CRP19 MECHANICAL INSUFFLATION-EXSUFFLATION IN IMPAIRED COUGH OF DIFFERENT AETIOLOGY

Xiao Shuang Chua, Hwee Nee Chin, Lailatul Fauziah, Nasirah Rosli, Yee Yen Tan
Department of Paediatrics, Hospital Tengku Ampuan Rahimah Klang, Selangor, Malaysia

Mechanical insufflation-exsufflation (MI-E) is a specialized device that delivers a positive pressure to insufflate the lungs, followed by a rapid negative pressure to mimic a cough. Evidence of benefit of MI-E has been largely focused on neuromuscular diseases (NMD). However, in our experience, MI-E can also be useful also in patients with impaired cough of aetiology other than NMD.

We describe three patients with impaired cough of different aetiologies who had benefited from MI-E therapy. Case 1 was an infant with Spinal Muscular Atrophy (SMA) type 1. Case 2 was a toddler with spastic quadriplegic cerebral palsy with bulbar involvement (absent gag and cough reflex). Case 3 was a teenager with severe restrictive lung disease due to scoliosis. All of them were acutely admitted for pneumonia, initially treated with the standard antibiotics and conventional chest physiotherapy, however remained in respiratory distress and were not able to wean off respiratory support. After two weeks of admission, they were referred to the Paediatric Respiratory team. Due to impaired cough, MI-E therapy was commenced for all of them. Adjunct airway clearance therapies and lung recruitment strategies were used as appropriate, for example non-invasive ventilation. All of them had marked improvement. Within 1-4 weeks, they were able to wean respiratory support. Chest x-ray clearance were documented for all of them. There was no adverse event associated with the use of MI-E.

In summary, MI-E should be considered for patients with impaired cough of any aetiology and are admitted for acute respiratory tract infection. MI-E is especially important for those who are not responding to standard therapy leading to prolonged hospital stay. MI-E, when used appropriately on patients with impaired cough, could potentially lead to a smoother and quicker recovery.