Mechanical insufflator-exsufflators

Winck JC, Goncalves MR, Lourenco C, et al. Effects of mechanical insufflation-exsufflation on respiratory parameters for patients with chronic airway secretion encumbrance. Chest 2004 126 774-780. 

The Ottawa Hospital. Respiratory therapy policy and procedure mechanical insufflation-exsufflation for paralytic/restrictive disorders. Available at http //www.irrd.ca/education/policy/mie-policy.pdf. Tzeng AC, Bach JR. Prevention of pulmonary morbidity for patients with neuromuscular disease. Chest 2000 118 1390-1396. 

Bach JR. Mechanical insufflation-exsufflation. Comparison of peak expiratory flows with manually assisted and unassisted coughing techniques. Chest 1993 104(5) 1553-1562. 

Sancho J, Servera E, Diaz J. Efficacy of mechanical insufflation-exsufflation in medically stable patients with amyotrophic lateral sclerosis. Chest 2004 125 1400-1405. 

Sancho J, Servera E, Vergara P, et al. 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. 

Gomez-Merino E, Sancho J, Marin J, et al. Mechanical insufflation-exsufflation pressure, volume, and flow relationships and the adequacy of the manufacturer s guidelines. Am J Phys... 

Mechanical insufflator-exsufflators (Cough-Assist, J. H. Emerson Co., Cambridge, Massachusettes, U.S.A.) deliver deep insufflations (at positive pressures of 30 to 50 cmH20) followed immediately by deep exsufflations (at negative pressures of -30 to -50 cmH20). The insufflation and exsufflation pressures and delivery times are independently adjustable (71). With an inspiratory time of two seconds and an expiratory time of three seconds, there exists a very good correlation between the pressures used and the flows obtained (72). 

Figure 11 Mechanical insufflation-exsufflation provided via an oral-nasal mask in a monitorized patient with neuromuscular disease.

Except after a meal, an abdominal thrust is applied in conjunction with the insufflation-exsufflation mechanically assisted coughing (MAC) (66). MI-E can be provided via an oronasal mask (Eig. 11), a simple mouthpiece, or via a translaryngeal or tracheostomy tube. When delivered via the latter, the cuff, when present, should be inflated (73). 

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