From bedside to bench - In vivo and in vitro evaluation of mechanically assisted cough treatment in a patient with bulbar Amyotrophic Lateral Sclerosis

• Published in: Respiratory medicine case reports 2022-01, Vol.37, p.101649, Article 101649
• Main Authors: Andersen, Tiina, Fondenes, Ove, Røksund, Ola Drange, Clemm, Hege, Halvorsen, Thomas, Vollsæter, Maria
• Format: Article
• Language: English
• Subjects: Amyotrophic lateral sclerosis; Bulbar insufficiency; Case Report; Mechanical insufflation-exsufflation; Mechanically assisted cough; Rise time; Waveforms
• ISSN: 2213-0071; 2213-0071
• DOI: 10.1016/j.rmcr.2022.101649

When the ability to cough is impaired, secretion clearance may be assisted and augmented by Mechanical Insufflation-Exsufflation (MI-E) treatment. In patients with Amyotrophic Lateral Sclerosis, the efficacy of MI-E may be hampered by counterproductive upper airway responses. Careful adjustment of MI-E settings can be beneficial. During the disease progression, a 41-year-old woman with bulbar Amyotrophic Lateral Sclerosis experienced that treatment with MI-E was exhausting and inefficient. Despite adjustments of settings, all treatment led to retching. A change of MI-E device led to more effective treatment. A bench test revealed variations in flow and pressure waveforms in the two devices. When MI-E treatment fails, differences in equipment delivery need to be considered in addition to the adjustment of MI-E settings. •Effective airway clearance and subjective tolerance must be targeted to maintain compliance with MI-E therapy in ALS.•Examination of MI-E waveforms may provide clinically relevant information.•Skillful adjustment of MI-E settings and knowledge of performance between devices may be important with challenging patients.