IPPB-assisted coughing in neuromuscular disorders
- 1 June 2006
- journal article
- research article
- Published by Wiley in Pediatric Pulmonology
- Vol. 41 (6) , 551-557
- https://doi.org/10.1002/ppul.20406
Abstract
In neuromuscular disorders, reduced peak cough flows (PCFs) are considered to increase the risk of respiratory complications such as pneumonia or chronic atelectasis. Different methods were described to improve PCF. However, these studies were primarily carried out in adults, and there is limited information regarding the use and efficacy of these methods in children with respiratory muscle weakness. The aim of this study was to investigate whether hyperinsufflation with an intermittent positive-pressure breathing (IPPB) device is effective in cough augmentation in pediatric patients. Spirometry (forced inspiratory vital capacity, FIVC; forced expiratory volume in 1 sec, FEV1), respiratory muscle pressures (peak inspiratory pressure, PIP; peak expiratory pressure, PEP), and PCF were measured in 29 schoolchildren with various neuromuscular disorders. IPPB-assisted hyperinsufflation was taught individually to increase lung volumes (maximum insufflation capacity, MIC) above FIVC. The impact of hyperinsufflation on peak cough flow was documented. In 28/29 patients, IPPB-assisted hyperinsufflation enhanced FIVC from 0.68 +/- 0.40 l to an MIC of 1.05 +/- 0.47 l (P < 0.001). Unassisted PCF was 119.0 +/- 57.7 l/min, and increased to 194.5 +/- 74.9 l/min (P < 0.001) in 27/29 patients. This effect was similar in young patients (ages 6-10 years) and older patients (aged >10 years). Augmentation of lung volumes from FIVC to MIC correlated with an increase of PCF (R = 0.42, P < 0.05). IPPB-assisted hyperinsufflation improves PCF in pediatric neuromuscular disorders. The results suggest that this technique can be used to improve clearance of airway secretions and therefore reduce respiratory morbidity in children with NMD.Keywords
This publication has 22 references indexed in Scilit:
- Spinal muscular atrophy type 1: Management and outcomesPediatric Pulmonology, 2002
- Migrating atelectasis in Werdnig-Hoffmann disease: Pulmonary manifestations in two cases of spinal muscular atrophy type 1Pediatric Pulmonology, 1999
- NEUROMUSCULAR VENTILATORY INSUFFICIENCY Effect of Home Mechanical Ventilator Use v Oxygen Therapy on Pneumonia and Hospitalization RatesAmerican Journal of Physical Medicine & Rehabilitation, 1998
- Update And Perspective on Noninvasive Respiratory Muscle AidsChest, 1994
- Respiratory Muscle Weakness during Upper Respiratory Tract InfectionsAmerican Review of Respiratory Disease, 1988
- Clearance of mucus by simulated coughJournal of Applied Physiology, 1985
- Atelectasis and Neuromuscular Respiratory FailureChest, 1984
- Cough dynamics during progressive expiratory muscle weakness in healthy curarized subjectsJournal of Applied Physiology, 1981
- Respiratory failure in neuromuscular diseasesThorax, 1971
- TREATMENT OF BRONCHITIS IN PATIENTS WITH RESPIRATORY-MUSCLE PARALYSIS AFTER POLIOMYELITISThe Lancet, 1957