背景:呼吸肌无力可损害咳嗽功能,导致下呼吸道感染。这些感染是神经肌肉疾病患者发病率和死亡率的重要因素。机械吹气-排气(MIE)用于增强这些患者的咳嗽功能。虽然广泛使用,关于最佳技术的建议数据很少。自推出以来,建议交付的压力增加了。人们担心使用更高的压力及其引起肺扩张和上气道闭合的可能性。
目的:高压MIE(HP-MIE)对肺复张的影响是什么,呼吸驱动,上呼吸道流量和患者舒适度,与低压MIE(LP-MIE)相比,
方法:临床稳定的患者使用家庭MIE伴继发于Duchenne肌营养不良(DMD)的呼吸肌无力,脊髓损伤(SCI)或长期气管造口通气(LTTV)按随机顺序接受LP-MIE(+30/-30cmH2O)和HP-MIE(+60/-60cmH2O).肺招募,在整个过程中测量神经呼吸驱动和咳嗽峰值呼气流量(CPF),患者在每次干预后报告舒适和呼吸困难。
结果:我们包括29例患者(10例DMD,8SCI,11LTTV)。与LP-MIE相比,HP-MIE增强了CPF(平均CPFHP-MIE228±81L/minvsLP-MIE179±67L/min,p=0.0001)肺募集无任何显著变化,神经呼吸驱动或患者报告呼吸困难。然而,在更明显的呼吸肌无力的患者中,HP-MIE导致上呼吸道闭合率增加,患者不适可能会影响临床疗效。
结论:与LP-MIE相比,HP-MIE并未导致肺扩张或呼吸困难。然而,晚期呼吸肌无力患者的耐受性较差.HP-MIE比LP-MIE产生更多的上呼吸道闭合,如果将CPF用作唯一的滴定目标,则可能会错过。
背景:本研究已在clinicaltrials.gov(NCT02753959)上注册。
BACKGROUND: Respiratory muscle weakness can impair cough function, leading to lower respiratory tract infections. These infections are an important contributor to morbidity and mortality in patients with neuromuscular disease. Mechanical insufflation-exsufflation (MIE) is used to augment cough function in these patients. Although MIE is widely used, there are few data to advise on the optimal technique. Since the introduction of MIE, the recommended pressures to be delivered have increased. There are concerns regarding the use of higher pressures and their potential to cause lung derecruitment and upper airway closure.
OBJECTIVE: What is the impact of high-pressure MIE (HP-MIE) on lung recruitment, respiratory drive, upper airway flow, and patient comfort, compared with low-pressure MIE (LP-MIE), in patients with respiratory muscle weakness?
METHODS: Clinically stable patients using domiciliary MIE with respiratory muscle weakness secondary to Duchenne muscle dystrophy, spinal cord injury, or long-term tracheostomy ventilation received LP-MIE (30/-30 cm H2O) and HP-MIE (60/-60 cm H2O) in a random sequence. Lung recruitment, neural respiratory drive, and cough peak expiratory flow were measured throughout, and patients reported comfort and breathlessness following each intervention.
RESULTS: A total of 29 patients (10 with Duchenne muscle dystrophy, eight with spinal cord injury, and 11 with long-term tracheostomy ventilation) were included in this study. HP-MIE augmented cough peak expiratory flow compared with LP-MIE (mean cough peak expiratory flow HP-MIE 228 ± 81 L/min vs LP-MIE 179 ± 67 L/min; P = .0001) without any significant change in lung recruitment, neural respiratory drive, or patient-reported breathlessness. However, in patients with more pronounced respiratory muscle weakness, HP-MIE resulted in an increased rate of upper airway closure and patient discomfort that may have an impact on clinical efficacy.
CONCLUSIONS: HP-MIE did not lead to lung derecruitment or breathlessness compared with LP-MIE. However, it was poorly tolerated in individuals with advanced respiratory muscle weakness. HP-MIE generates more upper airway closure than LP-MIE, which may be missed if cough peak expiratory flow is used as the sole titration target.
BACKGROUND: ClinicalTrials.gov; No.: NCT02753959; URL: www.
RESULTS: gov.