[YouTube] How often can I use MIE?

Please use this forum for any general discussions or questions you have about noninvasive ventilatory support and mechanical insufflation-exsufflation (MIE).
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curiousgeorge
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[YouTube] How often can I use MIE?

Postby curiousgeorge » Mon Dec 07, 2015 1:26 am

How often can I use mechanical insufflation-exsufflation (MIE)?

(Asked by a patient)

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EDIT:
This question has a video response.
https://youtu.be/dyrNgdzZxUI
Last edited by curiousgeorge on Wed Mar 23, 2016 2:17 pm, edited 1 time in total.

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bachjr
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Re: [YouTube] How often can I use MIE?

Postby bachjr » Mon Dec 07, 2015 1:29 am

Continuously when ill or whatever it takes to keep O2 sat baseline over 94%.

JB
John R. Bach MD
Medical Director, VentilaMed BreatheNVS
Medical Director, Center for Ventilator Management Alternatives
Professor of Physical Medicine and Rehabilitation, Professor of Neurology, Rutgers New Jersey Medical School

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Re: [YouTube] How often can I use MIE?

Postby curiousgeorge » Wed Mar 23, 2016 2:03 pm

My child cannot cooperate with MIE, what should I do?

(Asked by a parent)

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Re: [YouTube] How often can I use MIE?

Postby bachjr » Wed Mar 23, 2016 2:04 pm

Time MIE to the child’s breathing. MIE insufflation is applied when the belly goes out (inhalation) and exsufflation is applied when the bellies go back in (exhalation).

The CoughAssist[TM]'s “Cough Track” permits MIE to be triggered by the infant’s breathing. This can greatly improve patient-MIE synchrony.

Thus, while unable to air stack, small children can receive 10 to 15 maximal insufflations three times daily using MIE or an adult manual resuscitator and along with sleep noninvasive ventilatory support (NVS), lung growth is promoted and severe chest wall deformity prevented. It can also result in temporary increases in vital capacity. Insufflation and exsufflation pressure of 50 to 60 cm H2O need to be used for infants and small children as well as for adults.

JB
John R. Bach MD
Medical Director, VentilaMed BreatheNVS
Medical Director, Center for Ventilator Management Alternatives
Professor of Physical Medicine and Rehabilitation, Professor of Neurology, Rutgers New Jersey Medical School

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Re: [YouTube] How often can I use MIE?

Postby curiousgeorge » Thu Mar 24, 2016 11:36 am

In general, for patients with enterostomy feeds/ oral feeding, do you ask them to
-hold the feeds or be NPO* for 30 min before cough assist therapy
-hold the feeds for 60 min or be NPO for 60 min before cough assist therapy
-do not ask them to hold the enterostomy feeds at all or there is no need to be NPO

In our practice, we have been asking for patients to have their enterostomy feeds held/ NPO for 1 hour before therapy because of concerns related to GERD* secondary to the high pressures but curious to see what you guys are doing as I couldn't really find much in the literature in support of 1 or the other...worried I may be missing something so thought I would check with you guys

(Asked by a caretaker)

*NPO=nothing by mouth
*GERD=gastroesophageal reflux disease

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Re: [YouTube] How often can I use MIE?

Postby bachjr » Thu Mar 24, 2016 11:37 am

Even with bolus feeding, the risk is minimal to none and the real concern is to limit manually assisted cough around meals/feeds.

Mechanical insufflation-exsufflation (MIE) does not cause reflux but abdominal thrusts can. MIE used at optimal pressures, 50 to 60 cm H2O, usually gives optimal flows without an abdominal thrust or concomitant cough. With little kids we use the "CoughTrack" to let them trigger or time it to the kid.

JB
John R. Bach MD
Medical Director, VentilaMed BreatheNVS
Medical Director, Center for Ventilator Management Alternatives
Professor of Physical Medicine and Rehabilitation, Professor of Neurology, Rutgers New Jersey Medical School


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