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Changes in ventilation distribution in children with neuromuscular disease using the insufflator/exsufflator
Carmen Casaulta1,2, Florence Messerli1, Romy Rodriguez1
1Division of Paediatric Pulmonology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, 3010, Bern, Switzerland.
Insights
The insufflator/exsufflator technique did not show immediate improvements in lung function or ventilation distribution in children with neuromuscular disease. Further research may be needed to optimize this airway clearance method.
Area of Science:
- Pediatric Pulmonology
- Respiratory Physiology
- Neuromuscular Diseases
Background:
- Patients with neuromuscular disease often have impaired cough, leading to mucus retention and respiratory infections.
- Airway clearance techniques, such as the insufflator/exsufflator (IME) device, are used to manage mucus.
- The immediate physiological effects of IME on lung function are not well understood.
Purpose of the Study:
- To investigate the short-term effects of the insufflator/exsufflator technique on lung volumes, expiratory flows, and ventilation distribution.
- To assess immediate changes in respiratory mechanics following IME therapy in pediatric patients.
Main Methods:
- Eight stable pediatric subjects with neuromuscular disease underwent lung function tests.
- Tests included spirometry, multiple breath washout (MBW), and electrical impedance tomography (EIT).
- Measurements were taken before and after a chest physiotherapy session using an IME device.
Main Results:
- No significant short-term changes were observed in forced lung volumes or expiratory flows.
- Parameters of ventilation distribution derived from MBW and EIT showed no immediate improvement.
- The study did not demonstrate immediate beneficial effects of the IME technique on lung function in this cohort.
Conclusions:
- The current protocol for the insufflator/exsufflator maneuver did not yield demonstrable immediate changes in lung function or ventilation distribution.
- In this small group of pediatric patients with neuromuscular disease, IME therapy did not show short-term physiological benefits.
- Further investigation into optimizing IME protocols may be warranted.
Abstract:
Patients with neuromuscular disease often suffer from weak and ineffective cough resulting in mucus retention and increased risk for chest infections. Different airway clearance techniques have been proposed, one of them being the insufflator/exsufflator technique. So far, the immediate physiological effects of the insufflator/exsufflator technique on ventilation distribution and lung volumes are not known. We aimed to describe the immediate effects of the insufflator/exsufflator technique on different lung volumes, forced flows and ventilation distribution. Eight subjects (age 5.8-15.2 years) performed lung function tests including spirometry, multiple breath washout and electrical impedance tomography before and after a regular a chest physiotherapy session with an insufflator/exsufflator device. Forced lung volumes and flows as well as parameters of ventilation distribution derived from multiple breath washout and electrical impedance tomography were compared to assess the short-term effect of the therapy. In this small group of stable paediatric subjects with neuromuscular disease we could not demonstrate any short-term effects of insufflation/exsufflation manoeuvres on lung volumes, expiratory flows and ventilation distribution. With the currently used protocol of the insufflation/exsufflation manoeuvre, we cannot demonstrate any immediate changes in lung function.
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