Mechanical insufflation-exsufflation use in neuromuscular disease: a single centre cohort study

BMJ Open Respir Res, 2025 · DOI: 10.1136/bmjresp-2024-002651 · Published: January 1, 2025

Simple Explanation

Mechanical insufflation-exsufflation (MIE) is a technique used to help people with neuromuscular disease clear secretions from their airways. It involves delivering positive pressure to inflate the lungs, followed by negative pressure to simulate a cough. This study looks at how MIE is used in a large group of adults with neuromuscular disease, focusing on the settings used on the devices and how these settings relate to patient survival. The study found that while there are many possible settings on MIE devices, the settings used in practice tend to be within a narrow range, and that increasing age and ALS were associated with shorter life expectancy after starting MIE.

Study Duration

2013-2019

Participants

359 adults established on domiciliary MIE

Evidence Level

Retrospective observational study

Key Findings

1
The most common diagnostic groups using MIE were congenital neuromuscular disease (26%), spinal cord injury (23%), and amyotrophic lateral sclerosis (23%).
2
Median survival following the initiation of MIE was 66 months.
3
Increasing age and amyotrophic lateral sclerosis were significantly associated with shorter life expectancy, while the delivery of MIE via oronasal interface compared with tracheostomy was associated with longer life expectancy.

Research Summary

This study reports on 359 adults established on domiciliary MIE. The range of prescribed settings is narrow, reflecting the limited evidence base in this field and the need to better understand optimal targets for titration of different MIE settings. Median survival is approximately 5 years from initiation of MIE.

Practical Implications

Need for Further Research

Further research is needed to understand how to titrate MIE settings to achieve optimal secretion clearance.

Clinical Decision-Making Support

The study provides characteristics associated with worse survival, which can support clinical decision-making and prompt advanced care planning in high-risk individuals.

Guideline Development

The findings highlight the need for evidence-based guidelines on MIE settings and titration for different diagnostic groups.

Study Limitations

1
The dataset did not include individuals who were initiated on MIE before 2013.
2
As a retrospective study, we were limited to the information that was historically entered into the electronic record system.
3
As a single centre, the findings are limited to practice at our centre, which may not be representative of other long-term ventilation centres.

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