CHEST Guidelines-Upper-Airway-and-Translaryngeal-Resistance-During-

Upper-Airway-and-Translaryngeal-Resistance-During-

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The study investigates the feasibility of measuring upper airway and laryngeal resistances during Mechanical Insufflation-Exsufflation (MI-E), a device used to assist individuals with ineffective cough by employing cycles of positive and negative pressures. The research was conducted in a cross-sectional study involving 10 healthy adult participants. It aimed to explore how pressures progress through the airway during MI-E, and how resistances are distributed, particularly focusing on translaryngeal resistance (Rtl) and upper airway resistance (Ruaw). <br /><br />Using pressure measurements at the mask, epiglottis, and trachea, the researchers found that while positive pressures reached the trachea effectively, negative tracheal pressures were only about half of the intended settings. The study revealed that resistances are dynamic, influenced by participant effort, and the laryngeal responses during MI-E. The soft structures of the upper airway absorb much of the negative pressure, reducing its transmission effectively. <br /><br />The results suggest that Ruaw often exceeds Rtl, especially during exsufflation. Laryngeal adduction increased Rtl significantly, potentially impacting the efficacy of MI-E. These observations are important for understanding how airway pressures and resistances affect cough effectiveness, advocating for individualized pressure settings while using MI-E to optimize patient comfort and therapeutic benefits. Clinically, the study supports trends favoring lower insufflation pressures and higher negative pressures during exsufflation for better outcomes and patient adherence. <br /><br />Overall, the study concludes that measuring airway pressures and resistances during MI-E is feasible, providing insights into optimizing MI-E settings for patients, especially those with neuromuscular conditions, although the study highlights the invasive nature of pressure measurements and the need for tailored treatments to individual patient needs.

Keywords

Mechanical Insufflation-Exsufflation

upper airway resistance

laryngeal resistance

translaryngeal resistance

pressure measurements

positive and negative pressures

cough effectiveness

airway pressures

neuromuscular conditions

individualized treatment