Presiones y pico flujo tosido en la asistencia mecánica de la tos
Keywords:
enfermedad neuromuscular, insuflación, exsuflación, asistencia de la tos, debilidad tusígena, cuidados respiratorios.Abstract
Introducción: En las personas con enfermedad neuromuscular, la incapacidad para toser y para generar flujos espiratorios adecuados constituye el principal limitante para mantener una adecuada salud del sistema respiratorio. La asistencia mecánica de la tos es un dispositivo que genera presión positiva y negativa en la vía aérea y simula una tos normal. Se realizó una revisión bibliográfica. Se incluyeron 9 estudios, con un total de 235 sujetos adultos con enfermedad neuromuscular.Objetivos: Describir los valores de presiones de insuflación y exsuflación utilizados y su relación con los valores de pico flujo tosido.
Desarrollo: El 28 % era de género femenino y las edades estaban comprendidas entre 14 a 77 años. Las presiones utilizadas variaron entre los estudios, con valores que iban desde +15/ -15 cm H2O a los +40/ -40 cm H2O. Con respecto a los valores de pico flujo tosido, 7 estudios observaron incrementos estadísticamente significativos al aplicar la terapéutica. En estos estudios, para obtener un flujo espiratorio superior a 160 L/min se requirieron presiones de al menos -30/+30 cm H2O.
Conclusiones: Se requieren futuras investigaciones que permitan el desarrollo de un consenso respecto a aplicación de la asistencia mecánica de la tos en sujetos con enfermedad neuromuscular, así como establecer criterios de selección de las presiones de insuflación y exsuflación a programar durante la terapéutica.
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References
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2. Pinchak C, Salinas P, Prado F, Herrero M, Giménez G, García C, et al. Actualización en el manejo respiratorio de pacientes con enfermedades neuromusculares. Arch Pediatr Urug 2018[acceso: 04/08/2019]; 89(1):40-51. Disponible en: https://www.scielo.edu.uy/scielo.php?script=sci_arttext&pid=S1688-12492018000100040
3. Giménez GC, Prado F, Herrero MV, Bach JR. Alternativas de tratamiento en pacientes con patologías neuromusculares y afecciones respiratorias. Anales de la facultad de ciencias médicas (Asunción).2017 [acceso: 04/08/2019];050(02):79-088. Disponible en: https://docs.bvsalud.org/biblioref/2018/05/884522/08-respiratorio79-88.pdf
4. Bach JR. Amyotrophic lateral sclerosis: predictors for prolongation of life by noninvasive respiratory aids. Arch Phys Med Rehabil. 1995[acceso: 04/08/2019];76(9):828-32. Disponible en : https://www.archives-pmr.org/article/S0003-9993(95)80547-8/pdf
5. Gómez-Merino E, Sancho J, Marín J, Servera E, Blasco ML, Belda FJ, et al. Mechanical insufflation-exsufflation. Pressure, volume, and flow relationships and the adequacy of the manufacturer's guidelines. Am J Phys Med Rehabil. 2002[acceso: 04/08/2019];81(8):579-83. Disponible en: https://journals.lww.com/ajpmr/Abstract/2002/08000/Mechanical_Insufflation-_Exsufflation__Pressure,.4.aspx
6. Hanayama K, Ishikawa Y, Bach JR. Amyotrophic lateral sclerosis. Successful treatment of mucous plugging by mechanical insufflation- exsufflation. Am J Phys Med Rehabil. 1997;76(4):338-39.
7. Vianello A, Corrado A, Arcaro G, Gallan F, Ori C, Minuzzo M, et al. Mechanical insufflation-exsufflation improves outcomes for neuromuscular disease patients with respiratory tract infections. Am J Phys Med Rehabil. 2005;84(2):83-8.
8. Torres-Castro R, Monge G, Vera R, Puppo H. Estrategias terapéuticas para aumentar la eficacia de la tos en pacientes con enfermedades neuromusculares. Rev Med Chile. 2014[acceso:04/08/2019]; 142: 238-45. Disponible en: https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872014000200013.
9. Haas CF, Loik PS, Gay SE. Airway Clearance Applications in the Elderly and in Patients with Neurologic or Neuromuscular Compromise. Respir Care. 2007[acceso:04/08/2019];52(10):1362-81. Disponible en: https://rc.rcjournal.com/content/60/7/1071
10. Moran FC, Spittle AJ, Delany C. Lifestyle Implications of Home Mechanical Insufflation-Exsufflation for Children With Neuromuscular Disease and Their Families. Respir Care. 2015[acceso:04/08/2019];60(7):967-74. Disponible en: https://rc.rcjournal.com/content/60/7/967
11. Homnick DN. Mechanical Insufflation-Exsufflation for Airway Mucus Clearance. Respir Care. 2007[acceso:04/08/2019];52(10):1296-305. Disponible en: https://rc.rcjournal.com/content/respcare/52/10/1296.full.pdf
12. Miske LJ, Hickey EM, Kolb SM, Weiner DJ, Panitch HB. Use of the mechanical in-exsufflator in pediatric patients with neuromuscular disease and impaired cough. Chest. 2004[acceso:04/08/2019];125:1406-12. Disponible en: https://journal.chestnet.org/article/S0012-3692(15)32104-8/fulltext
13. Gomez-Merino E, Bach JR. Duchenne muscular dystrophy: Prolongation of life by noninvasive ventilation and mechanically assisted coughing. Am J Phys Med Rehabil. 2002;81:411-5.
14. Bach JR, Bianchi C, Aufiero E. Oximetry and indications for tracheotomy for amyotrophic lateral sclerosis. Chest. 2004[acceso:04/08/2019];126:1502-7. Disponible en: https://www.sciencedirect.com/science/article/pii/S0012369215313635
15. Bach JR, Intintola P, Alba AS, Holland I. The ventilator- assisted individual. Cost analysis of institutionalization vs rehabilitation and in-home management. Chest. 1992[acceso:04/08/2019];101:26-30. Disponible en: https://www.sciencedirect.com/science/article/pii/S0012369216331154
16. Bach J, Gupta K, Reyna M, Hon A. Spinal muscular atrophy type 1: Prolongation of survival by noninvasive respiratory aids. Pediatric Asthma Allergy Immunol. 2009;22:151-62.
17. Tzeng AC, Bach JR: Prevention of pulmonary morbidity for patients with neuromuscular disease. Chest. 2000[acceso:04/08/2019];118: 1390-6. Disponible en: https://journal.chestnet.org/article/S0012-3692(15)51214-2/fulltext
18. Bach JR, Baird JS, Plosky D, Nevado J, Weaver B: Spinal muscular atrophy type 1: management and outcomes. Pediatr Pulmonol. 2002;34:16-22.
19. J H Emerson Co. Cough Assist, User's Guide. Models CA-3000 & CA-3200, Models CA-3000 & CA-3200. USA: Emerson; 2000. [acceso: 07/07/2019]. Disponible en: https://www.nbngroup.com/manuals/machine/V-UserGuideCoughAssist.pdf
20. Philips, Respironics. Cough Assist T70 user manual. USA: Philips; 2013. [acceso:07/07/2019]. Disponible en: https://ontvep.ca/wp-content/uploads/2014/05/CoughAssist_E70_User_Manual_-_International_English.pdf.
21. Garstang SV, Kirshblum SC, Wood KE. Patient preference for inexsufflation for secretion management with spinal cord injury. J Spinal Cord Med. 2000;23(2):80-5.
22. Sancho J, Servera E, Vergara P, Marin J. Mechanical insufflation exsufflation vs. tracheal suctioning via tracheostomy tubes for patients with amyotrophic lateral sclerosis: a pilot study. Am J Phys Med Rehabil. 2003[acceso:04/08/2019];82(10):750-53. Disponible en: https://journals.lww.com/ajpmr/Abstract/2003/10000/Mechanical_Insufflation-_Exsufflation_vs__Tracheal.2.aspx
23. Goncalves MR, Honrado T, Winck JC. Effects of mechanical insufflation- exsufflation in preventing respiratory failure after extubation: A randomized controlled trial. Crit Care. 2012[acceso:04/08/2019];16-48. Disponible en: https://ccforum.biomedcentral.com/articles/10.1186/cc11249
24. Bach JR, Gonçalves MR, Hon A, Ishikawa Y, De Vito EL, Prado F, et al. Changing trends in the management of end-stage neuromuscular respiratory muscle failure. Am J Phys Med Rehabil. 2013[acceso:04/08/2019];92:267-77. Disponible en: https://journals.lww.com/ajpmr/Abstract/2013/03000/Changing_Trends_in_the_-Management_of_-End_Stage.10.aspx
25. Striegl AM, Redding GJ, DiBlasi R, Crotwell, D,Salyer J, Carter ER. Use of a Lung Model to Assess Mechanical In-Exsufflator Therapy in Infants with Tracheostomy. Pediatr Pulmonol. 2011; 46:211-217.
26. Anderson JL, Hasney KM, Beaumont NE. Systematic review of techniques to enhance peak cough flow and maintain vital capacity in neuromuscular disease: the case for mechanical insufflation-exsufflation. Physical Therapy Reviews. 2005;10(1):25-33.
27. Bach JR. Mechanical lnsufflation Exsufflation Comparison of Peak Expiratory Flows With Manually Assisted and Unassisted Coughing Techniques. Chest. 1993; 104:1553-62.
28. Sivasothy P, Brown L, Smith IE, Shneerson JM. Effect of manually assisted cough and mechanical insufflation on cough flow of normal subjects, patients with chronic obstructive pulmonary disease (COPD), and patients with respiratory muscle weakness. Thorax. 2001[acceso:04/08/2019];;56:438-44. Disponible en: https://thorax.bmj.com/content/56/6/438
29. Chatwin M, Ross E, Hart N, Nickol AH, Polkey MI, Simonds AK. Cough augmentation with mechanical insufflation/exsufflation in patients with neuromuscular weakness. Eur Respir J. 2003[acceso:04/08/2019]; 21: 502-8. Disponible en: https://erj.ersjournals.com/content/21/3/502
30. Winck JC, Goncalves JR, Lourenco C, Viana P, Almeida J, Bach JR. Effects of Mechanical Insufflation- Exsufflation on Respiratory Parameters for Patients With Chronic Airway Secretion Encumbrance. CHEST. 2004; 126:774-80.
31. Senent C, Golmard Jl, Salachas F, Chiner E, Morelot-Panzini C, Meninger V, et al. A comparison of assisted cough techniques in stable patients with severe respiratory insufficiency due to amyotrophic lateral sclerosis. Amyotrophic Lateral Sclerosis. 2011; 12: 26-32.
32. Lacombe M, Del Amo Castrillo L, Boré A, Chapeau D, Horvat E, Vaugier I, Lejaille M, et al. Comparison of Three Cough-Augmentation Techniques in Neuromuscular Patients: Mechanical Insufflation Combined with Manually Assisted Cough, Insufflation-Exsufflation Alone and Insufflation-Exsufflation Combined with Manually Assisted Cough. Respiration. 2014;88:215-22.
33. Kim SM, Choi WA, Won YH, Kang SW. A Comparison of Cough Assistance Techniques in Patients with Respiratory Muscle Weakness. Yonsei Med J. 2016 Nov; 57(6):1488-93.
34. Sancho J, Bures E, de La Asunción RN, Servera E. Effect of High-Frequency Oscillations on Cough Peak Flows Generated by Mechanical In-Exsufflation in Medically Stable Subjects With Amyotrophic Lateral Sclerosis. Respir Care. 2016 Aug[acceso:04/08/2019];; 61(8):1051-8. Disponible: https://rc.rcjournal.com/content/respcare/early/2016/05/17/respca-re.04552.full.pdf
35. Mustfa N, Aiello M, Lyall RA, Nikoletou D, Olivieri D, Leigh PN, et al. Cough augmentation in amyotrophic lateral sclerosis. Neurology. 2003;61:1285-87.
36. Sancho J, Servera E, Marin J, Vergara P, Belda FJ, Bach JR. Effect of lung mechanics on mechanically assisted flows and volumes. Am J Phys Med Rehabil. 2004;83(9):698-703.
37. Hon AH, Bach JR. Respiratory Muscle Aids in the Management of Neuromuscular Respiratory Impairment to Prevent Respiratory Failure and Need for Tracheostomy, Neuromuscular Disorders. USA:Dr. Ashraf Zaher; 2012. [acceso:04/08/2019]. InTech, Disponible en: Disponible en: https://www.intechopen.com/books/neuromuscular-disorders/respiratory-muscle-aids-in-the-management-of-neuromuscular-respiratory-impairment-to-prevent-res.
38. Suri P, Burns SP, Bach JR: Pneumothorax associated with mechanical insufflation- exsufflation and related factors. Am J Phys Med Rehabil. 2008[acceso:04/08/2019];87:951-55. Disponible en: https://journals.lww.com/ajpmr/Abstract/2008/11000/Pneumothorax_Associated-_with_Mechanical.10.aspx
39. Goncalves MR, Bach JR. Mechanical Insufflation-Exsufflation Improves Outcomes for Neuromuscular Disease Patients with Respiratory Tract Infections A Step in the Right Direction. Am J Phys Med Rehabil. 2005[acceso:04/08/2019];84:89-91. Disponible en: https://journals.lww.com/ajpmr/Abstract/2005/02000/Mechanical_Insufflation-_Exsufflation_Improves.2.aspx
40. Andersen T, Sandnes A, Hilland M, Halvorsen T, Fondenes O, Heimdal JH, et al. Laryngeal response patterns to mechanical insufflation exsufflation in healthy subjects. Am J Phys Med Rehabil. 2013;92:920-29.
41. Barach AL, Beck GJ, Bickerman HA, Seanor HE. Physical methods simulating cough mechanisms. Use in poliomyelitis, bronchial asthma, pulmonary emphysema and bronchiectasis. JAMA. 1952[acceso:04/08/2019]; 150(14):1380-85. Disponible: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/559540
42. Bach JR. Update and perspective on noninvasive respiratory muscle aids. Part 2: The expiratory aids. Chest. 1994;105(5):1538-44.
2. Pinchak C, Salinas P, Prado F, Herrero M, Giménez G, García C, et al. Actualización en el manejo respiratorio de pacientes con enfermedades neuromusculares. Arch Pediatr Urug 2018[acceso: 04/08/2019]; 89(1):40-51. Disponible en: https://www.scielo.edu.uy/scielo.php?script=sci_arttext&pid=S1688-12492018000100040
3. Giménez GC, Prado F, Herrero MV, Bach JR. Alternativas de tratamiento en pacientes con patologías neuromusculares y afecciones respiratorias. Anales de la facultad de ciencias médicas (Asunción).2017 [acceso: 04/08/2019];050(02):79-088. Disponible en: https://docs.bvsalud.org/biblioref/2018/05/884522/08-respiratorio79-88.pdf
4. Bach JR. Amyotrophic lateral sclerosis: predictors for prolongation of life by noninvasive respiratory aids. Arch Phys Med Rehabil. 1995[acceso: 04/08/2019];76(9):828-32. Disponible en : https://www.archives-pmr.org/article/S0003-9993(95)80547-8/pdf
5. Gómez-Merino E, Sancho J, Marín J, Servera E, Blasco ML, Belda FJ, et al. Mechanical insufflation-exsufflation. Pressure, volume, and flow relationships and the adequacy of the manufacturer's guidelines. Am J Phys Med Rehabil. 2002[acceso: 04/08/2019];81(8):579-83. Disponible en: https://journals.lww.com/ajpmr/Abstract/2002/08000/Mechanical_Insufflation-_Exsufflation__Pressure,.4.aspx
6. Hanayama K, Ishikawa Y, Bach JR. Amyotrophic lateral sclerosis. Successful treatment of mucous plugging by mechanical insufflation- exsufflation. Am J Phys Med Rehabil. 1997;76(4):338-39.
7. Vianello A, Corrado A, Arcaro G, Gallan F, Ori C, Minuzzo M, et al. Mechanical insufflation-exsufflation improves outcomes for neuromuscular disease patients with respiratory tract infections. Am J Phys Med Rehabil. 2005;84(2):83-8.
8. Torres-Castro R, Monge G, Vera R, Puppo H. Estrategias terapéuticas para aumentar la eficacia de la tos en pacientes con enfermedades neuromusculares. Rev Med Chile. 2014[acceso:04/08/2019]; 142: 238-45. Disponible en: https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872014000200013.
9. Haas CF, Loik PS, Gay SE. Airway Clearance Applications in the Elderly and in Patients with Neurologic or Neuromuscular Compromise. Respir Care. 2007[acceso:04/08/2019];52(10):1362-81. Disponible en: https://rc.rcjournal.com/content/60/7/1071
10. Moran FC, Spittle AJ, Delany C. Lifestyle Implications of Home Mechanical Insufflation-Exsufflation for Children With Neuromuscular Disease and Their Families. Respir Care. 2015[acceso:04/08/2019];60(7):967-74. Disponible en: https://rc.rcjournal.com/content/60/7/967
11. Homnick DN. Mechanical Insufflation-Exsufflation for Airway Mucus Clearance. Respir Care. 2007[acceso:04/08/2019];52(10):1296-305. Disponible en: https://rc.rcjournal.com/content/respcare/52/10/1296.full.pdf
12. Miske LJ, Hickey EM, Kolb SM, Weiner DJ, Panitch HB. Use of the mechanical in-exsufflator in pediatric patients with neuromuscular disease and impaired cough. Chest. 2004[acceso:04/08/2019];125:1406-12. Disponible en: https://journal.chestnet.org/article/S0012-3692(15)32104-8/fulltext
13. Gomez-Merino E, Bach JR. Duchenne muscular dystrophy: Prolongation of life by noninvasive ventilation and mechanically assisted coughing. Am J Phys Med Rehabil. 2002;81:411-5.
14. Bach JR, Bianchi C, Aufiero E. Oximetry and indications for tracheotomy for amyotrophic lateral sclerosis. Chest. 2004[acceso:04/08/2019];126:1502-7. Disponible en: https://www.sciencedirect.com/science/article/pii/S0012369215313635
15. Bach JR, Intintola P, Alba AS, Holland I. The ventilator- assisted individual. Cost analysis of institutionalization vs rehabilitation and in-home management. Chest. 1992[acceso:04/08/2019];101:26-30. Disponible en: https://www.sciencedirect.com/science/article/pii/S0012369216331154
16. Bach J, Gupta K, Reyna M, Hon A. Spinal muscular atrophy type 1: Prolongation of survival by noninvasive respiratory aids. Pediatric Asthma Allergy Immunol. 2009;22:151-62.
17. Tzeng AC, Bach JR: Prevention of pulmonary morbidity for patients with neuromuscular disease. Chest. 2000[acceso:04/08/2019];118: 1390-6. Disponible en: https://journal.chestnet.org/article/S0012-3692(15)51214-2/fulltext
18. Bach JR, Baird JS, Plosky D, Nevado J, Weaver B: Spinal muscular atrophy type 1: management and outcomes. Pediatr Pulmonol. 2002;34:16-22.
19. J H Emerson Co. Cough Assist, User's Guide. Models CA-3000 & CA-3200, Models CA-3000 & CA-3200. USA: Emerson; 2000. [acceso: 07/07/2019]. Disponible en: https://www.nbngroup.com/manuals/machine/V-UserGuideCoughAssist.pdf
20. Philips, Respironics. Cough Assist T70 user manual. USA: Philips; 2013. [acceso:07/07/2019]. Disponible en: https://ontvep.ca/wp-content/uploads/2014/05/CoughAssist_E70_User_Manual_-_International_English.pdf.
21. Garstang SV, Kirshblum SC, Wood KE. Patient preference for inexsufflation for secretion management with spinal cord injury. J Spinal Cord Med. 2000;23(2):80-5.
22. Sancho J, Servera E, Vergara P, Marin J. Mechanical insufflation exsufflation vs. tracheal suctioning via tracheostomy tubes for patients with amyotrophic lateral sclerosis: a pilot study. Am J Phys Med Rehabil. 2003[acceso:04/08/2019];82(10):750-53. Disponible en: https://journals.lww.com/ajpmr/Abstract/2003/10000/Mechanical_Insufflation-_Exsufflation_vs__Tracheal.2.aspx
23. Goncalves MR, Honrado T, Winck JC. Effects of mechanical insufflation- exsufflation in preventing respiratory failure after extubation: A randomized controlled trial. Crit Care. 2012[acceso:04/08/2019];16-48. Disponible en: https://ccforum.biomedcentral.com/articles/10.1186/cc11249
24. Bach JR, Gonçalves MR, Hon A, Ishikawa Y, De Vito EL, Prado F, et al. Changing trends in the management of end-stage neuromuscular respiratory muscle failure. Am J Phys Med Rehabil. 2013[acceso:04/08/2019];92:267-77. Disponible en: https://journals.lww.com/ajpmr/Abstract/2013/03000/Changing_Trends_in_the_-Management_of_-End_Stage.10.aspx
25. Striegl AM, Redding GJ, DiBlasi R, Crotwell, D,Salyer J, Carter ER. Use of a Lung Model to Assess Mechanical In-Exsufflator Therapy in Infants with Tracheostomy. Pediatr Pulmonol. 2011; 46:211-217.
26. Anderson JL, Hasney KM, Beaumont NE. Systematic review of techniques to enhance peak cough flow and maintain vital capacity in neuromuscular disease: the case for mechanical insufflation-exsufflation. Physical Therapy Reviews. 2005;10(1):25-33.
27. Bach JR. Mechanical lnsufflation Exsufflation Comparison of Peak Expiratory Flows With Manually Assisted and Unassisted Coughing Techniques. Chest. 1993; 104:1553-62.
28. Sivasothy P, Brown L, Smith IE, Shneerson JM. Effect of manually assisted cough and mechanical insufflation on cough flow of normal subjects, patients with chronic obstructive pulmonary disease (COPD), and patients with respiratory muscle weakness. Thorax. 2001[acceso:04/08/2019];;56:438-44. Disponible en: https://thorax.bmj.com/content/56/6/438
29. Chatwin M, Ross E, Hart N, Nickol AH, Polkey MI, Simonds AK. Cough augmentation with mechanical insufflation/exsufflation in patients with neuromuscular weakness. Eur Respir J. 2003[acceso:04/08/2019]; 21: 502-8. Disponible en: https://erj.ersjournals.com/content/21/3/502
30. Winck JC, Goncalves JR, Lourenco C, Viana P, Almeida J, Bach JR. Effects of Mechanical Insufflation- Exsufflation on Respiratory Parameters for Patients With Chronic Airway Secretion Encumbrance. CHEST. 2004; 126:774-80.
31. Senent C, Golmard Jl, Salachas F, Chiner E, Morelot-Panzini C, Meninger V, et al. A comparison of assisted cough techniques in stable patients with severe respiratory insufficiency due to amyotrophic lateral sclerosis. Amyotrophic Lateral Sclerosis. 2011; 12: 26-32.
32. Lacombe M, Del Amo Castrillo L, Boré A, Chapeau D, Horvat E, Vaugier I, Lejaille M, et al. Comparison of Three Cough-Augmentation Techniques in Neuromuscular Patients: Mechanical Insufflation Combined with Manually Assisted Cough, Insufflation-Exsufflation Alone and Insufflation-Exsufflation Combined with Manually Assisted Cough. Respiration. 2014;88:215-22.
33. Kim SM, Choi WA, Won YH, Kang SW. A Comparison of Cough Assistance Techniques in Patients with Respiratory Muscle Weakness. Yonsei Med J. 2016 Nov; 57(6):1488-93.
34. Sancho J, Bures E, de La Asunción RN, Servera E. Effect of High-Frequency Oscillations on Cough Peak Flows Generated by Mechanical In-Exsufflation in Medically Stable Subjects With Amyotrophic Lateral Sclerosis. Respir Care. 2016 Aug[acceso:04/08/2019];; 61(8):1051-8. Disponible: https://rc.rcjournal.com/content/respcare/early/2016/05/17/respca-re.04552.full.pdf
35. Mustfa N, Aiello M, Lyall RA, Nikoletou D, Olivieri D, Leigh PN, et al. Cough augmentation in amyotrophic lateral sclerosis. Neurology. 2003;61:1285-87.
36. Sancho J, Servera E, Marin J, Vergara P, Belda FJ, Bach JR. Effect of lung mechanics on mechanically assisted flows and volumes. Am J Phys Med Rehabil. 2004;83(9):698-703.
37. Hon AH, Bach JR. Respiratory Muscle Aids in the Management of Neuromuscular Respiratory Impairment to Prevent Respiratory Failure and Need for Tracheostomy, Neuromuscular Disorders. USA:Dr. Ashraf Zaher; 2012. [acceso:04/08/2019]. InTech, Disponible en: Disponible en: https://www.intechopen.com/books/neuromuscular-disorders/respiratory-muscle-aids-in-the-management-of-neuromuscular-respiratory-impairment-to-prevent-res.
38. Suri P, Burns SP, Bach JR: Pneumothorax associated with mechanical insufflation- exsufflation and related factors. Am J Phys Med Rehabil. 2008[acceso:04/08/2019];87:951-55. Disponible en: https://journals.lww.com/ajpmr/Abstract/2008/11000/Pneumothorax_Associated-_with_Mechanical.10.aspx
39. Goncalves MR, Bach JR. Mechanical Insufflation-Exsufflation Improves Outcomes for Neuromuscular Disease Patients with Respiratory Tract Infections A Step in the Right Direction. Am J Phys Med Rehabil. 2005[acceso:04/08/2019];84:89-91. Disponible en: https://journals.lww.com/ajpmr/Abstract/2005/02000/Mechanical_Insufflation-_Exsufflation_Improves.2.aspx
40. Andersen T, Sandnes A, Hilland M, Halvorsen T, Fondenes O, Heimdal JH, et al. Laryngeal response patterns to mechanical insufflation exsufflation in healthy subjects. Am J Phys Med Rehabil. 2013;92:920-29.
41. Barach AL, Beck GJ, Bickerman HA, Seanor HE. Physical methods simulating cough mechanisms. Use in poliomyelitis, bronchial asthma, pulmonary emphysema and bronchiectasis. JAMA. 1952[acceso:04/08/2019]; 150(14):1380-85. Disponible: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/559540
42. Bach JR. Update and perspective on noninvasive respiratory muscle aids. Part 2: The expiratory aids. Chest. 1994;105(5):1538-44.
Published
2020-01-31
How to Cite
1.
Herrero MV. Presiones y pico flujo tosido en la asistencia mecánica de la tos. Rev Cubana Med Milit [Internet]. 2020 Jan. 31 [cited 2025 Jan. 10];49(1):175-91. Available from: https://revmedmilitar.sld.cu/index.php/mil/article/view/373
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