[P2-52] The effectiveness of a combined therapy of NPPV and MI-E for chronic respiratory failure in children with severe motor disabilities
【Introduction】Mechanical insufflation-exsufflation (MI-E） has come to be used as a method for respiratory tract clearance in neuromuscular diseases, and patients under home ventilation management have been covered for medical insurance in Japan since 2010. Presently, therapy regimens comprised of a combination of Noninvasive Positive Pressure Ventilation (NPPV) and MI-E for chronic respiratory failure in children with severe motor and intellectual disabilities（SMID） have not been established as standard treatment. We investigated clinical course progression of patients receiving this combination therapy. 【Subjects】We investigated the clinical courses of four children who underwent NPPV and MI-E for chronic respiratory failure. 【Results】The four cases were patients with chronic respiratory failure complicating thoracic deformity, tracheal/bronchial stenosis and aspiration. Their ages at the time of starting the combination therapy ranged between 12 to 29 years old. In all cases, the NPPV was only used during the night, and the duration and frequency of the MI-E were determined individually. For the type of the MI-E, cuff-assist E70 was used. After initiating combination therapy, the frequency of occurrence of respiratory tract infection decreased, and resulting in decreased days of administration of antibacterial drugs. We also observed improvement in nighttime decreased partial pressure blood carbon dioxide and tachycardia. 【Conclusions】The results showed the effectiveness of NPPV and MI-E combination therapy for the management of chronic respiratory care in SMID. The combined use of MI-E with NPPV during nighttime can improve the QOL during daytime.