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Search Results (4)

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Keywords = mechanical in-exsufflation

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5 pages, 1031 KB  
Reply
Precision in Practice: Enhancing MI-E Therapy Evaluation for Improved Patient Outcomes, Excluding Speech and Swallowing. Reply to Allen et al. Comment on “Chatwin et al. Waves of Precision: A Practical Guide for Reviewing New Tools to Evaluate Mechanical In-Exsufflation Efficacy in Neuromuscular Disorders. J. Clin. Med. 2024, 13, 2643”
by Michelle Chatwin, Jesus Sancho, Manel Lujan, Tiina Andersen and Joao-Carlos Winck
J. Clin. Med. 2024, 13(17), 4992; https://doi.org/10.3390/jcm13174992 - 23 Aug 2024
Cited by 1 | Viewed by 882
Abstract
We would like to thank Allen et al [...] Full article
(This article belongs to the Section Respiratory Medicine)
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5 pages, 204 KB  
Comment
Comment on Chatwin et al. Waves of Precision: A Practical Guide for Reviewing New Tools to Evaluate Mechanical In-Exsufflation Efficacy in Neuromuscular Disorders. J. Clin. Med. 2024, 13, 2643
by Jodi Allen, Gemma Clunie, Helen Newman and Claire Slinger
J. Clin. Med. 2024, 13(17), 4991; https://doi.org/10.3390/jcm13174991 - 23 Aug 2024
Cited by 1 | Viewed by 1013
Abstract
We read with interest the paper published by Chatwin et al [...] Full article
(This article belongs to the Section Respiratory Medicine)
19 pages, 8452 KB  
Review
Waves of Precision: A Practical Guide for Reviewing New Tools to Evaluate Mechanical In-Exsufflation Efficacy in Neuromuscular Disorders
by Michelle Chatwin, Jesus Sancho, Manel Lujan, Tiina Andersen and Joao-Carlos Winck
J. Clin. Med. 2024, 13(9), 2643; https://doi.org/10.3390/jcm13092643 - 30 Apr 2024
Cited by 8 | Viewed by 3848
Abstract
Mechanical insufflation-exsufflation (MI-E) is essential for secretion clearance, especially in neuromuscular disorders. For the best outcomes, initiation of MI-E should be started at the correct time with regular evaluation to the response to treatment. Typically, cough peak flow has been used to evaluate [...] Read more.
Mechanical insufflation-exsufflation (MI-E) is essential for secretion clearance, especially in neuromuscular disorders. For the best outcomes, initiation of MI-E should be started at the correct time with regular evaluation to the response to treatment. Typically, cough peak flow has been used to evaluate cough effectiveness with and without MI-E. This review highlights the limitations of this and discussed other tools to evaluate MI-E efficacy in this rapidly developing field. Such tools include the interpretation of parameters (like pressure, flow and volumes) that derive from the MI-E device and external methods to evaluate upper airway closure. In this review we pinpoint the differences between different devices in the market and discuss new tools to better titrate MI-E and detect pathological responses of the upper airway. We discuss the importance of point of care ultrasound (POCUS), transnasal fiberoptic laryngoscopy and wave form analysis in this setting. To improve clinical practice newer generation MI-E devices should allow real-time evaluation of waveforms and standardize some of the derived parameters. Full article
(This article belongs to the Special Issue Non-invasive Respiratory Support: How to Get It Right in Clinical Medicine—Volume II)
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10 pages, 573 KB  
Article
Airway Care Interventions for Invasively Ventilated Critically Ill Adults—A Dutch National Survey
by Willemke Stilma, Sophia M. van der Hoeven, Wilma J. M. Scholte op Reimer, Marcus J. Schultz, Louise Rose and Frederique Paulus
J. Clin. Med. 2021, 10(15), 3381; https://doi.org/10.3390/jcm10153381 - 30 Jul 2021
Cited by 10 | Viewed by 3832
Abstract
Airway care interventions may prevent accumulation of airway secretions and promote their evacuation, but evidence is scarce. Interventions include heated humidification, nebulization of mucolytics and/or bronchodilators, manual hyperinflation and use of mechanical insufflation-exsufflation (MI-E). Our aim is to identify current airway care practices [...] Read more.
Airway care interventions may prevent accumulation of airway secretions and promote their evacuation, but evidence is scarce. Interventions include heated humidification, nebulization of mucolytics and/or bronchodilators, manual hyperinflation and use of mechanical insufflation-exsufflation (MI-E). Our aim is to identify current airway care practices for invasively ventilated patients in intensive care units (ICU) in the Netherlands. A self–administered web-based survey was sent to a single pre–appointed representative of all ICUs in the Netherlands. Response rate was 85% (72 ICUs). We found substantial heterogeneity in the intensity and combinations of airway care interventions used. Most (81%) ICUs reported using heated humidification as a routine prophylactic intervention. All (100%) responding ICUs used nebulized mucolytics and/or bronchodilators; however, only 43% ICUs reported nebulization as a routine prophylactic intervention. Most (81%) ICUs used manual hyperinflation, although only initiated with a clinical indication like difficult oxygenation. Few (22%) ICUs used MI-E for invasively ventilated patients. Use was always based on the indication of insufficient cough strength or as a continuation of home use. In the Netherlands, use of routine prophylactic airway care interventions is common despite evidence of no benefit. There is an urgent need for evidence of the benefit of these interventions to inform evidence-based guidelines. Full article
(This article belongs to the Special Issue Current Status of Cardiac Anesthesiology and Intensive Care)
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