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Mechanical Insufflation-Exsufflation vs. Tracheal Suctioning via Tracheostomy Tubes for Patients with Amyotrophic Lateral Sclerosis: A Pilot Study

Sancho, Jesús MD; Servera, Emilio MD, FCCP; Vergara, Pedro RT; Marín, Julio MD, FCCP

American Journal of Physical Medicine & Rehabilitation: October 2003 - Volume 82 - Issue 10 - p 750-753
doi: 10.1097/01.PHM.0000087456.28979.2E
Research Articles: Ventilation

Sancho J, Servera E, Vergara P, Marín J: Mechanical insufflation-exsufflation vs. tracheal suctioning via tracheostomy tubes for patients with amyotrophic lateral sclerosis: A pilot study. Am J Phys Med Rehabil 2003;82:750–753.

Objective To compare the effects of mechanical insufflation-exsufflation vs. suctioning via tracheostomy tubes on respiratory variables for six amyotrophic lateral sclerosis patients.

Design In this prospective crossover study, six consecutive patients with amyotrophic lateral sclerosis who required continuous mechanical ventilation via tracheostomy tubes and developed chest infections underwent measurement of pulse oxyhemoglobin saturation (SpO2), peak inspiratory pressure (PIP), mean airway pressure (Pawm), and work of breathing performed by the ventilator (WOBv) at baseline and 5 and 30 min after tracheal suctioning and 5 min after mechanical insufflation-exsufflation.

Results The baseline values were 93.50 ± 2.26% for SpO2 in ambient air, 18.50 ± 4.23 cm H2O for PIP, 4.67 ± 1.37 cm H2O for Pawm, and 1.03 ± 0.25 J/liters for WOBv. Only WOBv changed significantly, decreasing after tracheal suctioning (P < 0.05), whereas all variables improved significantly after mechanical insufflation-exsufflation.

Conclusion For ventilator-dependent patients with amyotrophic lateral sclerosis, mechanical insufflation-exsufflation via a tracheostomy tube with an inflated cuff may be more effective in eliminating airway secretions than conventional tracheal suctioning.

From the Department of Respiratory Medicine, Hospital Clínico Universitario, Universitat de Valencia, Spain.

All correspondence and requests for reprints should be addressed to Jesús Sancho, MD, Department of Respiratory Medicine, Hospital Clínico Universitario, Universitat de Valencia, Avd. Blasco Ibanez 17, Valencia, Spain 46020.

© 2003 Lippincott Williams & Wilkins, Inc.