Yonsei Med J.  2011 Nov;52(6):972-976. 10.3349/ymj.2011.52.6.972.

Artificial External Glottic Device for Passive Lung Insufflation

• Kim DH
• Kang SW
• Park YG
• Choi WA
• Lee HR

• KMID: 1058818
• DOI: http://doi.org/10.3349/ymj.2011.52.6.972

Abstract

PURPOSE
For patients with neuromuscular disease, air stacking, which inflates the lungs to deep volumes, is important for many reasons. However, neuromuscular patients with severe glottic dysfunction or indwelling tracheostomy tubes cannot air stack effectively. For these patients, we developed a device that permits deep lung insufflations substituting for glottic function.
MATERIALS AND METHODS
Thirty-seven patients with bulbar-innervated muscle weakness and/or tracheostomies were recruited. Twenty-three had amyotrophic lateral sclerosis, and 14 were tetraplegic patients due to cervical spinal cord injury. An artificial external glottic device (AEGD) was used to permit passive deep lung insufflation. In order to confirm the utility of AEGD, vital capacity, maximum insufflation capacity (MIC), and lung insufflation capacity (LIC) with AEGD (LICA) were measured.
RESULTS
For 30 patients, MICs were initially zero. However, with the use of the AEGD, LICA was measurable for all patients. The mean LICA was 1,622.7+/-526.8 mL. Although MIC was measurable for the remaining 7 patients without utilizing the AEGD, it was significantly less than LICA, which was 1,084.3+/-259.9 mL and 1,862.9+/-248 mL, respectively (p<0.05).
CONCLUSION
The AEGD permits lung insufflation by providing deeper lung volumes than possible by air stacking.

Keyword

Air stacking; lung insufflation; maximal insufflation capacity

MeSH Terms

Adult
Aged
Female
Forced Expiratory Flow Rates/physiology
Humans
Insufflation/*instrumentation/methods
Male
Middle Aged
Neuromuscular Diseases/*physiopathology/therapy
*Ventilators, Mechanical
Vital Capacity/physiology
Young Adult

Figure

• 

  Fig. 1 A fully assembled apparatus for measuring LIC with the artificial external glottic device (LICA): a resuscitation bag is connected to the AEGD. Connection part (A); Control part (B). LIC, lung insufflation capacity; AEGD, artificial external glottic device; LICA, LIC with AGED.

• 

  Fig. 2 Connection part of the artificial external glottic device (AEGD). (A) Disconnected view of the connection part. (B) Photograph of the connection part.

• 

  Fig. 3 Diagram of the control part of the artificial external glottic device (AEGD). (A) Demounted view of the control part: control part is connected to the connection part through (a), and measurement apparatus such as a spirometer through (b), the external glottic function is controlled by an externally exposed part (c) of the pushing bar a', air flows from (a) to (b) like an opening of a normal glottis. (B) Photograph of the control part of AEGD: ports connecting to the connection part (a); to the measurement apparatus such as a spirometer (b); and to the external control of the glottis (c).

• 

  Fig. 4 Actual application of the apparatus for the measurement of LICA. LICA, LIC with AEGD.

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