PDF(Pubmed)
Abstract：
Mechanical insufflation-exsufflation (MI-E) is essential for secretion clearance, especially in neuromuscular disorders. For the best outcomes, initiation of MI-E should be started at the correct time with regular evaluation to the response to treatment. Typically, cough peak flow has been used to evaluate cough effectiveness with and without MI-E. This review highlights the limitations of this and discussed other tools to evaluate MI-E efficacy in this rapidly developing field. Such tools include the interpretation of parameters (like pressure, flow and volumes) that derive from the MI-E device and external methods to evaluate upper airway closure. In this review we pinpoint the differences between different devices in the market and discuss new tools to better titrate MI-E and detect pathological responses of the upper airway. We discuss the importance of point of care ultrasound (POCUS), transnasal fiberoptic laryngoscopy and wave form analysis in this setting. To improve clinical practice newer generation MI-E devices should allow real-time evaluation of waveforms and standardize some of the derived parameters.
摘要：
机械吹气-排气（MI-E）对于分泌物清除至关重要，尤其是神经肌肉疾病。为了最好的结果，MI-E的开始应在正确的时间开始,并定期评估治疗反应.通常,咳嗽峰值流量已用于评估有和没有MI-E的咳嗽效果。这篇综述强调了这种局限性，并讨论了在这个快速发展的领域中评估MI-E疗效的其他工具。这些工具包括参数的解释(如压力，流量和体积）来自MI-E装置和评估上气道闭合的外部方法。在这篇综述中，我们指出了市场上不同设备之间的差异，并讨论了更好地滴定MI-E并检测上呼吸道病理反应的新工具。我们讨论了护理点超声（POCUS）的重要性，在这种情况下，经鼻纤维喉镜检查和波形分析。为了改善临床实践，新一代MI-E设备应允许实时评估波形并标准化某些导出参数。
