Department of Paediatric Medicine, Oslo University Hospital HF, Oslo, Norway; Norwegian Centre of Excellence for Home Mechanical Ventilation, Haukeland University Hospital, Bergen, Norway.
Norwegian Centre of Excellence for Home Mechanical Ventilation, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Norway.
Paediatr Respir Rev. 2018 Jun;27:69-73. doi: 10.1016/j.prrv.2017.08.003. Epub 2017 Nov 3.
Mechanical insufflation-exsufflation (MI-E) is a strategy to treat pulmonary exacerbations in neuromuscular disorders (NMDs). Pediatric guidelines for optimal setting titration of MI-E are lacking and the settings used in studies vary. Our objective was to assess the actual MI-E settings being used in current clinical treatment of children with NMDs and a survey was sent in July 2016 to European expertise centers. Ten centers from seven countries gave information on MI-E settings for 240 children aged 4 months to 17.8 years (mean 10.5). Settings varied greatly between the centers. Auto mode was used in 71%, triggering of insufflation in 21% and manual mode in 8% of the cases. Mean (SD) time for insufflation (Ti) and exsufflation (Te) were 1.9 (0.5) and 1.8 (0.6) s respectively, both ranging from 1 to 4s. Asymmetric time settings were common (65%). Mean (SD) insufflation (Pi) and exsufflation (Pe) pressures were 32.4 (7.8) and -36.9 (7.4), ranging 10 to 50 and -10 to -60cmHO, respectively. Asymmetric pressures were as common as symmetric. Both Ti, Te, Pi and Pe increased with age (p < 0.001). In conclusion, pediatric MI-E settings in clinical use varied greatly and altered with age, highlighting the need of more studies to improve our knowledge of optimal settings in MI-E in children with NMDs.
机械通气-呼气（MI-E）是治疗神经肌肉疾病（NMD）肺部恶化的一种策略。儿科 MI-E 最佳设置滴定的指南缺乏，而且研究中使用的设置也各不相同。我们的目的是评估当前临床治疗 NMD 儿童时实际使用的 MI-E 设置，并于 2016 年 7 月向欧洲专业中心发送了一项调查。来自七个国家的十个中心提供了 240 名 4 个月至 17.8 岁（平均 10.5 岁）儿童的 MI-E 设置信息。各中心之间的设置差异很大。自动模式在 71%的情况下使用，21%的情况下触发通气，8%的情况下使用手动模式。通气（Ti）和呼气（Te）的平均（SD）时间分别为 1.9（0.5）和 1.8（0.6）秒，范围均为 1 至 4 秒。不对称的时间设置很常见（65%）。通气（Pi）和呼气（Pe）的平均（SD）压力分别为 32.4（7.8）和-36.9（7.4），范围分别为 10 至 50 和-10 至-60cmHO。不对称压力与对称压力一样常见。Ti、Te、Pi 和 Pe 均随年龄增加而增加（p<0.001）。总之，临床使用的儿科 MI-E 设置差异很大，并随年龄而变化，这突出表明需要更多的研究来提高我们对 NMD 儿童 MI-E 最佳设置的认识。
