Instrumental and Manual Increase of Couch in Neuromuscular Patients

Hypothesis: Cough inefficiency in neuromuscular patients increases morbidity and mortality in case of airway infections and may lead to invasive ventilation. The use of techniques enhancing cough have been successful in improving the success of non invasive ventilation. We want to determine whether adding manual physiotherapist techniques to mechanical exsufflation improve cough efficiency and its ability to clear bronchial secretions.

Objectives: To compare cough flows obtained with different combination of the use of increased inspiratory capacity technique, mechanical insufflation-exsufflation technique and manually applied pressures techniques.

Method:open monocentric cross-over study (the patients are their own controls). Five combinations of cough increase techniques are compared Inclusion criteria: adult neuromuscular patients with a cough inefficiency at a stable state upon inclusion.

As this is a pilot study, 20 patients from the home ventilation unit of the intensive care of the Raymond Poincare teaching hospital (Garches, France) will be included during the usual follow-up of chronic respiratory failure.

Inclusion criteria

• adult patients
• neuromuscular disorders with a respiratory restrictive syndrome (VC < 40% and/or cough flow < 180 L/min and/or Pe max < 40 cmH2O)
• non invasive ventilation
• stable respiratory state > 1 month before inclusion
• signed informed consent form

Exclusion criteria

• unstable respiratory state with increased bronchial secretions
• unstable hemodynamics
• pneumothorax and or emphysema
• tracheostomy
• major bulbar involvement with swallowing dysfunction with the liquids
• Persons under Guardianship or Trusteeship
• Pregnant women
• not covered by the social security system
• refusal of study participation