@article {Sancho1051, author = {Jes{\'u}s Sancho and Enric Bures and Saray de La Asunci{\'o}n and Emilio Servera}, title = {Effect of High-Frequency Oscillations on Cough Peak Flows Generated by Mechanical In-Exsufflation in Medically Stable Subjects With Amyotrophic Lateral Sclerosis}, volume = {61}, number = {8}, pages = {1051--1058}, year = {2016}, doi = {10.4187/respcare.04552}, publisher = {Respiratory Care}, abstract = {BACKGROUND: Mechanically assisted coughing with mechanical in-exsufflation (MI-E) is recommended for noninvasive management of respiratory secretions in amyotrophic lateral sclerosis (ALS). To improve the effectiveness of the technique, a new device combining MI-E with high-frequency oscillations (HFO) has been developed. This work aimed to assess the effect of HFO on the cough peak flow generated by MI-E in medically stable subjects with ALS.METHODS: This was a prospective study that included subjects with ALS in a medically stable condition. Cough peak flow generated by MI-E was measured in 4 situations: without HFO, with HFO during insufflation, with HFO during exsufflation, and with HFO in both cycles. The parameters used were: insufflation pressure of +40 cm H2O, exsufflation pressure of -40 cm H2O, insufflation time 2 s, exsufflation time 3 s, amplitude of oscillations 10 cm H2O, and frequency of oscillations 15 Hz.RESULTS: Forty-seven subjects with ALS were included: 66\% males, 68.2 {\textpm} 9.2 y, 40\% with bulbar onset, FVC = 1.7 {\textpm} 1.1 L, percent-of-predicted FVC = 54.4 {\textpm} 26.6\%, cough peak flow = 3.8 {\textpm} 2.2 L/s, PImax = -39.4 {\textpm} 26.4 cm H2O, revised ALS scale = 28.5 {\textpm} 9.3, Norris bulbar subscore = 26.1 {\textpm} 10.4. No statistical differences were found in cough peak flow generated by MI-E in the 4 situations (without HFO = 4.0 {\textpm} 1.2 L/s, with insufflation HFO = 3.9 {\textpm} 1.2 L/s, with exsufflation HFO = 4.1 {\textpm} 1.2 L/s, with in-exsufflation HFO = 3.9 {\textpm} 1.1 L/s).CONCLUSIONS: The addition of HFO to mechanically assisted coughing with MI-E does not have an effect on the cough peak flow of medically stable subjects with ALS.}, issn = {0020-1324}, URL = {https://rc.rcjournal.com/content/61/8/1051}, eprint = {https://rc.rcjournal.com/content/61/8/1051.full.pdf}, journal = {Respiratory Care} }