PDF(Pubmed)
Abstract：
Mechanical insufflation-exsufflation (MI-E) has been used to supplement the ability to cough and expel pulmonary secretions in patients with neuromuscular disease who have a reduced ability to cough. The manufacturer\'s guidelines for MI-E recommend a setting of inspiratory pressure of +40 cmH2O and expiratory pressure of -40 cmH2O. However, patients with small stature and restricted ventilatory impairment are prone to pneumothorax, so the manufacturer\'s recommendations are not used as is, and should be adjusted for the physical and pulmonary characteristics of each patient. Here, we report a case in which MI-E was used for an amyotrophic lateral sclerosis (ALS) patient with short height, low BMI, and restricted lung capacity at inspiratory and expiratory pressures lower than the manufacturer\'s recommendations. In adjusting MI-E pressure, physical observations such as chest auscultation, visual chest dilation, and observation of secretion movement toward the tracheal tube were performed to avoid unnecessary pressure. As a result, the pressure level set was lower than the manufacturer\'s recommendation (25 cmH2O) but sufficient to improve atelectasis and no pneumothorax occurred. The method we practiced in this study is feasible in any clinical setting. We also believe that MI-E, when performed in conjunction with treatment response observation, can be expected to improve at lower pressures than generally recommended, thereby reducing the risk of lung injury and providing safer treatment.
摘要：
机械吹气-排气（MI-E）已用于补充咳嗽能力降低的神经肌肉疾病患者的咳嗽和排出肺部分泌物的能力。制造商关于MI-E的指南建议设定吸气压力为+40cmH2O，呼气压力为-40cmH2O。然而,身材矮小且通气障碍受限的患者容易发生气胸，所以制造商的建议不按原样使用，并应根据每个患者的身体和肺部特征进行调整。这里,我们报道了一个病例，其中MI-E被用于患有身材矮小的肌萎缩侧索硬化症（ALS）患者，低BMI,在吸气和呼气压力低于制造商建议的情况下，肺活量受限。在调整MI-E压力时，身体观察，如胸部听诊，视觉胸部扩张，并观察分泌物向气管导管的运动，以避免不必要的压力。因此,设定的压力水平低于制造商的建议(25cmH2O),但足以改善肺不张,且未发生气胸.我们在这项研究中实践的方法在任何临床环境中都是可行的。我们也相信MI-E,当与治疗反应观察结合进行时，可以预期在低于一般推荐的压力下改善，从而降低肺损伤的风险并提供更安全的治疗。
