Cough mechanical assistance in neuromuscular patients with respiratory failure: a retrospective evaluation

Background: Patients with neuromuscular diseases develop progressive respiratory failure and loss of the cough mechanisms. The Cough Assist (in-ex-sufflator) can be potentially useful to improve the clearance of secretions from the bronchial tree. We report here our experience in the S Maria Hospital, Terni, Italy. Materials and methods: we retrospectively collected data from the clinical charts of all patients discharged from the Respiratory Section of the S Maria Hospital and prescribed with a Cough Assist as a support for the homecare from January 1st 2003 to December 31st 2007. We collected demographics, basal condition, serial arterial blood gas analyses and microbiology data. Results: 13 patients, mean age 55,6±17,5, 69% male, 46% affected by amyotrophic lateral sclerosis were prescribed the Cough Assist support during the study period. Serial blood gas analyses (collected in a median period of 17 months, range 5-40) showed a slight improvement in the PaO2 (Basal value 73.9 mmHg vs Final PaO2 95.0 mmHg, p<0.05), other parameters did not show significant changes. Pseudomonas aeruginosa was isolated from 1 (7.7%) and 5 (38,5%, p=0.08) patients at the baseline and at the time of the last evaluation, respectively. Conclusions: from this limited, uncontrolled study, Cough Assist might have a role in slowing the progression of respiratory failure in neuromuscular patients, although it does not prevent infection by Gram negative agents