The effect of mechanical insufflation – exsufflation on spinal cord injury patients with respiratory problems. A systematic scoping review
Keywords:
spinal cord injuries, quadriplegia, tetraplegia, mechanical insufflation - exsufflation, cough assistAbstract
Respiratory dysfunction remains a significant cause of morbidity and mortality after spinal cord injury (SCI).
The purpose of this scoping review is to investigate the effectiveness of mechanical insufflation - exsufflation (MI-E) device, for cough augmentation and secretion management, in patients with SCI.
Electronic databases Medline (pubmed), Cochrane, PEDro, DynaMed, CINALH, and electronic libraries Scopus, ScienceDirect and Google Scholar were searched for relevant literature.
Inclusion criteria concerned studies referring to traumatic spinal cord injuries, carried out from 1/1/2000 until 9/12/2021, written in English language. All types of articles were accepted. Studies on children, animals and neuromuscular diseases as well as book chapters and article abstracts were excluded.
The articles were searched systematically. Fifteen studies were found to meet the inclusion criteria. The search revealed 1 randomized control trial (RCT), 5 retrospective studies, 2 cross-sectional studies, 3 observational studies and 4 case reports.
The reviewed evidence of the utilization of MI-E device resulted to improved pulmonary parameters, shorter hospitalization and successful weaning in patients with SCIs. Although, the reviewed evidence is weak and limited, in clinical practice the usage of MI-E device in patients with SCIs, is encouraging.
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References
1. WHO (World Health Organization) (www.who.int).
2. Majdan M, Plancikova D, Nemcovska E, Krajcovicova L, Brazinova A, Rusnak M. Mortality due to traumatic spinal cord injuries in Europe: a cross-sectional and pooled analysis of population-wide data from 22 countries. Scand J Trauma Resusc Emerg Med. 2017 Jul 3;25(1):64. doi: 10.1186/s13049-017-0410-0. PubMed PMID: 28673315.
3. Harvey L. Respiratory management. In: Anonymous, editor. Management of Spinal Cord Injuries: A Guide for Physiotherapists. Vol 1. New York: Elsevier Ltd; 2008. pp. 205–225. [Google Scholar]
4. Bhaskar KR, Brown R, O’Sullivan DD, Melia S, Duggan M, Reid L Am Rev Respir Dis. 1991 Mar; 143(3):640-8. [PubMed]
5. Auger C, Hernando V, Galmiche H. Use of Mechanical Insufflation-Exsufflation Devices for Airway Clearance in Subjects With Neuromuscular Disease. Respir Care. 2017 Feb;62(2):236-245. doi: 10.4187/respcare.04877. PMID: 28108686 Review.
6. Benditt JO. Respiratory Care of Patients With Neuromuscular Disease. Respir Care. 2019 Jun;64(6):679-688. doi: 10.4187/respcare.06827. PMID: 31110036 Free article. Review.
7. Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467–73.
8. Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther. 2003 Aug; 83(8):713-21.
9. Sackett DL, Straus SE, Richardson WS, et al. Evidence-Based Medicine: How to Practice and Teach EBM. 2nd ed. Edinburgh, Scotland: Churchill Livingstone Inc; 2000:173-177.
10. Michael Berlly, Kazuko Shem Respiratory Management During the First Five Days After Spinal Cord Injury. J Spinal Cord Med. 2007; 30(4): 309–318. doi: 10.1080/10790268.2007.11753946. PMCID: PMC2031940
11. Bach JR. Update and perspective on noninvasive respiratory muscle aids: part 2. The expiratory aids. Chest. 1994;1 05:1538-1544.
12. Miske LJ, Hickey EM, Kolb SM, Weiner DJ, Panitch HB. Use of the mechanical in-exsufflator in pediatric patients with neuromuscular disease and impaired cough. Chest. 2004; 125:1406-1412.
13. Bach JR. Mechanical insufflation-exsufflation. Comparison of peak expiratory flows with manually assisted and unassisted coughing techniques. Chest. 1993;1 04:1553- 1562.
14. Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19–32.
15. Pillastrini P, Bordini S, Bazzocchi G, Belloni G, Menarini M. Study of the effectiveness of bronchial clearance in subjects with upper spinal cord injuries: examination of a rehabilitation programme involving mechanical insufflation and exsufflation. Spinal Cord. 2006 Oct;44(10):614-6. doi:10.1038/sj.sc.3101870. Epub 2005 Dec 13. PMID: 16344851.
16. Prevost S, Brooks D, Bwititi PT. Mechanical insufflation-exsufflation: Practice patterns among respiratory therapists in Ontario. Can J Respir Ther. 2015 Spring;51(2):33-8. PMID: 26089736; PMCID: PMC4467476.
17. Bach JR, Saporito LR, Shah HR, Sinquee D. Decanulation of patients with severe respiratory muscle insufficiency: efficacy of mechanical insufflation- exsufflation. J Rehabil Med. 2014 Nov;46(10):1037-41. doi: 10.2340/16501977-1874. PMID: 25096928
18. McCaughey EJ, McLean AN, Allan DB, Gollee H. Abdominal functional electrical stimulation to enhance mechanical insufflation-exsufflation. J Spinal Cord Med. 2016 Nov;39(6):720-725. doi: 10.1080/10790268.2015.1114226. Epub 2015 Dec 21.PMID: 26689243; PMCID: PMC5137572.
19. Rose L, McKim D, Leasa D, Nonoyama M, Tandon A, Kaminska M, O’Connell C, Loewen A, Connolly B, Murphy P, Hart N, Road J. Monitoring Cough Effectiveness and Use of Airway Clearance Strategies: A Canadian and UK Survey. Respir Care. 2018 Dec;63(12):1506-1513. doi: 10.4187/respcare.06321. Epub 2018 Sep 11. PMID: 30206128.
20. Bach JR. Mechanical insufflation-exsufflation. Comparison of peak expiratory flow with manually assisted and unassisted coughing techniques. Chest 1993; 104: 1553–1621.Crew JD, Svircev JN, Burns SP. Mechanical insufflation-exsufflation device prescription for outpatients with tetraplegia. J Spinal Cord Med. 2010;33(2):128-34. doi: 10.1080/10790268.2010.11689687. PMID: 20486531
21. Crew JD, Svircev JN, Burns SP. Mechanical insufflation-exsufflation device prescription for outpatients with tetraplegia. J Spinal Cord Med. 2010;33(2):128-134. doi:10.1080/10790268.2010.11689687
22. Fauzi, Aishah A and Hasnan, N and Tan, JH. Pulmonary rehabilitation using mechanical insufflation-exsufflation therapy for spinal cord injury--two case studies in the university malaya medical centre. Journal of Health and Translational Medicine 2017; 20(2): 31-33.
23. Chang, Jee-Eun and Park, Sang-Hyun and Do, Sang-Hwan and Song, In Ae. Successful weaning from mechanical ventilation in the quadriplegia patient with C2 spinal cord injury undergoing C2-4 spine laminoplasty-A case report. Korean journal of anesthesiology. 2013; 64(6): 545. Korean Society of Anesthesiologists
24. Wong SL, Shem K, Crew J. Specialized respiratory management for acute cervical spinal cord injury: a retrospective analysis. Top Spinal Cord Inj Rehabil. 2012 Fall;18(4):283-90. doi: 10.1310/sci1804-283. PMID: 23459555
25. T Sugiyama, K Hanayama, H Metani, Kazunari Furusawa, Masaki Hyodo. Effects of mechanical insufflation-exsufflation on compartmental chest wall volume in patients with chronic cervical spinal cord injuries. Kawasaki Medical Journal 46:9-16 doi:10.11482/KMJ-E202046009
26. Garstang SV, Kirshblum SC, Wood KE. Patient preference for in-exsufflation for secretion management with spinal cord injury. J Spinal Cord Med. 2000 Summer;23(2):80-5. doi: 10.1080/10790268.2000.11753511. PMID: 10914345
27. Schmitt JK, Stiens S, Trincher R, Lam M, Sarkarati M, Linder S, Ho CH. Survey of use of the insufflator-exsufflator in patients with spinal cord injury. J Spinal Cord Med. 2007;30(2):127-30. doi: 10.1080/10790268.2007.11753923. PMID: 17591224
28. Juni P, Holenstein F, Sterne J. Direction and impact of language bias in metaanalyses of controlled trials: empirical study. Int J Epidemiol. 2002; 31 pp:115–123
29. Moher D, Fortin P, Jadad AR, et al. Completeness of reporting of trials published in languages other than English: implications for conduct and reporting of systematic reviews. Lancet. 1996; 347: pp.363–366.
30. Moher D, Pham B, Lawson ML, Klassen TP. The inclusion of reports of randomised trials published in languages other than English in systematic reviews. Health Technol Assess. 2003; 7: pp.1–90.
31. Morrison A, Polisena J, Husereau D, et al. The effect of English-language restriction on systematic review-based meta-analyses: a systematic review of empirical studies. Int J Technol Assess Health Care. 2012; 28: pp.138–144.
32. Sutton AJ, Duval SJ, Tweedie RL, et al. Empirical assessment of effect of publication bias on meta-analyses. 2000; 320: pp.1574–1577.
33. Sancho J, Servera E, Diaz J, Marin J. Efficacy of mechanical insufflation-exsufflation in medically stable patients with amyotrophic lateral sclerosis. Chest 2004;125:1400-5.
34. Gomez-Merino E, Sancho J, Marin J, et al. Mechanical insufflationexsufflation: Pressure, volume and flow relationships and the adequacy of the manufacturer’s guidelines. Am J Phys Med Rehabil 2002;81:579-83.
35. Cochrane L, Olson C, Murray S, Dupuis M, Tooman T, Hayes S. Gaps between knowing and doing: understanding and assessing the barriers to optimal health care. Contin Educ Health Prof J 2007;27(2):94-102.
36. Goldman JM, Rose LS, Morgan MD, Denison DM: Measurement of abdominal wall compliance in normal subjects and tetraplegic patients. Thorax 1986;41: 513-518.
37. Liszner K, Feinberg M. Cough assist strategy for pulmonary toileting in ventilator-dependent spinal cord injured patients. Rehabil Nurs 2006; 31: 218-21.
38. Sivasothy P, Brown L, Smith IE, Shneerson JM. Effect of manually assisted cough and mechanical insufflation on cough flow of normal subjects, patient with chronic obstructive pulmonary disease (COPD), and patients with respiratory muscle weakness. Thorax 2001;56:438–444.
39. Winck J, Goncalves M, Lourenco C, Viana P, Almeida J, Bach JR. Effects of mechanical insufflation-exsufflation on respiratory parameters for patients with chronic airway secretion encumbrance. Chest 2004;126:774-80.
40. Bach JR, Sinquee DM, Saporito LR, Botticello AL. Efficacy of mechanical insufflation-exsufflation in extubating unweanable subjects with restrictive pulmonary disorders. Respir Care. 2015 Apr;60(4):477-83. doi: 10.4187/respcare.03584. Epub 2014 Dec 9. PMID: 25492956.
41. Ehsanian, Reza MD, PhD; Klein, Christina MD; Mohole, Jyodi BS; Colaci, Joshua RRT-RSPT; Pence, Benjamin T. DO; Crew, James MD; McKenna, Stephen MD. A Novel Pharyngeal Clearance Maneuver for Initial Tracheostomy Tube Cuff Deflation in High Cervical Tetraplegia. American Journal of Physical Medicine & Rehabilitation: September 2019 - Volume 98 - Issue 9 - p 835-838. doi: 10.1097/PHM.0000000000001192
42. .Kopp MA, Watzlawick R, Martus P, et al: Long-term functional outcome in patients with acquired infections after acute spinal cord injury. Neurology 2017;88:892–900
2. Majdan M, Plancikova D, Nemcovska E, Krajcovicova L, Brazinova A, Rusnak M. Mortality due to traumatic spinal cord injuries in Europe: a cross-sectional and pooled analysis of population-wide data from 22 countries. Scand J Trauma Resusc Emerg Med. 2017 Jul 3;25(1):64. doi: 10.1186/s13049-017-0410-0. PubMed PMID: 28673315.
3. Harvey L. Respiratory management. In: Anonymous, editor. Management of Spinal Cord Injuries: A Guide for Physiotherapists. Vol 1. New York: Elsevier Ltd; 2008. pp. 205–225. [Google Scholar]
4. Bhaskar KR, Brown R, O’Sullivan DD, Melia S, Duggan M, Reid L Am Rev Respir Dis. 1991 Mar; 143(3):640-8. [PubMed]
5. Auger C, Hernando V, Galmiche H. Use of Mechanical Insufflation-Exsufflation Devices for Airway Clearance in Subjects With Neuromuscular Disease. Respir Care. 2017 Feb;62(2):236-245. doi: 10.4187/respcare.04877. PMID: 28108686 Review.
6. Benditt JO. Respiratory Care of Patients With Neuromuscular Disease. Respir Care. 2019 Jun;64(6):679-688. doi: 10.4187/respcare.06827. PMID: 31110036 Free article. Review.
7. Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467–73.
8. Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther. 2003 Aug; 83(8):713-21.
9. Sackett DL, Straus SE, Richardson WS, et al. Evidence-Based Medicine: How to Practice and Teach EBM. 2nd ed. Edinburgh, Scotland: Churchill Livingstone Inc; 2000:173-177.
10. Michael Berlly, Kazuko Shem Respiratory Management During the First Five Days After Spinal Cord Injury. J Spinal Cord Med. 2007; 30(4): 309–318. doi: 10.1080/10790268.2007.11753946. PMCID: PMC2031940
11. Bach JR. Update and perspective on noninvasive respiratory muscle aids: part 2. The expiratory aids. Chest. 1994;1 05:1538-1544.
12. Miske LJ, Hickey EM, Kolb SM, Weiner DJ, Panitch HB. Use of the mechanical in-exsufflator in pediatric patients with neuromuscular disease and impaired cough. Chest. 2004; 125:1406-1412.
13. Bach JR. Mechanical insufflation-exsufflation. Comparison of peak expiratory flows with manually assisted and unassisted coughing techniques. Chest. 1993;1 04:1553- 1562.
14. Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19–32.
15. Pillastrini P, Bordini S, Bazzocchi G, Belloni G, Menarini M. Study of the effectiveness of bronchial clearance in subjects with upper spinal cord injuries: examination of a rehabilitation programme involving mechanical insufflation and exsufflation. Spinal Cord. 2006 Oct;44(10):614-6. doi:10.1038/sj.sc.3101870. Epub 2005 Dec 13. PMID: 16344851.
16. Prevost S, Brooks D, Bwititi PT. Mechanical insufflation-exsufflation: Practice patterns among respiratory therapists in Ontario. Can J Respir Ther. 2015 Spring;51(2):33-8. PMID: 26089736; PMCID: PMC4467476.
17. Bach JR, Saporito LR, Shah HR, Sinquee D. Decanulation of patients with severe respiratory muscle insufficiency: efficacy of mechanical insufflation- exsufflation. J Rehabil Med. 2014 Nov;46(10):1037-41. doi: 10.2340/16501977-1874. PMID: 25096928
18. McCaughey EJ, McLean AN, Allan DB, Gollee H. Abdominal functional electrical stimulation to enhance mechanical insufflation-exsufflation. J Spinal Cord Med. 2016 Nov;39(6):720-725. doi: 10.1080/10790268.2015.1114226. Epub 2015 Dec 21.PMID: 26689243; PMCID: PMC5137572.
19. Rose L, McKim D, Leasa D, Nonoyama M, Tandon A, Kaminska M, O’Connell C, Loewen A, Connolly B, Murphy P, Hart N, Road J. Monitoring Cough Effectiveness and Use of Airway Clearance Strategies: A Canadian and UK Survey. Respir Care. 2018 Dec;63(12):1506-1513. doi: 10.4187/respcare.06321. Epub 2018 Sep 11. PMID: 30206128.
20. Bach JR. Mechanical insufflation-exsufflation. Comparison of peak expiratory flow with manually assisted and unassisted coughing techniques. Chest 1993; 104: 1553–1621.Crew JD, Svircev JN, Burns SP. Mechanical insufflation-exsufflation device prescription for outpatients with tetraplegia. J Spinal Cord Med. 2010;33(2):128-34. doi: 10.1080/10790268.2010.11689687. PMID: 20486531
21. Crew JD, Svircev JN, Burns SP. Mechanical insufflation-exsufflation device prescription for outpatients with tetraplegia. J Spinal Cord Med. 2010;33(2):128-134. doi:10.1080/10790268.2010.11689687
22. Fauzi, Aishah A and Hasnan, N and Tan, JH. Pulmonary rehabilitation using mechanical insufflation-exsufflation therapy for spinal cord injury--two case studies in the university malaya medical centre. Journal of Health and Translational Medicine 2017; 20(2): 31-33.
23. Chang, Jee-Eun and Park, Sang-Hyun and Do, Sang-Hwan and Song, In Ae. Successful weaning from mechanical ventilation in the quadriplegia patient with C2 spinal cord injury undergoing C2-4 spine laminoplasty-A case report. Korean journal of anesthesiology. 2013; 64(6): 545. Korean Society of Anesthesiologists
24. Wong SL, Shem K, Crew J. Specialized respiratory management for acute cervical spinal cord injury: a retrospective analysis. Top Spinal Cord Inj Rehabil. 2012 Fall;18(4):283-90. doi: 10.1310/sci1804-283. PMID: 23459555
25. T Sugiyama, K Hanayama, H Metani, Kazunari Furusawa, Masaki Hyodo. Effects of mechanical insufflation-exsufflation on compartmental chest wall volume in patients with chronic cervical spinal cord injuries. Kawasaki Medical Journal 46:9-16 doi:10.11482/KMJ-E202046009
26. Garstang SV, Kirshblum SC, Wood KE. Patient preference for in-exsufflation for secretion management with spinal cord injury. J Spinal Cord Med. 2000 Summer;23(2):80-5. doi: 10.1080/10790268.2000.11753511. PMID: 10914345
27. Schmitt JK, Stiens S, Trincher R, Lam M, Sarkarati M, Linder S, Ho CH. Survey of use of the insufflator-exsufflator in patients with spinal cord injury. J Spinal Cord Med. 2007;30(2):127-30. doi: 10.1080/10790268.2007.11753923. PMID: 17591224
28. Juni P, Holenstein F, Sterne J. Direction and impact of language bias in metaanalyses of controlled trials: empirical study. Int J Epidemiol. 2002; 31 pp:115–123
29. Moher D, Fortin P, Jadad AR, et al. Completeness of reporting of trials published in languages other than English: implications for conduct and reporting of systematic reviews. Lancet. 1996; 347: pp.363–366.
30. Moher D, Pham B, Lawson ML, Klassen TP. The inclusion of reports of randomised trials published in languages other than English in systematic reviews. Health Technol Assess. 2003; 7: pp.1–90.
31. Morrison A, Polisena J, Husereau D, et al. The effect of English-language restriction on systematic review-based meta-analyses: a systematic review of empirical studies. Int J Technol Assess Health Care. 2012; 28: pp.138–144.
32. Sutton AJ, Duval SJ, Tweedie RL, et al. Empirical assessment of effect of publication bias on meta-analyses. 2000; 320: pp.1574–1577.
33. Sancho J, Servera E, Diaz J, Marin J. Efficacy of mechanical insufflation-exsufflation in medically stable patients with amyotrophic lateral sclerosis. Chest 2004;125:1400-5.
34. Gomez-Merino E, Sancho J, Marin J, et al. Mechanical insufflationexsufflation: Pressure, volume and flow relationships and the adequacy of the manufacturer’s guidelines. Am J Phys Med Rehabil 2002;81:579-83.
35. Cochrane L, Olson C, Murray S, Dupuis M, Tooman T, Hayes S. Gaps between knowing and doing: understanding and assessing the barriers to optimal health care. Contin Educ Health Prof J 2007;27(2):94-102.
36. Goldman JM, Rose LS, Morgan MD, Denison DM: Measurement of abdominal wall compliance in normal subjects and tetraplegic patients. Thorax 1986;41: 513-518.
37. Liszner K, Feinberg M. Cough assist strategy for pulmonary toileting in ventilator-dependent spinal cord injured patients. Rehabil Nurs 2006; 31: 218-21.
38. Sivasothy P, Brown L, Smith IE, Shneerson JM. Effect of manually assisted cough and mechanical insufflation on cough flow of normal subjects, patient with chronic obstructive pulmonary disease (COPD), and patients with respiratory muscle weakness. Thorax 2001;56:438–444.
39. Winck J, Goncalves M, Lourenco C, Viana P, Almeida J, Bach JR. Effects of mechanical insufflation-exsufflation on respiratory parameters for patients with chronic airway secretion encumbrance. Chest 2004;126:774-80.
40. Bach JR, Sinquee DM, Saporito LR, Botticello AL. Efficacy of mechanical insufflation-exsufflation in extubating unweanable subjects with restrictive pulmonary disorders. Respir Care. 2015 Apr;60(4):477-83. doi: 10.4187/respcare.03584. Epub 2014 Dec 9. PMID: 25492956.
41. Ehsanian, Reza MD, PhD; Klein, Christina MD; Mohole, Jyodi BS; Colaci, Joshua RRT-RSPT; Pence, Benjamin T. DO; Crew, James MD; McKenna, Stephen MD. A Novel Pharyngeal Clearance Maneuver for Initial Tracheostomy Tube Cuff Deflation in High Cervical Tetraplegia. American Journal of Physical Medicine & Rehabilitation: September 2019 - Volume 98 - Issue 9 - p 835-838. doi: 10.1097/PHM.0000000000001192
42. .Kopp MA, Watzlawick R, Martus P, et al: Long-term functional outcome in patients with acquired infections after acute spinal cord injury. Neurology 2017;88:892–900
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