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Vol. 46. Issue 8.
Pages 420-425 (January 2010)
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Vol. 46. Issue 8.
Pages 420-425 (January 2010)
Original Article
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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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João Bentoa,
Corresponding author
joao.a.p.bento@gmail.com

Corresponding author.
, Miguel Gonçalvesa,b, Nuno Silvac, Tiago Pintoa, Anabela Marinhoa, João Carlos Wincka,b
a Pulmonology Department, HS João, Oporto, Portugal
b Faculty of Medicine, University of Porto, Oporto, Portugal
c Linde homecare, Oporto, Portugal
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Abstract
Introduction

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.

Methods

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 cmH2O, MEP = 22 cmH2O 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 SpO2 < 95 %. Median follow-up was 12 months (3-41 months).

Results

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.

Conclusions

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.

Keywords:
Mechanical insufflation-exsufflation
Home
Safety
Efficacy
Neuromuscular disease
Resumen
Introducción

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.

Métodos

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 cmH2O, MEP = 22 cmH2O 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 SpO2 fue < 95 %. El seguimiento mediano fue de 12 meses (3-41 meses).

Resultados

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.

Conclusiones

La IEM domiciliaria es bien tolerada, eficaz y segura cuando la utilizan cuidadores adiestrados apropiadamente. Debe considerarse un complemento de la ventilación mecánica.

Palabras clave:
Insuflación-exuflación mecánica
Domicilio
Seguridad
Eficacia
Enfermedad neuromuscular
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