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

• Published in: Journal of Neurorestoratology 2023-12, Vol.11 (4), p.100080, Article 100080
• Main Authors: Troxell, David A., Bach, John R., Nilsestuen, Jon O.
• Format: Article
• Language: English
• Subjects: 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)
• ISSN: 2324-2426; 2324-2426
• DOI: 10.1016/j.jnrt.2023.100080

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 is a feature of at least one widely available MIE device.