دورية أكاديمية
The Effect of Pressure Changes During Mechanical Insufflation-Exsufflation on Respiratory and Airway Physiology.
| العنوان: | The Effect of Pressure Changes During Mechanical Insufflation-Exsufflation on Respiratory and Airway Physiology. |
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| المؤلفون: | Shah NM; Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, United Kingdom. Electronic address: Neeraj.shah@gstt.nhs.uk., Apps C; Critical Care, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; GKT School of Medical Education, King's College London, London, United Kingdom., Kaltsakas G; Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, United Kingdom., Madden-Scott S; Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Critical Care, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom., Suh ES; Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, United Kingdom., D'Cruz RF; Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, United Kingdom., Arbane G; Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom., Patout M; AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service des Pathologies du Sommeil (Département R3S), Paris, France; Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France., Lhuillier E; Private practice, Maison-Laffite, France., Hart N; Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, United Kingdom., Murphy PB; Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, United Kingdom. |
| المصدر: | Chest [Chest] 2024 Apr; Vol. 165 (4), pp. 929-941. Date of Electronic Publication: 2023 Oct 14. |
| نوع المنشور: | Clinical Trial; Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier Country of Publication: United States NLM ID: 0231335 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1931-3543 (Electronic) Linking ISSN: 00123692 NLM ISO Abbreviation: Chest Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2016- : New York : Elsevier Original Publication: Chicago : American College of Chest Physicians |
| مواضيع طبية MeSH: | Insufflation*/adverse effects , Insufflation*/methods , Muscular Dystrophy, Duchenne*/complications , Respiratory Insufficiency*/etiology , Spinal Cord Injuries*/complications, Humans ; Cough ; Dyspnea ; Respiration |
| مستخلص: | Background: Respiratory muscle weakness can impair cough function, leading to lower respiratory tract infections. These infections are an important contributor to morbidity and mortality in patients with neuromuscular disease. Mechanical insufflation-exsufflation (MIE) is used to augment cough function in these patients. Although MIE is widely used, there are few data to advise on the optimal technique. Since the introduction of MIE, the recommended pressures to be delivered have increased. There are concerns regarding the use of higher pressures and their potential to cause lung derecruitment and upper airway closure. Research Question: What is the impact of high-pressure MIE (HP-MIE) on lung recruitment, respiratory drive, upper airway flow, and patient comfort, compared with low-pressure MIE (LP-MIE), in patients with respiratory muscle weakness? Study Design and Methods: Clinically stable patients using domiciliary MIE with respiratory muscle weakness secondary to Duchenne muscle dystrophy, spinal cord injury, or long-term tracheostomy ventilation received LP-MIE (30/-30 cm H Results: A total of 29 patients (10 with Duchenne muscle dystrophy, eight with spinal cord injury, and 11 with long-term tracheostomy ventilation) were included in this study. HP-MIE augmented cough peak expiratory flow compared with LP-MIE (mean cough peak expiratory flow HP-MIE 228 ± 81 L/min vs LP-MIE 179 ± 67 L/min; P = .0001) without any significant change in lung recruitment, neural respiratory drive, or patient-reported breathlessness. However, in patients with more pronounced respiratory muscle weakness, HP-MIE resulted in an increased rate of upper airway closure and patient discomfort that may have an impact on clinical efficacy. Interpretation: HP-MIE did not lead to lung derecruitment or breathlessness compared with LP-MIE. However, it was poorly tolerated in individuals with advanced respiratory muscle weakness. HP-MIE generates more upper airway closure than LP-MIE, which may be missed if cough peak expiratory flow is used as the sole titration target. Clinical Trial Registration: ClinicalTrials.gov; No.: NCT02753959; URL: www. Clinicaltrials: gov. Competing Interests: Financial/Nonfinancial Disclosures The authors have reported to CHEST the following: M. P. declares grants and consulting fees from Fisher & Paykel, Philips, and Resmed. None declared (N. M. S., C. A., G. K., S. M.-S., E.-S. S., R. F. D., G. A., E. L., N. H., P. B. M.). (Copyright © 2023 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.) |
| فهرسة مساهمة: | Keywords: cough; mechanical insufflation-exsufflation; neuromuscular weakness; secretion clearance |
| سلسلة جزيئية: | ClinicalTrials.gov NCT02753959 |
| تواريخ الأحداث: | Date Created: 20231016 Date Completed: 20240412 Latest Revision: 20240415 |
| رمز التحديث: | 20240416 |
| DOI: | 10.1016/j.chest.2023.10.015 |
| PMID: | 37844796 |
| قاعدة البيانات: | MEDLINE |
| تدمد: | 1931-3543 |
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| DOI: | 10.1016/j.chest.2023.10.015 |