Advertisement

Clinical Implications of Assisted Peak Cough Flow Measured With an External Glottic Control Device for Tracheostomy Decannulation in Patients With Neuromuscular Diseases and Cervical Spinal Cord Injuries: A Pilot Study

  • Seong-Woong Kang
    Correspondence
    Corresponding author Seong-Woong Kang, MD, PhD, Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul 135-720, Korea.
    Affiliations
    Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea
    Search for articles by this author
  • Won Ah Choi
    Affiliations
    Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea
    Search for articles by this author
  • Yu Hui Won
    Affiliations
    Research Institute of Clinical Medicine of Chonbuk National University, Biomechanical Research Institute of Chonbuk National University Hospital, Jeonju-si, Jeollabuk-do, Korea
    Search for articles by this author
  • Jang Woo Lee
    Affiliations
    Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea
    Search for articles by this author
  • Hoo Young Lee
    Affiliations
    Catholic University of Korea Catholic Medical Center National Traffic Injury Rehabilitation Hospital, Yangpyeong-gun, Gyeonggi-do, Korea
    Search for articles by this author
  • Dong Jin Kim
    Affiliations
    Department of Rehabilitation Medicine, SRC Rehabilitation Hospital, Gwangju-si, Gyeonggi-do, Korea
    Search for articles by this author
Published:March 19, 2016DOI:https://doi.org/10.1016/j.apmr.2016.02.023

      Abstract

      Objective

      To investigate the clinical usefulness and significance of an external control device substituting for glottic function in determining the feasibility of decannulation in tracheostomized patients with neuromuscular diseases and cervical spinal cord injuries whose assisted peak cough flow (APCF) was unmeasurable or <160L/min.

      Design

      Before-after trial.

      Setting

      Inpatient setting in a university hospital.

      Participants

      Tracheostomized patients (N=16; 11 with neuromuscular diseases and 5 with cervical spinal cord injuries) were recruited.

      Interventions

      Unassisted peak cough flow (UPCF) and APCF were measured with and without an external glottic control device. Among patients whose APCF without the device was <160L/min, if their APCF with the device was measured as ≥160L/min, they were decannulated. After decannulation, UPCF and APCF were measured again.

      Main Outcome Measures

      APCF with and without an external glottic control device as well as APCF after decannulation.

      Results

      After successful decannulation, APCFs were greater than or equal to those measured with the device before decannulation. No patients underwent intubation or retracheostomy, and there were no respiratory complications.

      Conclusions

      The external glottic control device substituting for innate glottic function is beneficial for determining tracheostomy decannulation. It provides an objective and accurate APCF. It is particularly helpful for patients whose APCF is ≥160L/min while using the device, even if APCF is <160L/min without this device.

      Keywords

      List of abbreviations:

      APCF (assisted peak cough flow), ASIA (American Spinal Injury Association), PCF (peak cough flow), UPCF (unassisted peak cough flow)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Frutos-Vivar F.
        • Esteban A.
        • Apezteguia C.
        • et al.
        Outcome of mechanically ventilated patients who require a tracheostomy.
        Crit Care Med. 2005; 33: 290-298
        • Esteban A.
        • Anzueto A.
        • Alia I.
        • et al.
        How is mechanical ventilation employed in the intensive care unit? An international utilization review.
        Am J Respir Crit Care Med. 2000; 161: 1450-1458
        • Ferrer M.
        • Bernadich O.
        • Nava S.
        • Torres A.
        Noninvasive ventilation after intubation and mechanical ventilation.
        Eur Respir J. 2002; 19: 959-965
        • Chew J.Y.
        • Cantrell R.W.
        Tracheostomy: complications and their management.
        Arch Otolaryngol. 1972; 96: 538-545
        • Bach J.R.
        A comparison of long-term ventilatory support alternatives from the perspective of the patient and care giver.
        Chest. 1993; 104: 1702-1706
        • Bach J.R.
        • Goncalves M.
        Ventilator weaning by lung expansion and decannulation.
        Am J Phys Med Rehabil. 2004; 83: 560-568
        • Stelfox H.T.
        • Crimi C.
        • Berra L.
        • et al.
        Determinants of tracheostomy decannulation: an international survey.
        Crit Care. 2008; 12: R26
        • Budweiser S.
        • Baur T.
        • Jorres R.A.
        • Kollert F.
        • Pfeifer M.
        • Heinemann F.
        Predictors of successful decannulation using a tracheostomy retainer in patients with prolonged weaning and persisting respiratory failure.
        Respiration. 2012; 84: 469-476
        • Heffner J.E.
        The technique of weaning from tracheostomy. Criteria for weaning: practical measures to prevent failure.
        J Crit Illn. 1995; 10: 729-733
        • Godwin J.E.
        • Heffner J.E.
        Special critical care considerations in tracheostomy management.
        Clin Chest Med. 1991; 12: 573-583
        • Bach J.R.
        • Saporito L.R.
        Criteria for extubation and tracheostomy tube removal for patients with ventilatory failure: a different approach to weaning.
        Chest. 1996; 110: 1566-1571
        • Kang S.W.
        • Rha D.W.
        • Ryu H.H.
        • Kang Y.S.
        • Kang Y.J.
        • Moon J.H.
        Analysis of pulmonary mechanics and the factors for coughing in Duchenne muscular dystrophy.
        J Korean Acad Rehabil Med. 2003; 27: 43-48
        • Kang S.W.
        • Ryu H.H.
        • Shin J.C.
        • Kim Y.R.
        • Kim J.E.
        The relationships of coughing to the respiratory muscle strength and pulmonary compliance in tetraplegic patients.
        J Korean Acad Rehabil Med. 2002; 26: 704-708
        • McKim D.A.
        • Hendin A.
        • LeBlanc C.
        • King J.
        • Brown C.R.
        • Woolnough A.
        Tracheostomy decannulation and cough peak flows in patients with neuromuscular weakness.
        Am J Phys Med Rehabil. 2012; 91: 666-670
        • Lee S.C.
        • Park J.H.
        • Kang S.W.
        • Kim D.H.
        • Song S.H.
        External control of exhalation for cough assistance: a method for patients with glottis dysfunction and/or tracheostomy.
        Arch Phys Med Rehabil. 2009; 90: 1402-1407
        • Bach J.R.
        • Ishikawa Y.
        • Kim H.
        Prevention of pulmonary morbidity for patients with Duchenne muscular dystrophy.
        Chest. 1997; 112: 1024-1028
        • Bach J.R.
        Noninvasive ventilation.
        in: Bach J.R. Guide to the evaluation and management of neuromuscular disease. Hanley & Belfus, Philadelphia1999: 89-122
        • Kirby N.A.
        • Barnerias M.J.
        • Siebens A.A.
        An evaluation of assisted cough in quadriparetic patients.
        Arch Phys Med Rehabil. 1966; 47: 705-710
      1. APPENDIX A: American Spinal Injury Association Standard Neurological Classification of Spinal Cord Injury.
        Continuum (Minneap Minn). 2011; 17: 644-645
        • McCool F.D.
        • Leith D.E.
        Pathophysiology of cough.
        Clin Chest Med. 1987; 8: 189-195
        • McCool F.D.
        Global physiology and pathophysiology of cough: ACCP evidence-based clinical practice guidelines.
        Chest. 2006; 129: 48s-53s
        • Choi W.A.
        • Park J.H.
        • Kim D.H.
        • Kang S.W.
        Cough assistance device for patients with glottis dysfunction and/or tracheostomy.
        J Rehabil Med. 2012; 44: 351-354