PURPOSE: NMD patients frequently have impaired cough. Inefficient bronchial clearance may cause ventilatory failure. Mechanical in-exsufflation (MI-E) is effective to improve airway clearance, however limited data exist on its home long-term use. Our purpose was to determine safety and effectiveness of home MI-E treatment.
METHODS: Retrospective analysis of 17 NMD patients (12 males) with median age of 54.5 yrs-old. All patients were on continuous home mechanical ventilation (3 under tracheostomy) and MI-E treatment with oximetry feed-back. Data were recorded as function of diagnosis, spirometry, respiratory muscle strength, unassisted peak cough flow and level of ventilatory support. Safety and efficacy were assessed based on number of complications and hospitalizations related to secretion encumbrance. Side effects were also assessed.
RESULTS: Patients fell into 5 different NMD: Amyotrophic Lateral Sclerosis (ALS) (10), Duchenne Muscular Dystrophy (DMD) (3), other Muscular Dystrophy (MD) (2), Multiple Sclerosis (MS) (1) and Transverse Myelitis (TM) (1). Pulmonary function previous to initiation of MI-E revealed: median FVC=0.78L (29%), median FEV1=0.68L (33%), median MIP=28cmH2O, median MEP=22cmH2O and median PCF=90L/min. Median follow-up under home MI-E was 9 months (1–35 months). Seven patients (6 with ALS, 1 with DMD) used MI-E daily, while 10 patients used it intermittently, during exacerbations. All patients with tracheostomy used MI-E every day and more times a day than patients under NIV, but none of those patients needed antibiotherapy. MI-E was well-tolerated. There were no complications related to the treatment. In general, MI-E was considered effective by caregivers. Timely initiation of MI-E (guided by oximetry feed-back) avoided hospitalization in 6 patients. Only 2 patients (in 3 occasions) had to be hospitalized due to difficulty in handling secretions.Four patients have died (all ALS), 3 of them related to disease progression and 1 from unknown reason.
CONCLUSION: Home MI-E was well tolerated and effective. We consider it safe if used adequately by well prepared caregivers.
CLINICAL IMPLICATIONS: Increased MI-E use during respiratory infections avoided hospitalization in non-tracheostomized patients. Daily home MI-E use decreased frequency of tracheobronchial infections in tracheostomized patients.
DISCLOSURE: Joao Bento, None.