Instrumental and Manual Increase of Couch in Neuromuscular Patients (OPTICOUGH)
Inefficient cough is responsible of respiratory complications in neuromuscular patients which can lead to hospitalisation and can be life threatening. Techniques enhancing cough efficiency are successful in improving the clearance of bronchial secretions and help non invasive ventilation efficiency especially in case of acute respiratory failure. Combining mechanical exsufflation to the manual techniques of physiotherapy might enhance efficiency. Therefore the investigators want to compare cough efficiency under different techniques of instrumental and manual of cough assistance in order to determine the best combination to optimize cough flow.
Chronic Respiratory Failure
Device: Alpha 200®
Device: Alpha 200® + physiotherapist
Device: Cough Assist®
Device: Cough Assist® + physiotherapist
|Study Design:||Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
|Official Title:||Instrumental and Manual Increase of Couch in Neuromuscular Patients: Effects of Different Techniques on the Generated Flow|
- cough flow obtained from the combination of mechanical and manual cough assistance techniques [ Time Frame: 2 Hours ] [ Designated as safety issue: No ]
- duration of efficient cough flow (above 180 l/min)under each cough assistance technique [ Time Frame: 2 Hours ] [ Designated as safety issue: No ]
- respiratory comfort [ Time Frame: 2 Hours ] [ Designated as safety issue: No ]evaluation with a visual analogical scale
- subjective evaluation of cough efficiency [ Time Frame: 2 Hours ] [ Designated as safety issue: No ]evaluation with a visual analogical scale
- Respiratory comfort [ Time Frame: 2 Hours ] [ Designated as safety issue: No ]evaluation with the Borg dyspnea scale
|Study Start Date:||January 2012|
|Study Completion Date:||July 2013|
|Primary Completion Date:||January 2012 (Final data collection date for primary outcome measure)|
Experimental: neuromuscular patients
neuromuscular patients with cough inefficiency in a stable respiratory state upon inclusion
Device: Alpha 200®
inspiratory capacity is increased with the use of constant pressure device: Alpha 200®Device: Alpha 200® + physiotherapist
inspiratory capacity is increased with the use of constant pressure device (Alpha 200®) combined with the manual pressures techniques to increase cough by the physiotherapistDevice: Cough Assist®
increased inspiratory capacity and mechanical exsufflation with the use of insufflation-exsufflation device (Cough Assist®)Device: Cough Assist® + physiotherapist
increased inspiratory capacity and mechanical exsufflation with the use of insufflation-exsufflation device (Cough Assist®) combined with the manual pressures techniques to increase cough by the physiotherapistOther: physiotherapist
manual pressures techniques to increase cough applied by the physiotherapist
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.
|RAYMOND POINCARE Hospital|
|Garches, France, 92380|
|Study Director:||Frederic Lofaso, Md-PhD||University of Versailles|
|Principal Investigator:||Helene Prigent, MD-PhD||University of Versailles|