Titre : | Feasibility of lung volume recruitment in early neuromuscular weakness: a comparison between amyotrophic lateral sclerosis, myotonic dystrophy and post-polio syndrome. |
Revue : | PM & R : the journal of injury, function, and rehabilitation, 7, 7 |
Auteurs : | Kaminska M ; Browman F ; Trojan DA ; Genge A ; Benedetti A ; Petrof BJ |
Type de document : | Article |
Année de publication : | 07/2015 |
Pages : | p. 677-684 |
Langues: | Anglais |
Résumé : |
BACKGROUND: Lung volume recruitment (LVR) is a cough assistance technique used in patients with neuromuscular disorders (NMD), most typically in those requiring non-invasive ventilation (NIV). Whether it may be useful in NMD patients with milder respiratory impairment is unknown.
OBJECTIVE: To assess the feasibility, impact on quality of life (QOL), and preliminary physiologic effects of daily LVR in different categories of NMD patients with early respiratory impairment. DESIGN: Feasibility study. SETTING: Academic tertiary care centre. PATIENTS: Amyotrophic lateral sclerosis (ALS), post-polio syndrome (PPS) and myotonic dystrophy (MD) outpatients (n=8, 10 and 6 respectively), with restrictive respiratory defects but not yet using NIV, were recruited. METHODS: Participants were asked to perform LVR up to 4 times daily, and to log their LVR use in a diary. Physiologic measurements and questionnaires were completed at baseline and after 3 months. MAIN OUTCOME MEASUREMENTS: Compliance with LVR use was assessed, as well as QOL and willingness to continue this treatment. Physiologic measurements included forced vital capacity (FVC), lung insufflation capacity (LIC) and the LIC minus FVC difference. RESULTS: Of the 24 recruited subjects, seven ALS, seven PPS and five MD subjects completed the study (n=19). At baseline, mean values for FVC and spontaneous peak cough flow (PCF) were 59.9% predicted and 373.1 L/min, respectively. For subjects completing the study, 74% were willing to continue long-term LVR use, and QOL scores were not adversely affected by LVR in any NMD subgroup. The LIC-FVC difference increased from baseline to follow-up by a mean of 0.243L (p=.006) in all subjects (n=19), suggesting a possible improvement in respiratory system mechanics. CONCLUSIONS: In NMD patients with early restrictive respiratory defects not yet requiring NIV, regular use of LVR is feasible with no negative impact on QOL over a 3-month period, and may have physiologic benefits. Further work is needed to determine whether early institution of LVR can improve respiratory system mechanics and help delay ventilatory failure in NMD. |
Pubmed / DOI : | DOI : 10.1016/j.pmrj.2015.04.001 / Pubmed : 25845857 |
En ligne : | http://www.ncbi.nlm.nih.gov/pubmed/25845857 |