Chatwin Michelle, Wakeman Ruth Helen
NMCCC, The National Hospital for Neurology and Neurosurgery, University College London Hospitals Foundation Trust, London WC1N 3BG, UK.
Clinical and Academic Department of Sleep and Breathing, Royal Brompton Hospital, Part of Guys and St Thomas' NHS Foundation Trust, London SW3 6NP, UK.
J Clin Med. 2023 Mar 31;12(7):2626. doi: 10.3390/jcm12072626.
The provision of mechanical insufflation-exsufflation (MI-E) devices to enhance cough efficacy is increasing. Typically, MI-E devices are used to augment cough in patients with neuromuscular disorders but also in patients who are weak in an acute care setting. Despite a growing evidence base for the use of these devices, there are barriers to the provision of MI-E, including clinician lack of knowledge and confidence. Enhancing clinician education and confidence is key. Individualized or protocolized approaches can be used to initiate MI-E. Evaluation of MI-E efficacy is critical. One method to evaluate effectiveness of MI-E is the MI-E-assisted cough peak flow (CPF). However, this should always be considered alongside other factors discussed in this review. The purpose of this review is to increase the theoretical understanding of the provision and evaluation of MI-E and provide insight into how this knowledge can be applied into clinical practice. Approaches to initiation and titration can be selected based on the clinical situation, patient diagnosis (including and beyond neuromuscular disorders), and clinician's confidence.
用于增强咳嗽效能的机械通气辅助排痰（MI-E）设备的使用正在增加。通常，MI-E设备用于增强神经肌肉疾病患者的咳嗽能力，也用于急性护理环境中身体虚弱的患者。尽管使用这些设备的证据基础不断扩大，但MI-E的提供仍存在障碍，包括临床医生缺乏知识和信心。加强临床医生的教育和信心是关键。可以采用个体化或规范化的方法来启动MI-E。评估MI-E的疗效至关重要。评估MI-E有效性的一种方法是MI-E辅助咳嗽峰流速（CPF）。然而，这应始终与本综述中讨论的其他因素一起考虑。本综述的目的是增加对MI-E的提供和评估的理论理解，并深入了解如何将这些知识应用于临床实践。启动和滴定的方法可以根据临床情况、患者诊断（包括神经肌肉疾病及其他疾病）和临床医生的信心来选择。
