complications. The main purpose of this study was to observe the lung capacity, cough capacity of the elderly patient with acute hip fracture, and assess the effects and the feasibility of using a special-designed “upper-body yoga” training to treat elderly patients with hip fracture. Methods This was a prospective, randomized, and single-blind study. Eighty-four subjects aged over 65 years were randomly divided into either a control group or a yoga group to undergo an abdominal breathing program or an “upper-body yoga” program until 4 weeks after surgery. The primary outcomes were forced vital capacity/predicted value (FVC%), peak cough flow (PCF), Barthel Index (BI), and the incidence of pneumonia. The secondary outcomes were the rates of right skills and inclination. Results Thirty-nine subjects in the yoga group and 40 subjects in the control group completed this study. At the end of the first training week, FVC% (74.14% ± 13.11% vs. 70.87% ± 10.46%, P = 0.231) showed no significant difference between the two groups, while the value of PCF (204.80 ± 33.45 L/min vs. 189.06 ± 34.80 L/min, P = 0.048) and BI (38.59 ± 8.66 vs. 33.00 ± 9.32, P = 0.009) in the yoga group was higher. After 4 weeks of treatment, FVC%, PCF, and BI were higher in the yoga group (78.83% ± 13.31 % vs. 72.20% ± 10.53%, P = 0.016; 216.16 ± 39.29 L/min vs. 194.95 ± 31.14 L/min, P = 0.008; 70.77 ± 10.23 vs. 65.75 ± 11.30, P = 0.019). One in the control group and nobody in the yoga group was diagnosed with pneumonia. There was no significant difference between the two groups in terms of the rates of right skills, whereas more elderly people preferred the training program of the “upper-body yoga.” Conclusion Elderly patients with acute hip fractures are at risk of impaired lung capacity and inadequate cough. “Upper-body yoga” training may improve the quality of daily life, vital capacity, and cough flow in elderly patients, making it a better choice for bedridden patients with hip fracture.
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Affiliation(s)
- Jinli Guo
- Department of Orthopedic, the Second Hospital of Shanxi Medical University, No. 382 of Wuyi Road, Xinghualing District, Taiyuan, 030001, China.
| | - Chaona Gao
- Department of Orthopedic, the Second Hospital of Shanxi Medical University, No. 382 of Wuyi Road, Xinghualing District, Taiyuan, 030001, China
| | - Haifeng Xin
- Department of Operating Room, the Second Hospital of Shanxi Medical University, Taiyuan, 030001, China
| | - Jiahui Li
- Department of Orthopedic, the Second Hospital of Shanxi Medical University, No. 382 of Wuyi Road, Xinghualing District, Taiyuan, 030001, China
| | - Bing Li
- Department of Orthopedic, the Second Hospital of Shanxi Medical University, No. 382 of Wuyi Road, Xinghualing District, Taiyuan, 030001, China
| | - Zhuan Wei
- Nursing College of Shanxi Medical University, Taiyuan, 030001, China
| | - Yiting Yue
- Nursing College of Shanxi Medical University, Taiyuan, 030001, China
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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.
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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.
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Awano H, Nagai M, Bo R, Murao M, Ishida Y, Tanaka T, Tomioka K, Nishiyama M, Nagase H, Iijima K. Preliminary Effectiveness and Safety of High Frequency Oscillation in Addition to Mechanical Insufflation and Exsufflation for Intratracheal Mucus Removal in Patients With Neuromuscular Disease: Protocol for a Prospective Study. JMIR Res Protoc 2019; 8:e12102. [PMID: 31250831 PMCID: PMC6620888 DOI: 10.2196/12102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/20/2018] [Accepted: 05/29/2019] [Indexed: 12/01/2022] Open
Abstract
Background Mechanical insufflation-exsufflation (MI-E) is necessary for noninvasive management of respiratory clearance in patients with neuromuscular disorders (NMDs). Its utility has been proven, and the technique is recommended in a number of international guidelines for the management of patients with NMDs. However, the clearance of thick secretions adhering to the tracheobronchial walls could be problematic when these patients suffer from respiratory tract infections. To improve the effectiveness of the noninvasive technique, a novel device combining MI-E with high frequency oscillation (HFO) has been developed. However, the efficacy of HFO therapy in NMDs has not been well studied. Objective The aim of this study was to elucidate the effect of MI-E combined with HFO for mucus removal in NMD patients. To evaluate its efficacy, changes in transcutaneous oxygen saturation (SpO2), which may predict intratracheal mucus removal, will be measured before and after use of MI-E. Methods This is a single-center, nonblinded, nonrandomized prospective study that will enroll 5 subjects hospitalized in Kobe University Hospital owing to respiratory tract infection. All subjects will receive MI-E therapy a few times daily and will receive HFO every other day, for 6 days. Before and after MI-E use, SpO2 will be obtained and the change in SpO2 (ΔSpO2) between MI-E with and without HFO will be calculated. For every subject, the average of ΔSpO2 with or without HFO will be obtained and the null hypothesis that there is a mean change of 0 in the SpO2 between MI-E with and without HFO will be tested using the paired t test. If the treatment with HFO is found to be statistically significantly superior to the treatment without HFO, the study will conclude that HFO addition is more efficacious than no HFO addition. Results A total of 2 subjects have already been recruited and enrolled in this study as of August 2018. Conclusions This unique protocol will assess the efficacy of adding HFO to MI-E during the acute phase of respiratory tract infection in patients with NMDs. International Registered Report Identifier (IRRID) DERR1-10.2196/12102
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Affiliation(s)
- Hiroyuki Awano
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masashi Nagai
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryosuke Bo
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Mariko Murao
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yusuke Ishida
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tsukasa Tanaka
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazumi Tomioka
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masahiro Nishiyama
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroaki Nagase
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazumoto Iijima
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
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Abstract
Muscular dystrophies represent a complex, varied, and important subset of neuromuscular disorders likely to require the care of a pulmonologist. The spectrum of conditions encapsulated by this subset ranges from severe and fatal congenital muscular dystrophies with onset in infancy to mild forms of limb and girdle weakness with onset in adulthood and minimal respiratory compromise. The list and classification of muscular dystrophies are undergoing near-constant revision, based largely on new insights from genetics and molecular medicine. The authors present an overview of the muscular dystrophies, including their basic features, common clinical phenotypes, and important facets of management.
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Matsuda C, Shimizu T, Nakayama Y, Haraguchi M. Cough peak flow decline rate predicts survival in patients with amyotrophic lateral sclerosis. Muscle Nerve 2018; 59:168-173. [DOI: 10.1002/mus.26320] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 08/02/2018] [Accepted: 08/06/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Chiharu Matsuda
- ALS Nursing Care Project, Tokyo Metropolitan Institute of Medical Science; 2-1-6 Kamikitazawa, Setagaya-ku Tokyo 156-8506 Japan
| | - Toshio Shimizu
- Department of Neurology; Tokyo Metropolitan Neurological Hospital; Tokyo Japan
- Department of Neurology; Tokyo Metropolitan Tama Medical Center; Tokyo Japan
| | - Yuki Nakayama
- ALS Nursing Care Project, Tokyo Metropolitan Institute of Medical Science; 2-1-6 Kamikitazawa, Setagaya-ku Tokyo 156-8506 Japan
| | - Michiko Haraguchi
- ALS Nursing Care Project, Tokyo Metropolitan Institute of Medical Science; 2-1-6 Kamikitazawa, Setagaya-ku Tokyo 156-8506 Japan
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Morrow B, Argent A, Zampoli M, Human A, Corten L, Toussaint M. Cough augmentation techniques for people with chronic neuromuscular disorders. Hippokratia 2018. [DOI: 10.1002/14651858.cd013170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Brenda Morrow
- University of Cape Town; Department of Paediatrics; 5th Floor ICH Building, Red Cross Memorial Children's Hospital Klipfontein Road, Rondebosch, 7700 Cape Town South Africa
| | - Andrew Argent
- Red Cross War Memorial Children's Hospital and University of Cape Town; Pediatric Intensive Care, Division of Pediatric Critical Care and Children's Heart Disease; Cape Town South Africa 8000
| | - Marco Zampoli
- Red Cross War Memorial Children's Hospital and University of Cape Town; Pulmonology, and Paediatric Medicine; 5th Floor ICH Building, Red Cross War Memorial Children?s Hospital Klipfontein Road, Rondebosch, 7700 Cape Town South Africa
| | - Anri Human
- Sefako Makgatho Health Sciences University; Physiotherapy Department, School of Health Care Sciences; Molotlegi Street Garankuwa Pretoria (Gauteng) South Africa 0208
| | - Lieselotte Corten
- University of Cape Town; Department of Health and Rehabilitation Sciences, Division of Physiotherapy; Cape Town South Africa
| | - Michel Toussaint
- Inkendaal Rehabilitation Hospital; Centre for Home Mechanical Ventilation and Specialized Centre for Neuromuscular Diseases; Inkendaalstraat 1 Vlezenbeek Belgium B-1602
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45
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Sheers N, Howard ME, Berlowitz DJ. Respiratory adjuncts to NIV in neuromuscular disease. Respirology 2018; 24:512-520. [DOI: 10.1111/resp.13431] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 09/19/2018] [Accepted: 10/01/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Nicole Sheers
- Department of Respiratory and Sleep MedicineAustin Health Melbourne VIC Australia
- Institute for Breathing and Sleep Melbourne VIC Australia
- The University of Melbourne Melbourne VIC Australia
| | - Mark E. Howard
- Department of Respiratory and Sleep MedicineAustin Health Melbourne VIC Australia
- Institute for Breathing and Sleep Melbourne VIC Australia
- The University of Melbourne Melbourne VIC Australia
| | - David J. Berlowitz
- Department of Respiratory and Sleep MedicineAustin Health Melbourne VIC Australia
- Institute for Breathing and Sleep Melbourne VIC Australia
- The University of Melbourne Melbourne VIC Australia
- Department of PhysiotherapyAustin Health Melbourne VIC Australia
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46
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Sheehan DW, Birnkrant DJ, Benditt JO, Eagle M, Finder JD, Kissel J, Kravitz RM, Sawnani H, Shell R, Sussman MD, Wolfe LF. Respiratory Management of the Patient With Duchenne Muscular Dystrophy. Pediatrics 2018; 142:S62-S71. [PMID: 30275250 DOI: 10.1542/peds.2018-0333h] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2018] [Indexed: 11/24/2022] Open
Abstract
In 2010, Care Considerations for Duchenne Muscular Dystrophy, sponsored by the Centers for Disease Control and Prevention, was published in Lancet Neurology, and in 2018, these guidelines were updated. Since the publication of the first set of guidelines, survival of individuals with Duchenne muscular dystrophy has increased. With contemporary medical management, survival often extends into the fourth decade of life and beyond. Effective transition of respiratory care from pediatric to adult medicine is vital to optimize patient safety, prognosis, and quality of life. With genetic and other emerging drug therapies in development, standardization of care is necessary to accurately assess treatment effects in clinical trials. This revision of respiratory recommendations preserves a fundamental strength of the original guidelines: namely, reliance on a limited number of respiratory tests to guide patient assessment and management. A progressive therapeutic strategy is presented that includes lung volume recruitment, assisted coughing, and assisted ventilation (initially nocturnally, with the subsequent addition of daytime ventilation for progressive respiratory failure). This revision also stresses the need for serial monitoring of respiratory muscle strength to characterize an individual's respiratory phenotype of severity as well as provide baseline assessments for clinical trials. Clinical controversies and emerging areas are included.
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Affiliation(s)
- Daniel W Sheehan
- Department of Pediatrics, Oishei Children's Hospital and The University at Buffalo, Buffalo, New York;
| | - David J Birnkrant
- Department of Pediatrics, MetroHealth Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Joshua O Benditt
- Department of Medicine, University of Washington, Seattle, Washington
| | - Michelle Eagle
- University of Newcastle, Newcastle upon Tyne, United Kingdom
| | - Jonathan D Finder
- Department of Pediatrics, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh and University of Pittsburgh, Pittsburgh, Pennsylvania
| | - John Kissel
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | - Hemant Sawnani
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Richard Shell
- Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio
| | | | - Lisa F Wolfe
- Department of Medicine, Northwestern University, Evanston, Illinois
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Rose L, McKim D, Leasa D, Nonoyama M, Tandon A, Bai YQ, Amin R, Katz S, Goldstein R, Gershon A. Patterns of healthcare utilisation for respiratory complications of adults with neuromuscular disease: a population study. Eur Respir J 2018; 52:13993003.00754-2018. [PMID: 30139772 DOI: 10.1183/13993003.00754-2018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 07/25/2018] [Indexed: 01/07/2023]
Abstract
Our objective was to quantify health service utilisation including monitoring and treatment of respiratory complications for adults with neuromuscular disease (NMD), identifying practice variation and adherence to guideline recommendations at a population level.We conducted a population-based longitudinal cohort study (2003-2015) of adults with NMD using hospital diagnostic and health insurance billing codes within administrative health databases.We identified 185 586 adults with NMD. Mean age 52 years, 59% female. 41 173 (22%) went to an emergency department for respiratory complications on average 1.6 times every 3 years; 14 947 (8%) individuals were admitted to hospital 1.4 times every 3 years. Outpatient respiratory specialist visits occurred for 64 084 (35%) with four visits every 3 years, although substantial variation in visit frequency was found. 157 285 (85%) went to the emergency department (all-cause) almost 4 times every 3 years, 100 052 (54%) were admitted to hospital. Individuals with amyotrophic lateral sclerosis/motor neurone disease (ALS/MND) had more emergency department visits compared with other types of NMD (p<0.0001).One-third of adults with NMD received respiratory specialist care at a frequency recommended by professional guidelines, although substantial variation exists. Emergent healthcare utilisation was substantial, emphasising the burden of NMD on the healthcare system and urgent need to improve community and social supports, particularly for ALS/MND patients.
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Affiliation(s)
- Louise Rose
- Sunnybrook Health Sciences Centre and Sunnybrook Research Institute, Toronto, ON, Canada.,Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Kings College London, London, UK.,Lawrence S. Bloomberg Faculty of Nursing and Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Institute of Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Douglas McKim
- The Ottawa Hospital Respiratory Rehabilitation and The Ottawa Hospital Sleep Centre, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - David Leasa
- Dept of Medicine, Divisions of Critical Care and Respirology, London Health Sciences Centre, London, ON, Canada.,Faculty of Medicine, Western University, London, ON, Canada
| | - Mika Nonoyama
- University of Ontario Institute of Technology, Toronto, ON, Canada.,Child Health Evaluative Sciences and Respiratory Therapy, SickKids, Toronto, ON, Canada.,Rehabilitation Sciences and Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Anu Tandon
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Yu Qing Bai
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Toronto, ON, Canada
| | - Reshma Amin
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Respiratory Medicine, SickKids, Toronto, ON, Canada.,SickKids Research Institute, Toronto, ON, Canada
| | - Sherri Katz
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Division of Respirology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Roger Goldstein
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,West Park Healthcare Centre, Toronto, ON, Canada
| | - Andrea Gershon
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Sunnybrook Research Institute and Institute of Clinical Evaluative Sciences, Toronto, ON, Canada.,Dept of Medicine, University of Toronto, Toronto, ON, Canada
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Messina S, Vita GL. Clinical management of Duchenne muscular dystrophy: the state of the art. Neurol Sci 2018; 39:1837-1845. [PMID: 30218397 DOI: 10.1007/s10072-018-3555-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 09/04/2018] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Duchenne muscular dystrophy (DMD) is a devastating, progressive neuromuscular disorder for which there is no cure. As the dystrophin gene is located on the X chromosome, DMD occurs predominately in males. DMD is caused by a lack of functional dystrophin protein resulting from mutations in the 2.2-Mb DMD gene, whichdisrupts the reading frame. Care considerations for DMD advocate a coordinated, multidisciplinary approach to the management of DMD in order to optimize management of the primary manifestations of DMD as well as any secondary complications that may arise. METHODS This review provides an overview of the multidisciplinary clinical management of DMD with regard to the respiratory, cardiology, orthopedic, and nutritional needs of patients with DMD. Recent advances in novel disease-modifying treatments for DMD are also discussed with specific reference to exon skipping and suppression of premature stop codons as promising genetic therapies. RESULTS The combination of multidisciplinary clinical management alongside novel gene therapiesoffers physicians a powerful armamentarium for the treatment of DMD.
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Affiliation(s)
- Sonia Messina
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy. .,Nemo Sud Clinical Centre, University Hospital "G. Martino", Messina, Italy. .,Unit of Neurology and Neuromuscular Diseases, AOU Policlinico "G. Martino", Building E, 2° Floor, Via Consolare Valeria 1, 98125, Messina, Italy.
| | - Gian Luca Vita
- Nemo Sud Clinical Centre, University Hospital "G. Martino", Messina, Italy
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Fitzgerald DA, Doumit M, Abel F. Changing respiratory expectations with the new disease trajectory of nusinersen treated spinal muscular atrophy [SMA] type 1. Paediatr Respir Rev 2018; 28:11-17. [PMID: 30414815 DOI: 10.1016/j.prrv.2018.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 07/05/2018] [Indexed: 11/27/2022]
Abstract
Spinal muscular atrophy [SMA] is the most common genetic cause of childhood mortality, primarily from the most severe form SMA type 1. It is a severe, progressive motor neurone disease, affecting the lower brainstem nuclei and the spinal cord. There is a graded level of severity with SMA children from a practical viewpoint described as "Non-sitters", "Sitters" and less commonly, "Ambulant" correlating with SMA Type 0/Type 1, Type 2 and Type 3 respectively. Children with SMA Type 0 have a severe neonatal form whilst those with SMA Type 1 develop hypoventilation, pulmonary aspiration, recurrent lower respiratory tract infections, dysphagia and failure to thrive before usually succumbing to respiratory failure and death before the age of 2 years. The recent introduction of the antisense oligonucleotide nusinersen into clinical practice in certain countries, following limited trials of less than two years duration, has altered the treatment landscape and improved the outlook considerably for SMN1 related SMA. Approximately 70% of infants appear to have a clinically significant response to nusinersen with improved motor function. It appears the earlier the treatment is initiated the better the response. There are other rarer genetic forms of SMA that are not treated with nusinersen. Clinical expectations will change although it is unclear as yet what the extent of response will mean in terms of screening initiatives [e.g., newborn screening], "preventative strategies" to maintain respiratory wellbeing, timing of introduction of respiratory supports, and prolonged life expectancy for the subcategory of children with treated SMA type 1. This article provides a review of the strategies available for supporting children with respiratory complications of SMA, with a particular emphasis on SMA Type 1.
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Affiliation(s)
- Dominic A Fitzgerald
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
| | - Michael Doumit
- Department of Physiotherapy, Sydney Children's Hospital, Randwick, Sydney, NSW, Australia; School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Francois Abel
- Department of Respiratory Medicine, Great Ormond Street Hospital, London, UK
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Hov B, Andersen T, Hovland V, Toussaint M. The clinical use of mechanical insufflation-exsufflation in children with neuromuscular disorders in Europe. Paediatr Respir Rev 2018; 27:69-73. [PMID: 29239774 DOI: 10.1016/j.prrv.2017.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 08/21/2017] [Accepted: 08/22/2017] [Indexed: 02/01/2023]
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 4s. 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 -60cmH2O, 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.
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Affiliation(s)
- Brit Hov
- Department of Paediatric Medicine, Oslo University Hospital HF, Oslo, Norway; Norwegian Centre of Excellence for Home Mechanical Ventilation, Haukeland University Hospital, Bergen, Norway.
| | - Tiina Andersen
- Norwegian Centre of Excellence for Home Mechanical Ventilation, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Norway.
| | - Vegard Hovland
- Department of Paediatric Medicine, Oslo University Hospital HF, Oslo, Norway.
| | - Michel Toussaint
- Centre for Neuromuscular Disorders and Home Mechanical Ventilation, UZ Brussel-Inkendaal, Vlezenbeek, Belgium.
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