4f65e1bb631c02515cdc5f912ac18ea7 pmc_11084470.pdf 10129c20b1b971ee42231647e7984e11da7974bf pmc_11084470.pdf 393479678911e433024896dd418385698417b79cee422a7953c1e8b5ffb35dcf pmc_11084470.pdf Title: Waves of Precision: A Practical Guide for Reviewing New Tools to Evaluate Mechanical In-Exsufflation Efficacy in Neuromuscular Disorders Subject: Mechanical insufflation-exsufflation (MI-E) is essential for secretion clearance, especially in neuromuscular disorders. For the best outcomes, initiation of MI-E should be started at the correct time with regular evaluation to the response to treatment. Typically, cough peak flow has been used to evaluate cough effectiveness with and without MI-E. This review highlights the limitations of this and discussed other tools to evaluate MI-E efficacy in this rapidly developing field. Such tools include the interpretation of parameters (like pressure, flow and volumes) that derive from the MI-E device and external methods to evaluate upper airway closure. In this review we pinpoint the differences between different devices in the market and discuss new tools to better titrate MI-E and detect pathological responses of the upper airway. We discuss the importance of point of care ultrasound (POCUS), transnasal fiberoptic laryngoscopy and wave form analysis in this setting. To improve clinical practice newer generation MI-E devices should allow real-time evaluation of waveforms and standardize some of the derived parameters. Keywords: mechanical in-exsufflation; peak cough flow; waveform analysis; upper airway obstruction; neuromuscular disorders Author: Michelle Chatwin, Jesus Sancho, Manel Lujan, Tiina Andersen and Joao-Carlos Winck Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25 CreationDate: Tue Apr 30 10:13:29 2024 CEST ModDate: Tue Apr 30 11:05:03 2024 CEST Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 19 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 8655222 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- CIQLLF+VnURWPalladioL Type 1 Custom yes yes yes 10 0 IVEZFS+URWPalladioL-Bold Type 1 Custom yes yes yes 16 0 QRHPTL+URWPalladioL-Roma Type 1 Custom yes yes yes 22 0 ZWPYQQ+URWPalladioL-Ital Type 1 Custom yes yes yes 27 0 XPUSBJ+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes 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720 0 FCEKAM+PalatinoLinotype-Italic TrueType WinAnsi yes yes no 726 0 FCEKAN+PalatinoLinotype-Bold TrueType WinAnsi yes yes no 729 0 FCEKAO+PalatinoLinotype-Roman TrueType WinAnsi yes yes no 732 0 FCEKGN+ArialMT CID TrueType Identity-H yes yes yes 735 0 WHJIKF+VnURWPalladioL-Italic Type 1 Custom yes yes yes 754 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2025-02-06 02:51:07 CET RepresentationInformation: pmc_11084470.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2025-01-30 02:31:06 CET Size: 8655222 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 945 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Clinical and Functional Options to Evaluate Mechanical Insufflation-Exsufflation (MI-E) Destination: section.2 Children: Item: Title: Cough Peak Flow for the Analysis of MI-E Efficay Destination: subsection.2.1 Item: Title: Mechanical Insufflation-Exsufflation Volumes for the Analysis of MI-E Efficay Destination: subsection.2.2 Item: Title: Graphic Analysis, Waveform Evaluation of Cough Mechanics during MI-E for the Analysis of MI-E Efficay Destination: subsection.2.3 Children: Item: Title: The Normal MI-E Waveform: Variants of Normality; Identification of Points of Interest in Normal Waveforms Destination: subsubsection.2.3.1 Item: Title: The Abnormal MI-E Curve Destination: subsubsection.2.3.2 Item: Title: Auscultation to Detect the Upper Airway and Laryngeal Closure during MI-E, for the Analysis of MI-E Efficay Destination: subsection.2.4 Item: Title: Direct Visualization of the Upper Airway, Nasal Fiberoptic Laryngoscopy Destination: subsection.2.5 Item: Title: Computed Tomography to Detect MI-E Efficay Destination: subsection.2.6 Item: Title: Point of Care Ultrasound (POCUS) to Evaluate the Upper Airway and MI-E Efficay Destination: subsection.2.7 Children: Item: Title: Ultrasonographic Upper Airway Structures Destination: subsubsection.2.7.1 Item: Title: Other Options to Evaluate MI-E Efficacy Destination: subsection.2.8 Item: Title: Future Directions Destination: section.3 Item: Title: Conclusions Destination: section.4 Item: Title: References Destination: section.5 Info: Title: Waves of Precision: A Practical Guide for Reviewing New Tools to Evaluate Mechanical In-Exsufflation Efficacy in Neuromuscular Disorders Author: Michelle Chatwin, Jesus Sancho, Manel Lujan, Tiina Andersen and Joao-Carlos Winck Subject: Mechanical insufflation-exsufflation (MI-E) is essential for secretion clearance, especially in neuromuscular disorders. For the best outcomes, initiation of MI-E should be started at the correct time with regular evaluation to the response to treatment. Typically, cough peak flow has been used to evaluate cough effectiveness with and without MI-E. This review highlights the limitations of this and discussed other tools to evaluate MI-E efficacy in this rapidly developing field. Such tools include the interpretation of parameters (like pressure, flow and volumes) that derive from the MI-E device and external methods to evaluate upper airway closure. In this review we pinpoint the differences between different devices in the market and discuss new tools to better titrate MI-E and detect pathological responses of the upper airway. We discuss the importance of point of care ultrasound (POCUS), transnasal fiberoptic laryngoscopy and wave form analysis in this setting. To improve clinical practice newer generation MI-E devices should allow real-time evaluation of waveforms and standardize some of the derived parameters. 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