http://simri.it/en/
2018 31 MAG
Type of content: news
Communicative register:
Focus area: Physicians

The use of mechanical insufflation-exsufflation in children with neuromuscular disorders needs evidence

Recently, a norvegian group of study produced a review about the clinical use of mechanical insufflation-exsufflation in children with neuromuscular disorders in Europe.

Children with neuromuscular disorders often have impaired ability to cough, causing respiratory complications. The use of mechanical insufflation-exsufflation (MI-E) is a strategy to treat respiratory tract infections, as it increases peak cough flow (PCF), thus removes bronchial secretion. MI-E settings such as in- and exsufflation times and pressures and inspiration flow can be titrated. A wide range of settings have been used in pediatric MI-E studies, possibly adapted from adult studies. Neither guidelines nor evidence of optimal MI-E settings for infants and children are available. 
Recently, a norvegian group of study produced a review about the clinical use of mechanical insufflation-exsufflation in children with neuromuscular disorders in Europe.
Data were collected in 10 European centers with expertise in long term mechanical ventilation (Belgium, England, Italy, Netherlands, Norway, Spain, and Sweden, resulting in 240 cases.
Data requested were diagnosis, age, PCF, and primary settings of insufflation and exsufflation times (Ti and Te), pressures (Pi and Pe), the mode (Manual/Auto), use of triggering function or Pause time (Tp), and the inspiratory flow.
The present survey showed a wide variation of MI-E settings used in children with NMDs and that settings altered with age.  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 4 s. Asymmetric time settings were common (65%). Asymmetric pressures were as common as symmetric. Both Ti, Te, Pi and Pe increased with age (p < 0.001).
The great variability of settings from this study is in line with great variation used in previous MI-E studies, highlighting the lack of evidence and guidelines in pediatric MI-E titration.

References:
- Morrow B, Zampoli M, van Aswegen H, Argent A. Mechanical insufflation- exufflation for people with neuromuscular disorders (Review). Cochrane Library 2013(12).
- Hov B et al. The clinical use of mechanical insufflation-exsufflation in children with neuromuscular disorders in Europe. Paediatr Resp Rev (2017), https://doi.org/10.1016/j.prrv.2017.08.003

Article by Claudio Cherchi