{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T10:40:53Z","timestamp":1787913653839,"version":"build-2784847793"},"reference-count":34,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2019,1,1]],"date-time":"2019-01-01T00:00:00Z","timestamp":1546300800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100011645","name":"kaohsiung medical university chung-ho memorial hospital","doi-asserted-by":"publisher","award":["KMUH-106R76"],"award-info":[{"award-number":["KMUH-106R76"]}],"id":[{"id":"10.13039\/501100011645","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Ther Adv Respir Dis"],"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:sec><jats:title>Background:<\/jats:title><jats:p> To determine the effectiveness of combined noninvasive ventilation (NIV) and mechanical insufflator-exsufflator (MI-E) for acute respiratory failure (ARF) in patients with neuromuscular disease (NMD), and outcome predictors. <\/jats:p><\/jats:sec><jats:sec><jats:title>Methods:<\/jats:title><jats:p> A prospectively observational study of patients with ARF was conducted in a pediatric intensive care unit (PICU). All received combined NIV\/MI-E during PICU stays between 2007 and 2017. Pertinent clinical variables of heart rate (HR), respiratory rate (RR), pH, PaCO<jats:sub>2<\/jats:sub>, and PaO<jats:sub>2<\/jats:sub>\/FiO<jats:sub>2<\/jats:sub> ratio were collected at baseline and at 2 h, 4-8 h, and 12-24 h after initiating use of NIV\/MI-E. Treatment success was defined as avoiding intubation. <\/jats:p><\/jats:sec><jats:sec><jats:title>Results:<\/jats:title><jats:p> A total of 62 ARF episodes in 56 patients with NMD (median age, 13 years) were enrolled. The most frequent underlying NMD was spinal muscular atrophy (32\/62, 52%). ARF was primarily due to pneumonia (65%). The treatment success rate was 86%. PICU stay and hospitalization were shorter in the success group (9.4\u2009\u00b1\u20096.1 vs. 21.9\u2009\u00b1\u200913.9 days and 16.3\u2009\u00b1\u20097.8 vs. 33.6\u2009\u00b1\u200917.9 days, respectively; both p\u2009&lt;\u20090.05). HR, RR, pH, and PaCO<jats:sub>2<\/jats:sub> showed a progressive improvement, particularly after 4 h following successful NIV\/MI-E treatment. RR decrease at 4 h, and pH increase and PaCO<jats:sub>2<\/jats:sub> decrease at 4-8 h might predict success of NIV\/MI-E treatment. The multivariate analysis identified PaCO<jats:sub>2<\/jats:sub> at 4-8 h of 58.0 mmHg as an outcome predictor of NIV\/MI-E treatment. <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions:<\/jats:title><jats:p> Applying combined NIV\/MI-E in the acute care setting is an efficient means of averting intubation in NMD patients with ARF. Clinical features within 8 h of the institution may predict treatment outcome. The reviews of this paper are available via the supplemental material section. <\/jats:p><\/jats:sec>","DOI":"10.1177\/1753466619875928","type":"journal-article","created":{"date-parts":[[2019,9,23]],"date-time":"2019-09-23T11:35:23Z","timestamp":1569238523000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":19,"title":["Combined noninvasive ventilation and mechanical insufflator\u2013exsufflator for acute respiratory failure in patients with neuromuscular disease: effectiveness and outcome predictors"],"prefix":"10.1177","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7713-3627","authenticated-orcid":false,"given":"Tai-Heng","family":"Chen","sequence":"first","affiliation":[{"name":"Division of Pediatric Emergency, Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung"},{"name":"PhD Program in Translational Medicine, Graduate Institute of Clinical Medicine, Kaohsiung Medical University and Academia Sinica"},{"name":"Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen-Chen","family":"Liang","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung"},{"name":"Departments of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I-Chen","family":"Chen","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung"},{"name":"Departments of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Ching","family":"Liu","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jong-Hau","family":"Hsu","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Kaohsiung Medical University Hospital, #100, Tz-You 1st Road, Kaohsiung, 80708"},{"name":"Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuh-Jyh","family":"Jong","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Kaohsiung Medical University Hospital, No. 100, Tzyou 1st Road, Kaohsiung 80708"},{"name":"Departments Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung"},{"name":"Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung"},{"name":"Department of Biological Science and Technology, Institute of Molecular Medicine and 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