Airway clearance techniques in neuromuscular disorders: A state of the art review

Michelle Chatwin; Michel Toussaint; Miguel R Gonçalves; Nicole Sheers; Uwe Mellies; Jesus Gonzales-Bermejo; Jesus Sancho; Brigitte Fauroux; Tiina Andersen; Brit Hov; Malin Nygren-Bonnier; Matthieu Lacombe; Kurt Pernet; Mike Kampelmacher; Christian Devaux; Kathy Kinnett; Daniel Sheehan; Fabrizio Rao; Marcello Villanova; David Berlowitz; Brenda M Morrow

doi:10.1016/j.rmed.2018.01.012

Airway clearance techniques in neuromuscular disorders: A state of the art review

Respir Med. 2018 Mar:136:98-110. doi: 10.1016/j.rmed.2018.01.012. Epub 2018 Feb 6.

Authors

Michelle Chatwin¹, Michel Toussaint², Miguel R Gonçalves³, Nicole Sheers⁴, Uwe Mellies⁵, Jesus Gonzales-Bermejo⁶, Jesus Sancho⁷, Brigitte Fauroux⁸, Tiina Andersen⁹, Brit Hov¹⁰, Malin Nygren-Bonnier¹¹, Matthieu Lacombe¹², Kurt Pernet², Mike Kampelmacher¹³, Christian Devaux¹⁴, Kathy Kinnett¹⁵, Daniel Sheehan¹⁶, Fabrizio Rao¹⁷, Marcello Villanova¹⁸, David Berlowitz⁴, Brenda M Morrow¹⁹

Affiliations

¹ Academic and Clinical Department of Sleep and Breathing and NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, Sydney Street, London, UK. Electronic address: m.chatwin@rbht.nhs.uk.
² Centre for Home Mechanical Ventilation and Specialized Centre for Neuromuscular Diseases, Inkendaal Rehabilitation Hospital, Vlezenbeek, Belgium.
³ Noninvasive Ventilatory Support Unit, Pulmonology Department, Emergency and Intensive Care Medicine Department, São João University Hospital, Faculty of Medicine, University of Porto, Portugal.
⁴ Institute for Breathing and Sleep and Victorian Respiratory Support Service, Austin Health, Melbourne, Australia.
⁵ Departement of Pediatric Pulmonology and Sleep Medicine, Cystic Fibrosis Center Essen, University of Essen, Germany.
⁶ Sorbonne Université, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département "R3S"), Paris, France.
⁷ Respiratory Care Unit, Respiratory Medicine Department, Hospital Clinico Universitario, Valencia, Institute of Health Research INCLIVA, Valencia, Spain.
⁸ Pediatric Noninvasive Ventilation and Sleep Unit, Necker University Hospital, Paris, Paris Descartes University, Paris Research Unit INSERM U 955, Team 13, Creteil, France.
⁹ Norwegian Centre of Excellence for Home Mechanical Ventilation, Thoracic Department and Department of Physiotherapy, Haukeland University Hospital, Bergen Norway, Department of Clinical Science, Medical Faculty, University of Bergen, Bergen, Norway.
¹⁰ Dept of Peadiatric Medicine, Oslo University Hospital, Oslo, Norway and Norwegian Centre of Excellence for Home Mechanical Ventilation, Haukeland University Hospital, Bergen, Norway.
¹¹ Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Functional Area Occupational Therapy and Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden.
¹² Adult Intensive Care Unit, Raymond Poincaré Hospital (AP-HP) Garches, France.
¹³ Home Ventilation Service, University Medical Centre Utrecht, Utrecht, The Netherlands.
¹⁴ Direction des Actions Médicales, Paramédicales et Psychologiques, Association Française Contre Les Myopathies-Téléthon, 91000 EVRY, France.
¹⁵ Parent Project Muscular Dystrophy, 401 Hackensack Ave 9th Floor, Hackensack, NJ 07601, United States.
¹⁶ Assisted Breathing Center, Women and Children's Hospital of Buffalo Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, United States.
¹⁷ Respiratory Unit, Neuromuscular OmniCentre (NeMO), Neurorehabilitation, University of Milan, Niguarda Hospital, Milan, Italy.
¹⁸ Neuromuscular Rehabilitation Unit, Nigrisoli Hospital, Viale Ercolani 7/b - 40125, Bologna, Italy.
¹⁹ Department of Paediatrics and Child Health, University of Cape Town, Klipfontein Rd, Rondebosch, Cape Town, South Africa.

PMID: 29501255
DOI: 10.1016/j.rmed.2018.01.012

Abstract

This is a unique state of the art review written by a group of 21 international recognized experts in the field that gathered during a meeting organized by the European Neuromuscular Centre (ENMC) in Naarden, March 2017. It systematically reports the entire evidence base for airway clearance techniques (ACTs) in both adults and children with neuromuscular disorders (NMD). We not only report randomised controlled trials, which in other systematic reviews conclude that there is a lack of evidence base to give an opinion, but also include case series and retrospective reviews of practice. For this review, we have classified ACTs as either proximal (cough augmentation) or peripheral (secretion mobilization). The review presents descriptions; standard definitions; the supporting evidence for and limitations of proximal and peripheral ACTs that are used in patients with NMD; as well as providing recommendations for objective measurements of efficacy, specifically for proximal ACTs. This state of the art review also highlights how ACTs may be adapted or modified for specific contexts (e.g. in people with bulbar insufficiency; children and infants) and recommends when and how each technique should be applied.

Keywords: Homecare; Neuromuscular disease; Non-invasive ventilation; Respiratory failure; Tracheostomy.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Cough / physiopathology*
Humans
Inhalation / physiology
Lung Volume Measurements / instrumentation
Lung Volume Measurements / methods
Mucociliary Clearance / physiology
Neuromuscular Diseases / physiopathology*
Respiration, Artificial / methods
Respiratory Insufficiency / physiopathology
Respiratory Muscles / physiology