PDF(Pubmed)
Abstract：
BACKGROUND: Mechanical insufflation-exsufflation (MI-E) and manually assisted cough are frequently employed cough augmentation methods for enhancing cough efficiency in individuals with cervical spinal cord injury (CSCI). This study aimed to evaluate the synergistic impact of combining manually assisted cough and MI-E on cough peak flow in subjects with CSCI and identify their related factors.
METHODS: Fifteen subjects with CSCI with cough peak flow > -270 L/min underwent 5 consecutive days of 5 cough augmentation sessions; cough peak flow during exsufflation and the total insufflation volume (TIV) during insufflation were measured. Only MI-E was administered on days 1 and 5, whereas on days 2-4 one MI-E-only session followed by 3 MI-E and manually assisted cough sessions was implemented followed by a fifth MI-E-only session. The cumulative and carry-over effects of increasing treatment sessions and any associated factor on cough peak flow during MI-E-assisted coughing were assessed using a linear mixed model (LMM) with repetitive air-flow measurements within the same participants.
RESULTS: No cumulative or carry-over effects of manually assisted cough and MI-E were shown with the accumulation of treatment days or sessions. The LMM confirmed that using manually assisted cough (-0.283 L/s, P < .001), TIV (-0.045 L/s, P = .002), and the individual manually assisted cough variance (-0.022 L/s, P = .01) significantly influenced cough peak flow. Estimated mean cough peak flows for MI-E with manually assisted cough and MI-E alone were -4.006 L/s (95% CI -4.237 to -3.775) and -3.723 L/s (95% CI -3.953 to -3.492), respectively, surpassing the initial voluntary cough peak flow without MI-E assistance (-1.65 ± 0.53 L/s).
CONCLUSIONS: The use of manually assisted cough and amount of TIV correlated with improved cough peak flow, emphasizing the importance of adequate in-expiratory support. No carry-over effect was associated with using manually assisted cough, highlighting the need to combine MI-E with manually assisted cough for each MI-E treatment to achieve optimal cough effectiveness.
METHODS: Fifteen subjects with CSCI with cough peak flow > -270 L/min underwent 5 consecutive days of 5 cough augmentation sessions; cough peak flow during exsufflation and the total insufflation volume (TIV) during insufflation were measured. Only MI-E was administered on days 1 and 5, whereas on days 2-4 one MI-E-only session followed by 3 MI-E and manually assisted cough sessions was implemented followed by a fifth MI-E-only session. The cumulative and carry-over effects of increasing treatment sessions and any associated factor on cough peak flow during MI-E-assisted coughing were assessed using a linear mixed model (LMM) with repetitive air-flow measurements within the same participants.
RESULTS: No cumulative or carry-over effects of manually assisted cough and MI-E were shown with the accumulation of treatment days or sessions. The LMM confirmed that using manually assisted cough (-0.283 L/s, P < .001), TIV (-0.045 L/s, P = .002), and the individual manually assisted cough variance (-0.022 L/s, P = .01) significantly influenced cough peak flow. Estimated mean cough peak flows for MI-E with manually assisted cough and MI-E alone were -4.006 L/s (95% CI -4.237 to -3.775) and -3.723 L/s (95% CI -3.953 to -3.492), respectively, surpassing the initial voluntary cough peak flow without MI-E assistance (-1.65 ± 0.53 L/s).
CONCLUSIONS: The use of manually assisted cough and amount of TIV correlated with improved cough peak flow, emphasizing the importance of adequate in-expiratory support. No carry-over effect was associated with using manually assisted cough, highlighting the need to combine MI-E with manually assisted cough for each MI-E treatment to achieve optimal cough effectiveness.
摘要：
背景：机械吹气-排气（MI-E）和手动辅助咳嗽是经常采用的咳嗽增强方法，用于提高颈髓损伤（CSCI）患者的咳嗽效率。本研究旨在评估人工辅助咳嗽和MI-E联合对CSCI受试者咳嗽峰流量的协同影响，并确定其相关因素。
方法：15例CSCI患者咳嗽峰值流量>-270L/min，连续5天进行5次咳嗽增强治疗；测量排气期间的咳嗽峰值流量和吹气期间的总吹气量（TIV）。在第1天和第5天仅施用MI-E，而在第2-4天仅进行一次MI-E治疗，然后进行3次MI-E和手动辅助咳嗽治疗，然后进行第五次MI-E治疗。使用线性混合模型（LMM）对同一参与者进行重复的空气流量测量，评估了MI-E辅助咳嗽期间增加治疗疗程以及任何相关因素对咳嗽峰值流量的累积和延续效应。
结果：没有显示人工辅助咳嗽和MI-E随治疗天数或疗程的累积或延续效应。LMM确认使用手动辅助咳嗽（-0.283L/s，P<.001),TIV(-0.045L/s,P=.002)，和个人手动辅助咳嗽方差(-0.022L/s，P=0.01）显着影响咳嗽峰流量。手动辅助咳嗽和单独MI-E的MI-E的估计平均咳嗽峰值流量为-4.006L/s（95％CI-4.237至-3.775）和-3.723L/s（95％CI-3.953至-3.492），分别,超过没有MI-E辅助的初始自愿咳嗽峰值流量（-1.65±0.53L/s）。
结论：使用手动辅助咳嗽和TIV量与改善咳嗽峰流量相关，强调充分的呼气内支持的重要性。没有结转效果与使用手动辅助咳嗽相关，强调每种MI-E治疗需要将MI-E与手动辅助咳嗽相结合，以达到最佳咳嗽效果。
方法：15例CSCI患者咳嗽峰值流量>-270L/min，连续5天进行5次咳嗽增强治疗；测量排气期间的咳嗽峰值流量和吹气期间的总吹气量（TIV）。在第1天和第5天仅施用MI-E，而在第2-4天仅进行一次MI-E治疗，然后进行3次MI-E和手动辅助咳嗽治疗，然后进行第五次MI-E治疗。使用线性混合模型（LMM）对同一参与者进行重复的空气流量测量，评估了MI-E辅助咳嗽期间增加治疗疗程以及任何相关因素对咳嗽峰值流量的累积和延续效应。
结果：没有显示人工辅助咳嗽和MI-E随治疗天数或疗程的累积或延续效应。LMM确认使用手动辅助咳嗽（-0.283L/s，P<.001),TIV(-0.045L/s,P=.002)，和个人手动辅助咳嗽方差(-0.022L/s，P=0.01）显着影响咳嗽峰流量。手动辅助咳嗽和单独MI-E的MI-E的估计平均咳嗽峰值流量为-4.006L/s（95％CI-4.237至-3.775）和-3.723L/s（95％CI-3.953至-3.492），分别,超过没有MI-E辅助的初始自愿咳嗽峰值流量（-1.65±0.53L/s）。
结论：使用手动辅助咳嗽和TIV量与改善咳嗽峰流量相关，强调充分的呼气内支持的重要性。没有结转效果与使用手动辅助咳嗽相关，强调每种MI-E治疗需要将MI-E与手动辅助咳嗽相结合，以达到最佳咳嗽效果。
