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Table 3 Cross-over trials

From: Benefits of interventions for respiratory secretion management in adult palliative care patients—a systematic review

Population/PEDro Scale Interventions Outcomes
Senent et al (2011) [23]
Neuromuscular diseases (n = 16)
3
Coached unassisted cough No improvements
Couched unassisted cough + abdominal thrust No improvements
Abdominal thrust + Air Stacking Improvements: PCF:284(146–353)L/min, ↑238 % than baseline 84(35–118)L/min (statistically higher than first two methods)
Abdominal thrust + usual patient’s bi-level ventilator Improvements: PCF:212(99–595)L/min, ↑152 % than baseline (statistically higher than first two methods)/Comfort (VAS): 8(7–8)pts,↑60 % than baseline 5(4–7)pts (statistically higher than all other methods).
Abdominal thrust + IPAP of +30cmH2O Improvements: PCF: 233(100–389)L/min, ↑177 % than baseline (statistically higher than first two methods).
MIE (40cmH2O) Improvements: PCF: 488(243–605)L/min (↑480 %) than baseline/Effectiveness (VAS): 8(6–8)pts ↑100 % than baseline 4(2–7)pts (statistically higher than all other methods).
   NMD (n = 7) ALS (n = 13) COPD (n = 9)
Winck et al (2004) [24]
Neuromuscular Disease and COPD (n = 29)
3
MIE (15cmH2O) No Improvements No Improvements No Improvements
MIE (30cmH2O) No Improvements No Improvements No Improvements
MIE (40cmH2O) Improvements: PCF: 220(190–300)L/min, ↑22 % than baseline 180(150–275)L/min/SpO2: 94(92–96), than 98(97–98), ↑4 %/Dyspnoea (BORG) 0.75(0–2.3)pts, ↓62 % than baseline 2(0.4–3.3)pts. Improvements:PCF:200(170–352)L/min ↑17 % than baseline 170(128–300)L/min/SpO2: 98(97–98)%,↑4 % than baseline 94(94–95)% Improvements: SpO2: 97(95–97)%, ↑5 %/ than baseline 92(91–94)%, Dyspnoea (BORG) 1(1–2.5)pts, ↓200 % than baseline 3(2–4)pts.
Bach (1993) [25]
Neuromuscular diseases (n = 21)
4
Air Stacking Improvements: PCF: 3.37 ± 1.07 L/s, ↑86 % than baseline 1.81 ± 1.03 L/s
Manually Assisted Cough Improvements: PCF: 4.27 ± 1.29 L/s, ↑135 % than baseline
MIE (Individualized pressure) Improvements PCF: 7.47 ± 1.02 L/s, ↑312 % than baseline (higher than all other methods)/FVC: 0.54 ± 0.39 L, ↑10 % than baseline 0.49 ± 0.37 L/FEF25-75 %: 0.91 ± 0.69 L/s, ↑13 % than baseline 0.80 ± 0.59 L/s
Sancho et al (2003) [26]
ALS (n = 6)
5
Tracheal Suctioning Improvements: WB: 0.95 ± 0.23 J/L, ↓7 % than baseline 1.03 ± 0.25 J/L
Worsening: All patients referred as less comfortable and effective than MIE
MIE (40cmH2O) Improvements: SpO2:,↑3 % than baseline 93.5 ± 2.25 %/Peak Inspiratory Pressure: 15.33 ± 4.13cmH2O, ↓17 % than baseline 18.5 ± 4.23cmH2O/Mean Airway Pressure: 3.83 ± 1.72cmH2O, ↓8 % than baseline 4.67 ± 1.37cmH2O/WB: 0.87 ± 0.26, ↓15 % than baseline
Population/PEDro Scale Interventions Outcomes
Chatwin, et al (2009) [27]
Neuromuscular diseases (n = 8)
4
Chest Physiotherapy + MIE Improvements: ↓ Duration of the intervention (17 min shorter than only Physiotherapy)
Chatwin et al (2003) [28]
Neuromuscular Diseases (n = 14)
3
Standard Physiotherapy Assisted Cough No improvements
Cough + Non-Invasive Ventilation No improvements
Exsufflation Assisted Cough Improvements: PCF ↑a
MIE Improvements: PCF ↑a
Lacombe, et al (2014) [29]
Neuromuscular Disease (n = 18)
5
MIE (highest tolerable pressure) Improvements: PCF ↑ a than baseline; Effective Cough Time ↑a compared to baseline
MAC + IPAP Improvements: Effectiveness: 8.3(7.2–9)pts, ↑29.6 % than MIE 6.4(4.8–8.2)pts; PCF ↑a; Effective Cough Time ↑ a (all compared to MIE)
MAC + MIE (highest tolerable pressure) Improvements: Effectiveness: 8.5(6.2–9)pts, ↑32.8 % higher than MIE; PCF ↑a; Effective Cough Time↑a (all compared to MIE)
Linder (1993) [30]
Patients with quadriplegia (n = 8)
5
Cough with FES Improvements: PEMax: 60 ± 22.8cmH2O, ↑119,7 % than baseline 27.3 ± 6.4cmH2O
MAC Improvements: PEMax: 83 ± 18.7cmH2O, ↑ 38.3 % than Cough with FES
Toussaint et al (2003) [31]
Duchenne dystrophy patients (n = 8)
4
Cough assistance techniques No improvements
Percussive Ventilation + cough assistance techniques Improvements: Removed secretion: 6.53. ± 4.77 g,↑42.8 % than Cough assisted techniques 4.57 ± 3.5 g; (Only in a sub-group of five hypersecretive patients)
O’Connell, et al (2011) [32]
Cystic Fibrosis (n = 4)
4
Hypertonic Saline using Jet Nebulizer No improvements
Hypertonic Saline using PEP mask Improvements: Subjective report of chest tightness 1.7pts, ↓68 % than without PEP mask 5.3pts
  1. Values presented as mean ± standard deviation or median (interquartile range). Insufflation-Exsufflation; MAC Manually assisted cough, NMD Neuromuscular Disease, ALS Amyotrophic lateral sclerosis, COPD Chronic obstructive pulmonary disease, SpO 2 Peripheral oxygen saturation, FVC Forced vital capacity, FEF25–75 % Mean forced expiratory flow at 25–75 % expiratory period, WB Work of breath, FES Functional electrical stimulation, PEMax Maximum expiratory pressure, PEP Positive expiratory pressure. aResults presented graphically in the original paper