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

作者：Kim Sun Mi; Choi Won Ah; Won Yu Hui; Kang Seong Woong^*

来源：Yonsei Medical Journal, 2016, 57(6): 1488-1493.

DOI：10.3349/ymj.2016.57.6.1488

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

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.

• 出版日期2016-11