Study of effectiveness of bronchial clearence in subjects with upper spinal cord injuries. Examination of a rehabilitation programme involving mechanical insufflation and exsufflation

Study design: this randomized controlled trial designed to establish the effectiveness of mechanical insufflation and exsufflation in post-tracheostomy subjects with upper spinal cord injuries (C1-C7), ASIA A classification and bronchial hypersecretion. Objectives: to establish whether the use of mechanical insufflation/exsufflation leads to a significant increase in the following parameters: FVC, FEV1, FEV1/FVC, PEF, Pa O2, Pa CO2, pH, Sa O2. Setting: Montecatone Rehabilitation Institute, Imola, Italy Methods: The patients were split into two groups: the Experimental Group (EG) and the Control Group (CG). Each patient was given 10 treatments: the EG was given manual respiratory physiokinesitherapy associated with mechanical insufflation/exsufflation, while the CG was only given manual physiokinesitherapy. The treatment sessions covered the necessary amount of time in order to achieve sufficient clearance. Results: at the end of the treatment associated with the mechanical insufflation/exsufflation, the Experimental Group showed a significant increase in FVC, FEV1 and PEF, although it was not possible to compare the latter with the Control Group. The other parameters were also subject to variations, although not statistically significant. The Control Group did not show signs of any significant change. Conclusion: the use of mechanical insufflation/exsufflation in subjects with the aforementioned characteristics is shown to be an effective adjuvant to manual respiratory physiokinesitherapy, since it makes it possible to achieve adequate bronco-pulmonary clearance, even removing thick, deep secretions and making it possible to insufflate any areas affected by atelectasis.