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Indications and Compliance of Home Mechanical Insufflation-Exsufflation in Patients with Neuromuscular Diseases
Indicaciones y cumplimiento con la insuflación-exuflación mecánica domiciliaria en pacientes con enfermedades neuromusculares
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array:6 [ 0 => array:4 [ "nombre" => "João" "apellidos" => "Bento" "email" => array:1 [ 0 => "joao.a.p.bento@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Miguel" "apellidos" => "Gonçalves" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0015" ] ] ] 2 => array:3 [ "nombre" => "Nuno" "apellidos" => "Silva" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0020" ] ] ] 3 => array:3 [ "nombre" => "Tiago" "apellidos" => "Pinto" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "Anabela" "apellidos" => "Marinho" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0010" ] ] ] 5 => array:3 [ "nombre" => "João Carlos" "apellidos" => "Winck" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Pulmonology Department, HS João, Oporto, Portugal" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0010" ] 1 => array:3 [ "entidad" => "Faculty of Medicine, University of Porto, Oporto, Portugal" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0015" ] 2 => array:3 [ "entidad" => "Linde homecare, Oporto, Portugal" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Indicaciones y cumplimiento con la insuflación-exuflación mecánica domiciliaria en pacientes con enfermedades neuromusculares" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2009-10-20" "fechaAceptado" => "2010-04-22" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec156098" "palabras" => array:5 [ 0 => "Mechanical insufflation-exsufflation" 1 => "Home" 2 => "Safety" 3 => "Efficacy" 4 => "Neuromuscular disease" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec156097" "palabras" => array:5 [ 0 => "Insuflación-exuflación mecánica" 1 => "Domicilio" 2 => "Seguridad" 3 => "Eficacia" 4 => "Enfermedad neuromuscular" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Neuromuscular disease (NMD) patients frequently have impaired cough. Mechanical insufflation-exsufflation (MI-E) has proven efficacy in improving airway clearance, however data related to its long-term home use is lacking. The purpose of this study was to describe indications, safety and compliance of home MI-E in NMD patients.</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Four years observational analysis of 21 NMD patients on home MI-E. Diagnosis included bulbar and non-bulbar Amyotrophic Lateral Sclerosis (ALS) and other NMD. Median age was 58 years. Only cooperative patients with unassisted baseline Peak Cough Flow (PCF) < 270 L/min were included. All patients were under continuous mechanical ventilation (6 by tracheostomy). Pulmonary function before initiation of MI-E (median): FVC = 0.81 L, MIP = 28 cmH<span class="elsevierStyleInf">2</span>O, MEP = 22 cmH<span class="elsevierStyleInf">2</span>O and PCF = 60 L/min. MI-E was performed by previously trained non-professional caregivers, with an on-call support of a trained health care professional. Patients had pulse oximetry monitorization and applied MI-E whenever SpO<span class="elsevierStyleInf">2</span> < 95 %. Median follow-up was 12 months (3-41 months).</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Ten patients (9 ALS) used MI-E daily. Eleven patients used MI-E intermittently, during exacerbations, and in 8 patients early application of MI-E (guided by oximetry feed-back) avoided hospitalization. All tracheostomized patients used MI-E daily and more times a day than patients under NIV. Four patients (3 bulbar ALS), were hospitalized due to secretion encumbrance. MI-E was well-tolerated and there were no complications. In general, caregivers considered MI-E effective. During this period, 4 patients died, related to disease progression.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Home MI-E is well tolerated, effective and safe if used by well trained caregivers. MI-E should be considered as a complement to mechanical ventilation.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Introducción</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Con frecuencia, los pacientes con enfermedades neuromusculares (ENM) presentan un deterioro del mecanismo de la tos. Se ha demostrado la eficacia de la insuflación-exuflación mecánica (IEM) en la mejora del aclaramiento de las vías respiratorias aunque no se dispone de datos relacionados con su utilización domiciliaria a largo plazo. El objetivo del presente estudio fue describir las indicaciones, tolerabilidad y cumplimiento con la IEM domiciliaria en pacientes con ENM.</p> <span class="elsevierStyleSectionTitle">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Análisis observacional de 4 años de duración de 21 pacientes ENM tratados con IEM domiciliaria. El diagnóstico incluyó esclerosis lateral amiotrófica (ELA) bulbar y no bulbar y otras ENM. La edad mediana fue de 58 años. Sólo se incluyeron pacientes cooperadores con valores de flujo pico de tos basal (FTM) no asistido < 270 l/min. Todos los pacientes estaban sometidos a ventilación mecánica continua (seis mediante traqueostomía). La función pulmonar previa al inicio de la IEM (mediana) era: FVC, 0,81 l, MIP, 28 cmH<span class="elsevierStyleInf">2</span>O, MEP = 22 cmH<span class="elsevierStyleInf">2</span>O y PCF = 60 l/min. Cuidadores no profesionales adiestrados previamente con el apoyo permanente de un profesional sanitario experto efectuaron la IEM. En los pacientes se monitorizó la pulsioximetría y se aplicó IEM siempre que la SpO<span class="elsevierStyleInf">2</span> fue < 95 %. El seguimiento mediano fue de 12 meses (3-41 meses).</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Utilizaron diariamente IEM 10 pacientes (nueve con ELA). La utilizaron de forma intermitente 11 pacientes durante las exacerbaciones y en 8 la aplicación precoz de IEM (guiada por la información de la oximetría) evitó la hospitalización. Todos los pacientes traqueostomizados utilizaron la IEM a diario y un mayor número de veces al día que los pacientes sometidos a ventilación mecánica no invasiva (VNI). Requirieron ingreso hospitalario 4 pacientes (3 ELA bulbar) debido a la acumulación de secreciones. La IEM fue bien tolerada y no se asoció a complicaciones. En general, los cuidadores la consideraron eficaz. Durante este período, 4 pacientes fallecieron, en relación con la progresión de la enfermedad.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La IEM domiciliaria es bien tolerada, eficaz y segura cuando la utilizan cuidadores adiestrados apropiadamente. Debe considerarse un complemento de la ventilación mecánica.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:29 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 3 | 7 |
| 2024 October | 39 | 39 | 78 |
| 2024 September | 31 | 29 | 60 |
| 2024 August | 48 | 45 | 93 |
| 2024 July | 33 | 25 | 58 |
| 2024 June | 48 | 38 | 86 |
| 2024 May | 47 | 32 | 79 |
| 2024 April | 28 | 34 | 62 |
| 2024 March | 25 | 24 | 49 |
| 2024 February | 28 | 22 | 50 |
| 2023 March | 3 | 5 | 8 |
| 2023 February | 13 | 38 | 51 |
| 2023 January | 17 | 28 | 45 |
| 2022 December | 26 | 31 | 57 |
| 2022 November | 11 | 24 | 35 |
| 2022 October | 27 | 36 | 63 |
| 2022 September | 15 | 24 | 39 |
| 2022 August | 17 | 37 | 54 |
| 2022 July | 20 | 48 | 68 |
| 2022 June | 21 | 28 | 49 |
| 2022 May | 20 | 37 | 57 |
| 2022 April | 16 | 48 | 64 |
| 2022 March | 26 | 50 | 76 |
| 2022 February | 13 | 29 | 42 |
| 2022 January | 16 | 39 | 55 |
| 2021 December | 27 | 52 | 79 |
| 2021 November | 16 | 46 | 62 |
| 2021 October | 28 | 60 | 88 |
| 2021 September | 19 | 62 | 81 |
| 2021 August | 16 | 32 | 48 |
| 2021 July | 15 | 35 | 50 |
| 2021 June | 18 | 46 | 64 |
| 2021 May | 12 | 44 | 56 |
| 2021 April | 79 | 90 | 169 |
| 2021 March | 40 | 40 | 80 |
| 2021 February | 21 | 29 | 50 |
| 2021 January | 14 | 19 | 33 |
| 2020 December | 18 | 24 | 42 |
| 2020 November | 26 | 35 | 61 |
| 2020 October | 16 | 14 | 30 |
| 2020 September | 11 | 4 | 15 |
| 2020 August | 21 | 22 | 43 |
| 2020 July | 23 | 20 | 43 |
| 2020 June | 24 | 5 | 29 |
| 2020 May | 22 | 16 | 38 |
| 2020 April | 21 | 27 | 48 |
| 2020 March | 13 | 23 | 36 |
| 2020 February | 41 | 18 | 59 |
| 2020 January | 59 | 22 | 81 |
| 2019 December | 36 | 24 | 60 |
| 2019 November | 33 | 30 | 63 |
| 2019 October | 10 | 38 | 48 |
| 2019 September | 12 | 36 | 48 |
| 2019 August | 17 | 11 | 28 |
| 2019 July | 18 | 49 | 67 |
| 2019 June | 10 | 84 | 94 |
| 2019 May | 13 | 30 | 43 |
| 2019 April | 16 | 39 | 55 |
| 2019 March | 12 | 30 | 42 |
| 2019 February | 7 | 11 | 18 |
| 2019 January | 5 | 4 | 9 |
| 2018 December | 8 | 28 | 36 |
| 2018 November | 15 | 12 | 27 |
| 2018 October | 13 | 22 | 35 |
| 2018 September | 10 | 17 | 27 |
| 2018 May | 2 | 0 | 2 |
| 2018 April | 9 | 8 | 17 |
| 2018 March | 4 | 5 | 9 |
| 2018 February | 8 | 6 | 14 |
| 2018 January | 9 | 11 | 20 |
| 2017 December | 3 | 15 | 18 |
| 2017 November | 4 | 12 | 16 |
| 2017 October | 12 | 22 | 34 |
| 2017 September | 7 | 17 | 24 |
| 2017 August | 7 | 16 | 23 |
| 2017 July | 17 | 15 | 32 |
| 2017 June | 25 | 23 | 48 |
| 2017 May | 18 | 27 | 45 |
| 2017 April | 15 | 8 | 23 |
| 2017 March | 5 | 5 | 10 |
| 2017 February | 11 | 6 | 17 |
| 2017 January | 8 | 4 | 12 |
| 2016 December | 14 | 6 | 20 |
| 2016 November | 15 | 9 | 24 |
| 2016 October | 19 | 13 | 32 |
| 2016 September | 15 | 19 | 34 |
| 2016 August | 19 | 6 | 25 |
| 2016 July | 9 | 5 | 14 |
| 2016 May | 1 | 0 | 1 |
| 2016 March | 8 | 0 | 8 |
| 2016 February | 6 | 0 | 6 |
| 2016 January | 6 | 0 | 6 |
| 2015 December | 4 | 0 | 4 |
| 2015 October | 57 | 23 | 80 |
| 2015 September | 50 | 20 | 70 |
| 2015 August | 41 | 25 | 66 |
| 2015 July | 43 | 13 | 56 |
| 2015 June | 43 | 14 | 57 |
| 2015 May | 68 | 42 | 110 |
| 2015 April | 40 | 19 | 59 |
| 2015 March | 59 | 18 | 77 |
| 2015 February | 46 | 18 | 64 |
| 2015 January | 40 | 11 | 51 |
| 2014 December | 45 | 13 | 58 |
| 2014 November | 55 | 14 | 69 |
| 2014 October | 46 | 17 | 63 |
| 2014 September | 41 | 19 | 60 |
| 2014 August | 42 | 16 | 58 |
| 2014 July | 66 | 16 | 82 |
| 2014 June | 71 | 13 | 84 |
| 2014 May | 61 | 22 | 83 |
| 2014 April | 60 | 15 | 75 |
| 2014 March | 69 | 18 | 87 |
| 2014 February | 74 | 16 | 90 |
| 2014 January | 56 | 17 | 73 |
| 2013 December | 56 | 17 | 73 |
| 2013 November | 43 | 15 | 58 |
| 2013 October | 51 | 19 | 70 |
| 2013 September | 46 | 13 | 59 |
| 2013 August | 65 | 22 | 87 |
| 2013 July | 59 | 15 | 74 |
| 2013 June | 39 | 8 | 47 |
| 2013 May | 42 | 6 | 48 |
| 2013 April | 24 | 9 | 33 |
| 2013 March | 10 | 3 | 13 |
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