Abstract
Background: Respiratory insufficiency is the most common cause of mortality among patients with a neuromuscular disease. Methods: We explored the effects of high frequency wall compression and intrapulmonary percussive ventilation, compared with standard care or no treatment, on the lung volume and capacity, and quality of life in patients with neuromuscular disease during respiratory infections or in stable periods. We further assessed the effects of these two interventions on clinical value, complications, and survival. The literature search was performed on Embase, MEDLINE, CINAHL, CENTRAL and PEDro. Randomised controlled trials and cross-over studies were eligible. Results: Five studies were included, and results were presented narratively. High frequency wall compression was not shown to be superior to standard care in terms of lung volume and capacity, quality of life, complications, and survival rate. Compared with standard care, intrapulmonary percussive ventilation showed non-significant differences in terms of lung volume and capacity, and the risk of respiratory infection. Standard care was nevertheless associated with a significantly higher risk of days of hospitalisation (Incidence Rate Ratio 8.5 [1.1-67]) and of antibiotic use than intrapulmonary percussive ventilation (Incidence Rate Ratio 43 [6-333]). Conclusions: Due to large variety of reported outcomes, missing data and limited number of studies, no meta-analysis could be conducted. The results should be interpreted with caution as the results have a very low certainty of evidence and reported outcomes have a high risk of bias. The evidence for high frequency wall compression and intrapulmonary percussive ventilation is still insufficient to draw final conclusions. Protocol registration: PROSPERO ID: CRD42017064703.
Highlights
Ineffective cough mechanisms can occur in patients with neuromuscular disease (NMD) as a result of inspiratory and expiratory muscle weakness, as well as impaired glottic function1,2
Maintaining clear airways is crucial in patients with NMD, because respiratory insufficiency is one of the main causes of death4
One study18 assessed dyspnoea, and we found evidence against the Null-Hypothesis that high frequency chest wall compression (HFCWC) is not equal to the untreated groups (MD: -2.12 in favour of HFCWC with a with a 95% Confidence interval (CI) [-3.83, -0.41]; P= .02)
Summary
Ineffective cough mechanisms can occur in patients with neuromuscular disease (NMD) as a result of inspiratory and expiratory muscle weakness, as well as impaired glottic function. The standard secretion mobilisation techniques, such as postural drainage techniques, chest wall strapping, positive expiratory pressure and oscillatory positive expiratory pressure, are ineffective in very weak patients because they are effort-dependent, and these patients are generally unable to generate sufficient expiratory flow. The standard secretion mobilisation techniques, such as postural drainage techniques, chest wall strapping, positive expiratory pressure and oscillatory positive expiratory pressure, are ineffective in very weak patients because they are effort-dependent, and these patients are generally unable to generate sufficient expiratory flow3 These techniques are difficult to apply in cases of chest wall or spinal deformities, as well as osteoporotic ribs. Methods: We explored the effects of high frequency wall compression and intrapulmonary percussive ventilation, compared with standard care or no treatment, on the lung volume and capacity, and quality of life in patients with neuromuscular disease during respiratory infections or in stable periods. The evidence for high frequency wall compression and intrapulmonary percussive ventilation is still insufficient to draw final article can be found at the end of the article
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