What is the role of a mechanical insufflator-exsufflator in the treatment of amyotrophic lateral sclerosis (ALS)?

Updated: Jan 02, 2020
  • Author: Divakara Kedlaya, MBBS; Chief Editor: Ryan O Stephenson, DO  more...
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Answer

An alternative (or adjunct) to suctioning can be provided with a mechanical insufflator-exsufflator. This respiratory aid assists in clearing debris by providing deep insufflation, immediately followed by a forced exsufflation to create artificially about 10 L/sec of expiratory flow (a normal cough expels air at approximately 16 L/sec). This can be administered directly via a tracheostomy tube with the cuff inflated or via an oral nasal mask.

The mechanical insufflator-exsufflator can be used acutely to relieve mucous plugs, but it also may be used routinely to provide assisted coughs and maintain clear airways. When used in combination with other respiratory muscle aids, it can avert tracheostomy tube placement, maintain quality of life, and prolong survival.


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