Physiologic benefits of mechanical insufflation-exsufflation in children with neuromuscular diseases
Physiologic benefits of mechanical insufflation-exsufflation in children with neuromuscular diseases
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DOI：
10.1378/chest.07-1615
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发表时间：
2008-01-01
期刊：
影响因子：
9.6
通讯作者：
Lofaso, Frederic
中科院分区：
文献类型：
--
作者：
Fauroux, Brigitte;Guilleinot, Nathahe;Lofaso, Frederic
研究目的：分析机械辅助(咳嗽辅助；JH Emerson公司；马萨诸塞州剑桥)机械充气-排气(MI-E)治疗神经肌肉疾病的生理效应和耐受性。设计：前瞻性临床试验。地点：某大学医院儿科肺科生理学实验室。患者：17例Duchenne肌营养不良症(n=4)、脊髓性肌萎缩症(n=4)或其他先天性肌病(n=9)患儿，病情稳定。干预：循环加压15，30，40em H2O，S注气2例，S排气3例。一次应用包括在每个压力下进行六个循环，总共三次应用。测量和结果：在每一次应用中都测量了呼吸道压力和气流。在每次用药前和用药后评估呼吸模式、肺活量(VC)、鼻腔吸气压(SNIP)、最大呼气流量(PEF)和呼吸舒适度。患者的耐受性良好，所有患者的呼吸舒适度评分均显著提高(p=0.02)。MI-E应用期间的过期容量显著增加，在40 cm H2O时达到VC的两倍。平均和最大吸气和呼气流量随压力的增加而增加。应用MI-E后呼吸模式没有改变，脉搏血氧饱和度保持在正常值内，但平均呼气末二氧化碳分压显著下降。应用MI-E后VC无明显变化，但平均SNIP和PEF明显改善。结论：MI-E对病情稳定的神经肌肉疾病患儿具有良好的耐受性和生理短期效益。
Study objectives: To analyze the physiologic effects and tolerance of mechanical insufflation-exsufflation (MI-E) by means of mechanical cough assistance (Cough Assist; JH Emerson.Company; Cambridge, MA) for children with neuromuscular disease.Design: Prospective clinical trial.Setting: Physiology laboratory of a pediatric pulmonary department of a university hospital.Patients: Seventeen children with Duchenne muscular dystrophy (n = 4), spinal muscular atrophy (n = 4), or other congenital myopathy (n = 9) who were in a stable state. Interventions: Pressures of 15, 30, and 40 em H2O were cycled to each patient, with 2 s for insufflation and 3 s for exsufflation. One application consisted of six cycles at each pressure for a total of three applications.Measurements and results: Airway pressure and airflow were measured during every application. Breathing pattern, vital capacity (VC), sniff nasal inspiratory pressure (SNIP), peak expiratory flow (PEF), and respiratory comfort were evaluated at baseline and after each application. The tolerance of the patients was excellent,,with a significant increase in the respiratory comfort score in all of the patients (p = 0.02). Expired volume during the MI-E application increased significantly to reach twice the VC at 40 cm H2O. Mean and maximal inspiratory and expiratory flows increased in a pressure-dependent manner. Breathing pattern did not change after the MI-E applications and pulse oximetric saturation remained stable within normal values, but the mean end-tidal carbon dioxide pressure decreased significantly. VC did not change, but the mean SNIP and PEF improved significantly after MI-E applications.Conclusions: Our results confirm the good tolerance and physiologic short-term benefit of the MI-E in children with neuromuscular disease who were in a stable state.