Rate of oral intake and effects of mechanical insufflation-exsufflation on pulmonary complications in patients with duchenne muscular dystrophy.
Toshihiko Miura, Akiyoshi Takami, Misato Makino and 2 others
PMID 28356637WHAT IT FOUND
Fever rates requiring antibiotics did not show a clear difference across cough-assist periods. 43 of 45 DMD patients on full-time ventilation continued oral intake; several treatments were given together, so cough assist alone cannot be credited.
Key findings
01Among 45 patients on full-time NPPV, 43 (95.6%) continued oral intake for an average of 7.2 ± 4.7 years (maximum 16.4 years) without needing tracheal intubation for acute respiratory failure from asphyxia or aspiration pneumonia.
02Fever requiring antibiotics did not differ significantly among the periods, although period C tended to have the highest rate.
03MI-E was introduced when unassisted cough peak flow was below 270 L/min; 35 of 45 full-time NPPV patients used it constantly 3-5 times/day, and 10 used it only for emergencies 0-1 time/month.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for SLPs
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What it does not show
This was a retrospective record review at one hospital, so it cannot prove that MI-E caused the outcomes. Patients who could not be assessed for respiratory function because of impaired comprehension, autism, or tracheostomy were excluded, so the results may not apply to more impaired DMD patients. Swallowing difficulty was not confirmed by video fluoroscopy, and fevers requiring antibiotics were not proven to be aspiration pneumonia. Fever rates did not differ significantly across periods, so the study did not show that MI-E prevented pulmonary complications. Patients also used NPPV during meals and had altered food textures, so the contribution of MI-E alone cannot be separated.
The easy way to misread this
Do not conclude that cough assist alone made oral intake safe or reduced infections. Fever rates requiring antibiotics did not show a clear difference across periods, and patients also used ventilation during meals and had altered food textures, so the effects cannot be separated.