Effect of home mechanical in-exsufflation on hospitalisation and life-style in neuromuscular disease: A pilot study

Authors

  • Fiona CE Moran,

    Corresponding author
    • Department of Physiotherapy, Royal Children's Hospital, Melbourne, Victoria, Australia
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  • Alicia Spittle,

    1. Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia
    2. Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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  • Clare Delany,

    1. Department of Children's Bioethics Centre, Royal Children's Hospital, Melbourne, Victoria, Australia
    2. Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia
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  • Colin F Robertson,

    1. Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
    2. Department of Paediatrics, Melbourne School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
    3. Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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  • John Massie

    1. Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
    2. Department of Paediatrics, Melbourne School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
    3. Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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  • Conflict of interest: All authors have no conflicts of interest to disclose.
  • This study was performed at The Royal Children's Hospital, Melbourne, Australia.
  • No funding was received for this study.

Correspondence: Miss Fiona CE Moran, Department of Physiotherapy, Royal Children's Hospital, Flemington Road, Parkville, Vic. 3052, Australia. Fax: +613 9359 1546; email: fiona.moran@rch.org.au

Abstract

Aim

Mechanical in-exsufflation (MI-E) augments the weakened cough of patients with neuromuscular disease (NMD), clearing secretions and overcoming atelectasis. Little has been published on the impact of MI-E alone on rates of hospitalisation and quality of life (QOL). The aim of this study was to assess the impact of home MI-E on hospital admissions and life-style in children with NMD.

Methods

A retrospective chart review was performed on children using MI-E, including data on the number of admissions to hospital, length of stay and hours of ventilation. A parental survey was used to gather information on the impact of MI-E on life-style for the child and family.

Results

Ten children with NMD (seven spinal muscular atrophy, two Duchenne muscular dystrophy and one centronuclear myopathy) using MI-E at home were identified. MI-E use commenced at mean age of 8.5 years (range 1.1–16.9) with 1.4 years of use (range 0.3–3.8). MI-E pressures ranged from +/−30 to 40 cmH2O with no complications reported. There was a significant reduction in hospital days at 6 (P = 0.036) and 12 (P = 0.028) months following commencement of home MI-E compared with the same period preceding MI-E use. The survey highlighted positive benefits of MI-E use, in particular the ability to treat many pulmonary exacerbations at home.

Conclusions

Home MI-E use by children with NMD can reduce hospitalisation and benefit families by maintaining their child at home.

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