Suri Pradeep, Burns Stephen P, Bach John R
Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA.
Am J Phys Med Rehabil. 2008 Nov;87(11):951-5. doi: 10.1097/PHM.0b013e31817c181e.
Impaired cough that results in ineffective airway secretion clearance is an important contributor to pulmonary complications in patients with neuromuscular weakness including spinal cord injury. Mechanical insufflation-exsufflation (MI-E) is a respiratory aid used by patients with weak respiratory muscles to increase cough peak flows and improve cough effectiveness. Relative contraindications to MI-E are said to include susceptibility to pneumothorax, but the association of pneumothorax with MI-E use has never before been described. We report two cases of pneumothorax in patients with respiratory muscle weakness associated with daily use of MI-E: one was a 58-yr-old male with C4 ASIA C tetraplegia, and the other was a 26-yr-old male with Duchenne muscular dystrophy. Both patients also used positive-pressure ventilatory assistance. Although seemingly rare in this patient population, ventilator users also using MI-E who have increasing dyspnea or who require increasing positive inspiratory pressures when using noninvasive ventilation should be evaluated for pneumothorax.
咳嗽功能受损导致气道分泌物清除无效，是包括脊髓损伤在内的神经肌肉无力患者发生肺部并发症的重要原因。机械通气辅助排痰（MI-E）是呼吸肌无力患者使用的一种呼吸辅助手段，可增加咳嗽峰值流速并提高咳嗽有效性。MI-E的相对禁忌证据说包括气胸易感性，但此前从未描述过气胸与使用MI-E之间的关联。我们报告了两例与每日使用MI-E相关的呼吸肌无力患者发生气胸的病例：一例是一名58岁的男性，患有C4 ASIA C级四肢瘫痪；另一例是一名26岁的男性，患有杜氏肌营养不良症。两名患者均使用了正压通气辅助。尽管在该患者群体中似乎很少见，但对于使用MI-E的呼吸机使用者，如果出现呼吸困难加重或在使用无创通气时需要增加正吸气压力，应评估是否存在气胸。
