Waveforms Analysis in Patients With Amyotrophic Lateral Sclerosis for Enhanced Efficacy of Mechanically Assisted Coughing.

Autor:	Sancho, Jesus, Ferrer, Santos, Bures, Enric, Fernandez-Presa, Lucía, Bañuls, Pilar, Gonzalez, M. Cruz, Signes-Costa, Jaime
Předmět:	CONFIDENCE intervals MULTIVARIATE analysis INSUFFLATION RESPIRATORY obstructions MEDICAL protocols AMYOTROPHIC lateral sclerosis COUGH WAVE analysis DESCRIPTIVE statistics RESEARCH funding ODDS ratio DATA analysis software LOGISTIC regression analysis RECEIVER operating characteristic curves PHENOTYPES LONGITUDINAL method MOTOR neurons
Zdroj:	Respiratory Care; Oct2022, Vol. 67 Issue 10, p1226-1235, 10p
Abstrakt:	BACKGROUND: Effectiveness of mechanical assisted coughing with insufflation-exsufflation (MI-E) in amyotrophic lateral sclerosis (ALS) depends largely on severity of bulbar dysfunction, which can generate different upper-airway responses. The aim of the study was to evaluate the use of graphs generated by MI-E in ALS to detect airway obstruction and set parameters to achieve an effective mechanically assisted coughing. METHODS: This was a prospective study enrolling patients with ALS. Several sessions with MI-E were applied, administering different insufflation-exsufflation (± 20, ± 30, ± 40, ± 50 cm H2O) levels in each session. The graphs produced were recorded and analyzed, and the results were used to select the parameters resulting in more effective MI-E. RESULTS: Sixty-nine subjects with ALS were included, yielding a total of 351 analyzed records. A pattern of obstruction during insufflation was detected in 34 subjects (50.7%) and of upper-airway collapse during exsufflation in 18 subjects (26%). The variable associated with obstruction during insufflation was bulbar upper motor neuron dysfunction (odds ratio 7.19 [95% CI 2.32-22.29], P = .001), whereas bulbar lower motor neuron dysfunction was related to upper-airway collapse during exsufflation (odds ratio 0.32 [95% CI 0.11-0.98], P = .046). After parameters were adjusted, in 68 subjects (98.55%) an effective MI-E was achieved. The only variable that predicted absence of alterations in the graphs was Norris bulbar score (odds ratio 0.87 [95% CI 0.78-0.96], P = .007). CONCLUSIONS: Analysis of graphics generated by applying MI-E in ALS was an effective method to detect upper-airway responses and select optimal set parameters. Obstruction during insufflation is related to bulbar upper motor neuron dysfunction and collapse during exsufflation to bulbar lower motor neuron dysfunction. [ABSTRACT FROM AUTHOR]
Databáze:	Supplemental Index
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