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Changes in gastric pressure and volume during mechanical in-exsufflation
Laura J Miske1, Joseph M McDonough, Daniel J Weiner
1Department of Nursing, The Children's Hospital of Philadelphia, Pennsylvania 19104, USA. miske@email.chop.edu
Pediatric Pulmonology
|September 6, 2012
Summary
Mechanical insufflator-exsufflator (MI-E) use in patients with neuromuscular weakness after abdominal surgery is safe. Gastric pressure during MI-E treatment was lower than during spontaneous coughing, indicating no increased risk of wound dehiscence.
Area of Science:
- Respiratory physiology
- Medical device safety
- Neuromuscular disorders
Background:
- Mechanical insufflator-exsufflator (MI-E) devices aid spontaneous cough in patients with neuromuscular weakness.
- Post-abdominal surgery use of MI-E is often avoided due to concerns about wound dehiscence and excessive abdominal pressure.
Purpose of the Study:
- To investigate gastric pressure (Pgas) during MI-E use in patients with neuromuscular weakness.
- To compare Pgas during MI-E with pressures generated during spontaneous coughing.
- To assess the safety of MI-E in the post-operative abdominal surgery period.
Main Methods:
- Thirteen subjects (0.8-23.1 years) with neuromuscular weakness and a gastrostomy tube underwent MI-E treatment.
- Gastric pressure was measured via a transducer through the gastrostomy tube.
- Respiratory inductance plethysmography assessed chest and abdominal volume changes.
- Three subjects also performed spontaneous coughs for comparison.
Main Results:
- Maximum Pgas during MI-E was 24 cmH2O (applied pressures 20-40 cmH2O).
- Maximum Pgas during spontaneous cough in three subjects was 25 cmH2O.
- MI-E generated lower Pgas compared to spontaneous coughing in these subjects.
Conclusions:
- MI-E use results in less positive abdominal pressure than spontaneous coughing.
- MI-E is likely safe for use in the post-operative period following abdominal surgery in patients with neuromuscular weakness.
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