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In individuals with ventilatory pump failure (VPF) prophylactic, mechanically assisted airway clearance (ACT) by means of Mechanical Insufflation Exsufflation (MIE), is an important mitigation strategy to prevent respiratory infection, decompensation, and ultimately acute respiratory failure (ARF). VPF secondary to respiratory muscle dysfunction is a significant risk factor in neuromuscular disorders, spinal cord injury, chest wall disease, and may occur in some instances of morbid obesity. In the intensive care unit (ICU), MIE has been shown to help avoid the need for tracheostomy tube placement and improve the success rate of extubation from mechanical ventilation, especially when MIE is used in combination with continuous noninvasive ventilatory support (CNVS). Globally, clinicians are recognizing that initial titration of the settings and ongoing management of MIE can be guided by the flow and pressure waveforms that are a feature of at least one widely available MIE device.


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History, evolution, and graphic analyses of mechanical insufflation exsufflation for treatment of neurological disorders

Show Author's information David A. Troxella,#John R. Bachb( )Jon O. Nilsestuenc,d,$
Biomedical and Health Sciences (RBHS) Rutgers University - New Jersey Medical School, 65 Bergen St, Newark, NJ 07107, USA
Department of Physical Medicine and Rehabilitation, Professor of Neurology, Department of Neurology, Rutgers University - New Jersey Medical School, 183 South Orange Ave., Building F1559, Newark, NJ 07103, USA
University of Texas Medical Branch, 400 Harborside Dr Unit 123, Galveston, TX 77555, USA
Research & Education Respiratory Quality Services, 12830 Murphy Rd, Stafford, TX 77477, USA

# Permanent Address: 5 Tweed Ct Highland Mills NY 10930.

$ Permanent Address: 1818 Parkview Dr. Friendswood TX 77546.

Abstract

In individuals with ventilatory pump failure (VPF) prophylactic, mechanically assisted airway clearance (ACT) by means of Mechanical Insufflation Exsufflation (MIE), is an important mitigation strategy to prevent respiratory infection, decompensation, and ultimately acute respiratory failure (ARF). VPF secondary to respiratory muscle dysfunction is a significant risk factor in neuromuscular disorders, spinal cord injury, chest wall disease, and may occur in some instances of morbid obesity. In the intensive care unit (ICU), MIE has been shown to help avoid the need for tracheostomy tube placement and improve the success rate of extubation from mechanical ventilation, especially when MIE is used in combination with continuous noninvasive ventilatory support (CNVS). Globally, clinicians are recognizing that initial titration of the settings and ongoing management of MIE can be guided by the flow and pressure waveforms that are a feature of at least one widely available MIE device.

Keywords: Amyotrophic lateral sclerosis (ALS), Continuous noninvasive ventilatory support (CNVS), Cough peak flows (CPF), Mechanical insufflation exsufflation (MI-E, MIE), Motor neuron disease (MND), Neuromuscular disease (NMD)

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Publication history
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Publication history

Received: 03 May 2023
Revised: 27 July 2023
Accepted: 19 August 2023
Published: 26 September 2023
Issue date: December 2023

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© 2023 The Authors.

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This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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