Abstract
This study examined long term effectiveness of mechanical in-exsufflator (MI-E) use in persons with severe motor and intellectual disabilities (SMID). Six individuals aged 9-59 years (4 males and 2 females) with recurrent respiratory tract infections and respiratory failure, who managed via a tracheotomy or endotracheal intubation were examined. The duration of tracheotomy management was 3-16 years (5 subjects) and the duration of ventilator management was 3-10 years (3 subjects). The MI-E was accessed via the tracheotomy orifice or intubation tube, set to give 30~40 cm H20 both the inspiratory and expiratory pressure with the inspiratory to expiratory time 2:1 seconds. One set included 10 or 5 cycles, and with a roughly 1 minute interval, 2-4 sets were conducted 5 days a week. The 3 subjects who were capable of spontaneous respiration were given a bronchoscopy and measured the ventilation volume. Some subjects showed a decreased tendency in the frequency of use of antibacterial drugs so treat respiratory tract infection, and some showed an increased tendency in ventilation volume, suggesting benefit of MI-E respiratory management in severely disabled individuals. However, tracheomalacia has become evident in 2 subjects with reduced improvements in atelectasis after starting to use the MI-E, showing the need for follow-up assessments. A larger number of cases must be examined in order to determine the risk of tracheomalacia from MI-E use and the safety of long term use in those with comorbid central hypoventilation.
