Yonsei Med J.  2016 Nov;57(6):1488-1493. 10.3349/ymj.2016.57.6.1488.

A Comparison of Cough Assistance Techniques in Patients with Respiratory Muscle Weakness

• Kim SM
• Choi WA
• Won YH
• Kang SW

• KMID: 2427169
• DOI: http://doi.org/10.3349/ymj.2016.57.6.1488

Abstract

PURPOSE
To assess the ability of a mechanical in-exsufflator (MI-E), either alone or in combination with manual thrust, to augment cough in patients with neuromuscular disease (NMD) and respiratory muscle dysfunction.
MATERIALS AND METHODS
For this randomized crossover single-center controlled trial, patients with noninvasive ventilator-dependent NMD were recruited. The primary outcome was peak cough flow (PCF), which was measured in each patient after a cough that was unassisted, manually assisted following a maximum insufflation capacity (MIC) maneuver, assisted by MI-E, or assisted by manual thrust plus MI-E. The cough augmentation techniques were provided in random order. PCF was measured using a new device, the Cough Aid.
RESULTS
All 40 enrolled participants (37 males, three females; average age, 20.9±7.2 years) completed the study. The mean (standard deviation) PCFs in the unassisted, manually assisted following an MIC maneuver, MI-E-assisted, and manual thrust plus MI-E-assisted conditions were 95.7 (40.5), 155.9 (53.1), 177.2 (33.9), and 202.4 (46.6) L/min, respectively. All three interventions significantly improved PCF. However, manual assistance following an MIC maneuver was significantly less effective than MI-E alone. Manual thrust plus MI-E was significantly more effective than both of these interventions.
CONCLUSION
In patients with NMD and respiratory muscle dysfunction, MI-E alone was more effective than manual assistance following an MIC maneuver. However, MI-E used in conjunction with manual thrust improved PCF even further.

Keyword

Neuromuscular disease; peak cough flow; cough augmentation; mechanical in-exsufflator

MeSH Terms

Adolescent
Adult
Aged
*Cough
Cross-Over Studies
Female
Humans
Insufflation/*instrumentation/methods/statistics & numerical data
Male
Middle Aged
Neuromuscular Diseases/*physiopathology
Peak Expiratory Flow Rate/physiology
Pressure
Respiratory Function Tests/instrumentation/methods
Respiratory Muscles/*physiopathology
Respiratory Therapy/*methods
Treatment Outcome
Vital Capacity/physiology

Figure

• 

  Fig. 1 Flow analyzer test system. When performing a cough-assistance technique, the air that is inhaled from the MI-E or Ambu bag through the patient connection part does not leak though the valve; when the patient exhales or coughs, the pushing bar is pressed at the same time, and the exhaled air is pushed through the pushing bar. (A) Disassembled view. (B) Complete view showing the inner parts. MI-E, mechanical in-exsufflator.

• 

  Fig. 2 Measurement of manually assisted peak cough flow following a maximum insufflation capacity maneuver.

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  Fig. 3 Measurement of mechanical insufflation-exsufflator-assisted peak cough flow.

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