Introduction. Protocolised mechanical insufflation- exsufflation (MIE) has been demonstrated to be more effective in augmenting cough compared to standardised MIE settings (Lalmolda et al. Arch Bronconeumol. 2019;55(5):246?251). We aimed to evaluate if protocolised MIE titration at a tertiary ventilation centre resulted in a wider range of settings delivered to patients with neuromuscular disease (NMD)
Methods. MIE settings were recorded from e-health records between May and August 2021 when titration was not protocolised (cohort A). An MIE titration protocol (MIETP) that delivered pressure (P) and time (T) in systematic increments was embedded into practice. Final settings were based on peak cough flow and patient feedback. Comparison data were collected prospectively from July 2022 (cohort B). Data displayed as mean (SD)
Results. 56 patients were included in this study. The introduction of a MIETP resulted in different settings delivered to our patients (Table 1).
Table 1. Summary of MIE Settings
| Cohort A (n= 36) | Cohort B (n=21) | p-value | |
| Inufflation- P (cm/H2O) | 36 (5) | 34 (6) | 0.10 |
| Exsufflation-P (cm/H2O) | -47 (8) | -38 (8) | < 0.001 |
| Insufflation-T (s) | 2.7 (0.5) | 2.0 (0.3) | < 0.001 |
| Exsufflation-T (s) | 2.6 (0.4) | 1.8 (0.4) | < 0.001 |
Conclusion. Introduction of protocolised MIE resulted in lower exsufflation pressures and reduced insufflation- exsufflation times. With increasing evidence that higher pressures may be detrimental in some patients, a titration protocol may be a useful intervention to deliver MIE settings personalised to each patient. To our knowledge, these are the first data to evaluate insufflation-exsufflation time in vivo.