FLOW-GENERATING EQUIPMENT TO INCREASE THE PEAK FLOW OF COUGH, IN CHILDREN WITH NEUROMUSCULAR DISEASES AND USERS OF NONINVASIVE VENTILATION

Marisol Barros Poblete, Luis Vasconcello Castillo, Javiera Rosales Fuentes, Vanessa Regiane Resqueti, Rebeca Paiva Reinero, Roberto Vera-Uribe, Rodrigo Torres.Castro, Jaime Ahumada
Purpose:

Our objective was to compare the peak cough flow (PCF) with different cough augmentation techniques in patients with NMD and NIV.

Methods:

A cross-sectional study was performed on patients with NMD admitted to the National home non-invasive ventilation service of the Ministry of Health of Chile. We excluded the tracheostomized and non-collaborator patients. We measured the PCF in five techniques: manual assistance cough (MAC), glossopharyngeal breathing (GPB), air stacking (AS), NIV with 30 cmH2O of IPAP (NIV30), and mechanical in-exsufflation (MIE), and we compared with a spontaneous cough.

Statistic analysis 

SPSS 11.0 software (IMB, Armok, USA) was used for the statistical analysis. Descriptive statistics were presented as mean ± standard deviation for the variables with the normal distribution and frequencies for the variable variables.


Results:

We recruited 19 patients, 63% male (n=12). All patients had a good level of collaboration when performing the techniques. The mean age was 17±2.3 years. The diagnostics were Duchenne muscular dystrophy at 52.6%, spinal muscular atrophy type II at 15.7%, Ulrich muscular dystrophy at 10.5%, and others at 21%. The baseline PCF was 227±96 L/min. For the different techniques, the PCF was: MAC 264±98 L/min (p=0.08), GPB 276±98 L/min (p=0.004), AS 321±101 L/min (p0.001), NIV30 308±102 L/min (p0.001), MIE 294±116 L/min (p=0.04).


Conclusion(s):

All techniques, except MAC, demonstrated increased PCF in patients with neuromuscular diseases and non-invasive ventilation. The most effective techniques were air stacking and non-invasive ventilation.


Implications:

This work opens a path with little evidence, which provides the first evidence to develop a new technique for cough assistance in patients with neuromuscular pathology, which in advanced stages already have available non-invasive ventilatory support equipment, which will optimize ventilatory support and respiratory care in these patients, impacting on respiratory morbidity and survival. In this sense, cough efficiency is a critical point for proper management where respiratory physiotherapy in patients with neuromuscular disease has much to contribute.

Funding acknowledgements:
This work is not funded
Keywords:
Neuromuscular Disease
Respiratory Physiotherapy
Respiratory Care
Primary topic:
Cardiorespiratory
Second topic:
Paediatrics
Third topic:
Disability and rehabilitation
Did this work require ethics approval?:
Yes
Name the institution and ethics committee that approved your work:
Project approved by the Ethics Committee of the Faculty of Medicine of the University of Chile.
Provide the ethics approval number:
235-2016
Has any of this material been/due to be published or presented at another national or international conference prior to the World Physiotherapy Congress 2025?:
No

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