PT - JOURNAL ARTICLE AU - Jesus Sancho AU - Santos Ferrer AU - Enric Bures AU - Lucía Fernandez-Presa AU - Pilar Bañuls AU - M Cruz Gonzalez AU - Jaime Signes-Costa TI - Waveforms Analysis in Patients With Amyotrophic Lateral Sclerosis for Enhanced Efficacy of Mechanically Assisted Coughing AID - 10.4187/respcare.09978 DP - 2022 Oct 01 TA - Respiratory Care PG - 1226--1235 VI - 67 IP - 10 4099 - http://rc.rcjournal.com/content/67/10/1226.short 4100 - http://rc.rcjournal.com/content/67/10/1226.full AB - BACKGROUND: Effectiveness of mechanical assisted coughing with insufflation-exsufflation (MI-E) in amyotrophic lateral sclerosis (ALS) depends largely on severity of bulbar dysfunction, which can generate different upper-airway responses. The aim of the study was to evaluate the use of graphs generated by MI-E in ALS to detect airway obstruction and set parameters to achieve an effective mechanically assisted coughing.METHODS: This was a prospective study enrolling patients with ALS. Several sessions with MI-E were applied, administering different insufflation-exsufflation (± 20, ± 30, ± 40, ± 50 cm H2O) levels in each session. The graphs produced were recorded and analyzed, and the results were used to select the parameters resulting in more effective MI-E.RESULTS: Sixty-nine subjects with ALS were included, yielding a total of 351 analyzed records. A pattern of obstruction during insufflation was detected in 34 subjects (50.7%) and of upper-airway collapse during exsufflation in 18 subjects (26%). The variable associated with obstruction during insufflation was bulbar upper motor neuron dysfunction (odds ratio 7.19 [95% CI 2.32–22.29], P = .001), whereas bulbar lower motor neuron dysfunction was related to upper-airway collapse during exsufflation (odds ratio 0.32 [95% CI 0.11–0.98], P = .046). After parameters were adjusted, in 68 subjects (98.55%) an effective MI-E was achieved. The only variable that predicted absence of alterations in the graphs was Norris bulbar score (odds ratio 0.87 [95% CI 0.78–0.96], P = .007).CONCLUSIONS: Analysis of graphics generated by applying MI-E in ALS was an effective method to detect upper-airway responses and select optimal set parameters. Obstruction during insufflation is related to bulbar upper motor neuron dysfunction and collapse during exsufflation to bulbar lower motor neuron dysfunction.