Table 3.
Studies examining volume and cough augmentation achieved during assisted inflation techniques, in medically stable participants with NMD.
| Author/s | Year | Number of participants | Population | Trial design | Hyperinflation therapy | Comparison b/w methods made? | Results |
|---|---|---|---|---|---|---|---|
| Bach (85) | 1993 | 21 | Slow NMD | Prospective | LVR with VCV-NIV MI-E |
Yes | MIC > VC PCFMI-E > PCFMIC+MAC > PCFMIC > PCF |
| Kang and Bach (133) | 2000 | 108 | MND Slow NMD |
Case series | LVR with bag or LVR with VCV-NIV |
No | 90/108 patients: MIC > VC PCFMIC+MAC > PCF |
| Sivasothy et al. (118) | 2001 | 12 | Slow NMD | Prospective Randomised order |
MAC MI with MI-E MI + MAC |
Yes | IC not measured PCFMI+MAC = PCFMAC > PCFMI = PCF |
| Chatwin et al. (95) | 2003 | 22 | Slow NMD | Prospective Randomised order |
MAC NIV ME of MI-E MI-E |
Yes | IC not measured PCFME = PCFMI-E > PCF |
| Mustfa et al. (119) | 2003 | 47 | MND | Prospective Randomised order |
MAC ME of MI-E MI of MI-E MI-E |
Yes | IC not measured PCFMAC = PCFME = PCFMI-E > PCF |
| Sancho et al. (173) | 2004 | 26 | MND | Prospective Order not randomised |
LVR + MAC MI-E + MAC |
Yes | 24/26 patients: MIC > VC |
| Kang et al. (170) | 2005 | 71 | DMD | Prospective | LVR MAC LVR + MAC |
Yes | MIC > VC PCFMIC+MAC > PCFMAC = PCFMIC > PCF |
| Trebbia et al. (92) | 2005 | 10 | Slow NMD | Prospective Randomised order |
MAC IPPB IPPB + MAC |
Yes | LIC with IPPB + MAC > IPPB alone PCFIPPB+MAC > PCFIPPB = PCFMAC > PCF |
| Dohna-Schwake et al. (188) | 2006 | 29 | NMD | Prospective | IPPB | No—single technique | 28/29 patients: LIC > VC 27/29 patients: PCFIPPB+MAC > PCF |
| Kang (134) | 2006 | 40 | SCI | Prospective | LVR MAC LVR + MAC |
Yes | MIC > VC PCFMIC+MAC > PCFMAC > PCFMIC > PCF |
| Bach et al. (174) | 2007 | 78 | DMD | Case series | LVR with bag or LVR with VCV-NIV GPB in subgroup |
Yes | 74/78 patients: MIC > VC PCFMIC+MAC > PCF |
| Bach et al. (164) | 2008 | 282 | MND Slow NMD |
Case series | LVR with bag or LVR with VCV-NIV LVR with bag & valve |
Between two techniques only | LIC > MIC > VC PCFMIC > PCF Did not measure PCFLIC |
| Ishikawa et al. (176) | 2008 | 61 | DMD | Prospective Randomised order |
LVR MAC LVR + MAC |
Yes | IC not measured PCFLVR+MAC > PCFLVR > PCFMAC > PCF |
| Toussaint et al. (90) | 2009 | 179 | Slow NMD | Prospective |
MAC LVR with VCV-NIV LVR + MAC |
Yes | IC not measured PCFLVR+MAC > PCFLVR = PCFMAC > PCF |
| Brito et al. (132) | 2009 | 28 | DMD | Prospective Randomised order |
MAC LVR LVR + MAC |
Yes | IC not measured PCFLVR+MAC > PCFLVR = PCFMAC > PCF |
| Senent et al. (93) | 2011 | 16 | MND | Prospective Randomised order |
MAC LVR + MAC NIV + MAC MI-E |
Yes | IC not measured PCFLVR+MAC = PCFNIV+MAC = PCFMI-E > PCFMAC > PCF |
| Bianchi et al. (189) | 2014 | 18 | Slow NMD | Prospective | MAC LVR GPB Self-thrust LVR + MAC GPB + MAC GPB + self-thrust |
Yes | IC not measured PCF assisted techniques > PCF unassisted. No difference between techniques |
| Lacombe et al. (190) | 2014 | 18 | Slow NMD | Prospective Randomised order |
IPPB + MAC MI-E MI-E + MAC |
Yes | LIC achieved with all three conditions greater than unassisted PCFIPPB+MAC > PCFMI-E+MAC > PCFMI-E > PCF |
| Mellies and Goebel (82) | 2014 | 29 | Slow NMD | Prospective Randomised to group |
IPPB Lung insufflation assist manoeuvre (LIAM)a |
No | LICIPPB > VC, and LICLIAM > VC Optimal LIC to achieve highest assisted PCF = 89%–91% of max LIC |
| Torres-Castro et al. (84) | 2014 | 15 | SCI | Prospective Randomised order |
MAC LVR LVR + MAC |
Yes | IC not measured PCFLVR+MAC > PCFLVR = PCFMAC > PCF |
| Toussaint et al. (191) | 2016 | 52 | DMD | Prospective Randomised to group |
LVR with bag LVR with VCV-NIV |
Yes | MICbag = MICVCV-NIV PCFbag = PCFVCV-NIV |
| Santos et al. (179) | 2017 | 47 | Slow NMD | Prospective | Passive MI-E Actively assisted MI-E |
Yes | LICactive > LICpassive > Spontaneous IC |
| Sarmento et al. (192) | 2017 | 12 MND 12 Controls |
MND | Cross-sectional Matched pairs | LVR | N/A: Comparison b/w MND and healthy controls | PCFLVR > PCF in MND Increase in IC (chest wall and abdominal compartmental volumes) via OEP during LVR |
| Nygren-Bonnier et al. (183) | 2018 | 10 | SCI | Prospective | Glossopharyngeal breathing | No—single technique | MIC > VC. Also increased TLC, HR during manoeuvre, decreased MAP |
| Kikuchi et al. (105) | 2018 | 12 | DMD | Prospective Randomised order | MAC LVR LVR + MAC MI-E MI-E + MAC |
Yes | LIC not measured, only PCFs PCFMI-E+MAC = PCFMI-E = PCFLVR+MAC > PCFLVR > PCFMAC > PCF |
| Iskandar et al. (193) | 2019 | 8 | DMD | Prospective | MAC LVR LVR + MAC |
Yes | LIC not measured, only PCFs PCFLVR+MAC = PCFLVR = PCFMAC > PCF |
| Del Amo Castrillo et al. (194) | 2019 | 20 | Slow NMD | Prospective Randomised order |
LVR with VCV-NIV (MIC) Volumetric cough mode (VCM)b (LIC) |
Yes | MIC vs. LIC not statistically different PCFLIC > PCFMIC > PCF Comfort and perceived cough effectiveness similar |
NMD, neuromuscular disease; MND, motor neurone disease; DMD, Duchenne muscular dystrophy; SCI, spinal cord injury; LVR, lung volume recruitment; VCV-NIV, volume-limited non-invasive ventilation; MAC, manually assisted cough; NIV, non-invasive ventilation; MI, mechanical insufflation; MI-E, mechanical insufflation-exsufflation; ME, mechanical exsufflation; IPPB, inspiratory positive pressure breathing; GPB, glossopharyngeal breathing; MIC, maximal insufflation capacity; VC, vital capacity; PCF, peak cough flow; LIC, lung insufflation capacity; IC, inflation capacity; TLC, total lung capacity; HR, heart rate; MAP, mean arterial blood pressure; OEP, opto-electronic plethysmography.
VENTIlogic LS ventilator mode: pressure-controlled manoeuvre with preset insufflation time and pressure plateau phase.
Astral 150 (Resmed) ventilator mode: volume-controlled hyperinflation breath titrated to achieve LIC, with maximum allowed 500% of baseline VT or PIP 50 cmH2O.
The shaded rows highlight studies that compared degree of inflation volume (i.e., LIC or MIC) between techniques.