Summary of Study on Mechanical Insufflation-Exsufflation (MI-E) in Children with Neuromuscular Weakness
Study Overview
A retrospective study conducted in Utrecht, Netherlands, examined the impact of Mechanical Insufflation-Exsufflation (MI-E) devices on children with neuromuscular weakness from 2005 to 2019. The study focused on the frequency of hospitalisations due to recurrent respiratory infections (RTIs) and the length of stay in the hospital, demonstrating that MI-E can reduce both.
Importance of MI-E Devices in Pediatrics
Children with neuromuscular diseases, such as spinal muscular atrophy (SMA) and Duchenne muscular dystrophy (DMD), often face challenges in coughing effectively, leading to increased risk of RTIs. Airway clearance techniques are crucial for managing these conditions. Although air stacking is commonly used in the Netherlands, MI-E is gaining attention for its potential benefits.
Study Design
- Participants: 37 children (average age 5.2 years) who began using MI-E at home.
- Method: Children typically used air stacking twice daily before transitioning to MI-E. Each MI-E session involved three cycles of inhalations and exhalations.
- Data Collection: The study analysed clinical data and parent/caregiver experiences, focusing on hospitalisations rates and duration of stays three years before and after MI-E initiation.
Key Findings
- Hospitalisation Rates: After starting MI-E, the median number of hospitalisation for RTIs per 1,000 days decreased significantly from 3.7 to 0.9. The median number of hospitalisation days also dropped dramatically from 33.6 to 2.7.
- Patient Experience: Among the 31 parents and caregivers who completed surveys, 84% rated MI-E highly for secretion removal and RTI prevention (median score of 9 out of 10). Comfort during treatment was rated at 8.5, with only a few reports of discomfort.
- Safety and Compliance: Four patients discontinued MI-E, primarily due to learning alternative respiratory methods or complications like pneumothorax. However, all parents expressed willingness to recommend MI-E to others.
Conclusion and Future Directions
The study indicates that MI-E can significantly benefit children with neuromuscular disorders by reducing hospitalisation and improving respiratory health with manageable intervention efforts. Future research should focus on identifying specific patient groups that benefit most from MI-E and assessing any associated risks. This study highlights the need for more extensive investigation into MI-E’s role in pediatric respiratory care.