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Improvement of Peak Cough Flow After the Application of a Mechanical In-Exsufflator in Patients with Neuromuscular Disease and Pneumonia
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A2176 - Improvement of Peak Cough Flow After the Application of a Mechanical In-Exsufflator in Patients with Neuromuscular Disease and Pneumonia
Author Block: W. Choi1, J. Jung1, H. Oh1, J. Lee2, D. Kim3, S. Kang1; 1Rehabilitation Medicine, Pulmonary Rehabilitation Center, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea, Republic of, 2Department of Physical Medicine and Rehabilitation, National Health Insurance Service, Ilsan Hospital, Goyang, Korea, Republic of, 3Rehabilitation Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea, Republic of.
Rational Mechanical in-exsufflator is useful for airway secretion management in patients with neuromuscular disease with reduced coughing ability. Although previous studies have shown that peak cough flow increases during or immediately after mechanical in-exsufflator application in patients with neuromuscular diseases, it is unclear whether it persists for a certain period after the application. This study aimed to investigate and demonstrate the persistent increase of peak cough flow after mechanical in-exsufflator application in patients with neuromuscular diseases and pneumonia.
Methods
This study was conducted on subjects with neuromuscular diseases with pneumonia who were admitted to a university hospital from August, 2015 to July 2016. Pneumonia was diagnosed based on clinical symptoms, and laboratory and radiologic findings. A mechanical in-exsufflator was applied with the patients in an upright or semi-upright sitting position (pressure setting, +40 and −40 cmH2O; in-exsufflation times, 2-3 and 1-2 seconds, respectively). The patients underwent five cycles with 20-30 seconds intervals to prevent hyperventilation. Peak cough flow without and with assistive maneuvers was evaluated before, and 15 and 45 minutes after mechanical in-exsufflator application.
Results
The peak cough flow was 92.6 L/min at baseline, and 100.4 and 100.7 L/min at 15 and 45 minutes after mechanical in-exsufflator application, respectively. The assisted peak cough flow at baseline, 15 minutes, and 45 minutes after mechanical in-exsufflator application was 170.7, 179.3, and 184.1 L/min, respectively. While peak cough flow and assisted peak cough flow increased significantly at 15 minutes after mechanical in-exsufflator application compared with baseline (p = 0.030, 0.016), no statistical difference was observed between 15 and 45 minutes.
Conclusion
Increased peak cough flow after mechanical in-exsufflator application persists for at least 45 minutes. The clinical importance of a mechanical in-exsufflator should be emphasized in patients with neuromuscular disease and pneumonia.
Author Block: W. Choi1, J. Jung1, H. Oh1, J. Lee2, D. Kim3, S. Kang1; 1Rehabilitation Medicine, Pulmonary Rehabilitation Center, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea, Republic of, 2Department of Physical Medicine and Rehabilitation, National Health Insurance Service, Ilsan Hospital, Goyang, Korea, Republic of, 3Rehabilitation Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea, Republic of.
Rational Mechanical in-exsufflator is useful for airway secretion management in patients with neuromuscular disease with reduced coughing ability. Although previous studies have shown that peak cough flow increases during or immediately after mechanical in-exsufflator application in patients with neuromuscular diseases, it is unclear whether it persists for a certain period after the application. This study aimed to investigate and demonstrate the persistent increase of peak cough flow after mechanical in-exsufflator application in patients with neuromuscular diseases and pneumonia.
Methods
This study was conducted on subjects with neuromuscular diseases with pneumonia who were admitted to a university hospital from August, 2015 to July 2016. Pneumonia was diagnosed based on clinical symptoms, and laboratory and radiologic findings. A mechanical in-exsufflator was applied with the patients in an upright or semi-upright sitting position (pressure setting, +40 and −40 cmH2O; in-exsufflation times, 2-3 and 1-2 seconds, respectively). The patients underwent five cycles with 20-30 seconds intervals to prevent hyperventilation. Peak cough flow without and with assistive maneuvers was evaluated before, and 15 and 45 minutes after mechanical in-exsufflator application.
Results
The peak cough flow was 92.6 L/min at baseline, and 100.4 and 100.7 L/min at 15 and 45 minutes after mechanical in-exsufflator application, respectively. The assisted peak cough flow at baseline, 15 minutes, and 45 minutes after mechanical in-exsufflator application was 170.7, 179.3, and 184.1 L/min, respectively. While peak cough flow and assisted peak cough flow increased significantly at 15 minutes after mechanical in-exsufflator application compared with baseline (p = 0.030, 0.016), no statistical difference was observed between 15 and 45 minutes.
Conclusion
Increased peak cough flow after mechanical in-exsufflator application persists for at least 45 minutes. The clinical importance of a mechanical in-exsufflator should be emphasized in patients with neuromuscular disease and pneumonia.
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