Table 3 Cross-over trials
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 | |||