The clinical use of mechanical insufflation-exsufflation in children with neuromuscular disorders in Europe

• Published in: Paediatric respiratory reviews Vol. 27; pp. 69 - 73
• Main Authors: Hov, Brit, Andersen, Tiina, Hovland, Vegard, Toussaint, Michel
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-06-2018
• Subjects: Airway management; Airway Management - methods; Child; Cough; Europe; Humans; Insufflation - methods; Mechanical insufflation-exsufflation; Neuromuscular diseases; Neuromuscular Diseases - complications; Neuromuscular Diseases - epidemiology; Pediatrics; Respiratory Insufficiency - etiology; Respiratory Insufficiency - therapy; Respiratory therapy; Treatment Outcome; Europe; Respiratory therapy; Pediatrics; Neuromuscular diseases; NMD; Mechanical insufflation-exsufflation; Cough; MI-E; Te; PCF; Airway management; Ti; Pe; Pi; Tp
• ISSN: 1526-0542; 1526-0550
• DOI: 10.1016/j.prrv.2017.08.003

Mechanical insufflation-exsufflation (MI-E) is a strategy to treat pulmonary exacerbations in neuromuscular disorders (NMDs). Pediatric guidelines for optimal setting titration of MI-E are lacking and the settings used in studies vary. Our objective was to assess the actual MI-E settings being used in current clinical treatment of children with NMDs and a survey was sent in July 2016 to European expertise centers. Ten centers from seven countries gave information on MI-E settings for 240 children aged 4 months to 17.8 years (mean 10.5). Settings varied greatly between the centers. Auto mode was used in 71%, triggering of insufflation in 21% and manual mode in 8% of the cases. Mean (SD) time for insufflation (Ti) and exsufflation (Te) were 1.9 (0.5) and 1.8 (0.6) s respectively, both ranging from 1 to 4s. Asymmetric time settings were common (65%). Mean (SD) insufflation (Pi) and exsufflation (Pe) pressures were 32.4 (7.8) and −36.9 (7.4), ranging 10 to 50 and −10 to −60cmH2O, respectively. Asymmetric pressures were as common as symmetric. Both Ti, Te, Pi and Pe increased with age (p < 0.001). In conclusion, pediatric MI-E settings in clinical use varied greatly and altered with age, highlighting the need of more studies to improve our knowledge of optimal settings in MI-E in children with NMDs.