{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T19:20:43Z","timestamp":1789586443118,"version":"build-2803163510"},"reference-count":70,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2023,3,31]],"date-time":"2023-03-31T00:00:00Z","timestamp":1680220800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>The provision of mechanical insufflation-exsufflation (MI-E) devices to enhance cough efficacy is increasing. Typically, MI-E devices are used to augment cough in patients with neuromuscular disorders but also in patients who are weak in an acute care setting. Despite a growing evidence base for the use of these devices, there are barriers to the provision of MI-E, including clinician lack of knowledge and confidence. Enhancing clinician education and confidence is key. Individualized or protocolized approaches can be used to initiate MI-E. Evaluation of MI-E efficacy is critical. One method to evaluate effectiveness of MI-E is the MI-E-assisted cough peak flow (CPF). However, this should always be considered alongside other factors discussed in this review. The purpose of this review is to increase the theoretical understanding of the provision and evaluation of MI-E and provide insight into how this knowledge can be applied into clinical practice. Approaches to initiation and titration can be selected based on the clinical situation, patient diagnosis (including and beyond neuromuscular disorders), and clinician\u2019s confidence.<\/jats:p>","DOI":"10.3390\/jcm12072626","type":"journal-article","created":{"date-parts":[[2023,3,31]],"date-time":"2023-03-31T01:37:02Z","timestamp":1680226622000},"page":"2626","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":42,"title":["Mechanical Insufflation-Exsufflation: Considerations for Improving Clinical Practice"],"prefix":"10.3390","volume":"12","author":[{"given":"Michelle","family":"Chatwin","sequence":"first","affiliation":[{"name":"NMCCC, The National Hospital for Neurology and Neurosurgery, University College London Hospitals Foundation Trust, London WC1N 3BG, UK"},{"name":"Clinical and Academic Department of Sleep and Breathing, Royal Brompton Hospital, Part of Guys and St Thomas\u2019 NHS Foundation Trust, London SW3 6NP, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth Helen","family":"Wakeman","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Royal Brompton Hospital, Part of Guys and St Thomas\u2019 NHS Foundation Trust, London SW3 6NP, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1157","DOI":"10.1152\/jappl.1985.58.4.1157","article-title":"Peripheral mucociliary clearance with high-frequency chest wall compression","volume":"58","author":"Gross","year":"1985","journal-title":"J. Appl. Physiol."},{"key":"ref_2","first-page":"162","article-title":"Mechanisms of mucous transport","volume":"127","author":"Warwick","year":"1983","journal-title":"Eur. J. Respir. Dis. Suppl."},{"key":"ref_3","first-page":"824","article-title":"Studies on the removal of inhaled particles from the lungs by voluntary coughing","volume":"80","author":"Camner","year":"1981","journal-title":"Chest"},{"key":"ref_4","first-page":"8","article-title":"Physiotherapy in infants and young children with cystic fibrosis: Current practice and future developments","volume":"97","author":"Lannefors","year":"2004","journal-title":"J. R. Soc. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1016\/j.rmed.2018.01.012","article-title":"Airway clearance techniques in neuromuscular disorders: A state of the art review","volume":"136","author":"Chatwin","year":"2018","journal-title":"Respir. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1232","DOI":"10.1378\/chest.94.6.1232","article-title":"Cough Capacity in Patients with Muscular Dystrophy","volume":"94","author":"Szeinberg","year":"1988","journal-title":"Chest"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1164\/ajrccm.156.2.9611029","article-title":"Effect of Upper Respiratory Tract Infection in Patients with Neuromuscular Disease","volume":"156","author":"Poponick","year":"1997","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1016\/j.nmd.2017.10.008","article-title":"In Proceedings of the 228th ENMC International Workshop: Airway Cearance Techniques in Neuromuscular Disorders, Naarden, The Netherlands, 3\u20135 March 2017","volume":"28","author":"Toussaint","year":"2018","journal-title":"Neuromuscul. Disord."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1097\/PHM.0b013e318174e4c7","article-title":"Cough Peak Flows: Standard Values for Children and Adolescents","volume":"87","author":"Bianchi","year":"2008","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_10","first-page":"S39","article-title":"The development of cough","volume":"131","author":"Leith","year":"1985","journal-title":"Am. Rev. Respir. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1566","DOI":"10.1378\/chest.110.6.1566","article-title":"Criteria for Extubation and Tracheostomy Tube Removal for Patients with Ventilatory Failure. A different approach to weaning","volume":"110","author":"Bach","year":"1996","journal-title":"Chest"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1024","DOI":"10.1378\/chest.112.4.1024","article-title":"Prevention of Pulmonary Morbidity for Patients with Duchenne Muscular Dystrophy","volume":"112","author":"Bach","year":"1997","journal-title":"Chest"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1390","DOI":"10.1378\/chest.118.5.1390","article-title":"Prevention of Pulmonary Morbidity for Patients with Neuromuscular Disease","volume":"118","author":"Tzeng","year":"2000","journal-title":"Chest"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1159\/000364911","article-title":"Comparison of Three Cough-Augmentation Techniques in Neuromuscular Patients: Mechanical Insufflation Combined with Manually Assisted Cough, Insufflation-Exsufflation Alone and Insufflation-Exsufflation Combined with Manually Assisted Cough","volume":"88","author":"Lacombe","year":"2014","journal-title":"Respiration"},{"key":"ref_15","unstructured":"Medical, B. (2022). Breas Medical, M\u00f6lnlycke."},{"key":"ref_16","unstructured":"Respironics, P. (2012). Cough Assist E70 User Manual, Philips Respironics."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.4187\/respcare.09704","article-title":"The Use of Mechanical Insufflation-Exsufflation in Invasively Ventilated Critically Ill Adults","volume":"67","author":"Swingwood","year":"2022","journal-title":"Respir. Care"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1285","DOI":"10.1212\/01.WNL.0000092018.56823.02","article-title":"Cough augmentation in amyotrophic lateral sclerosis","volume":"61","author":"Mustfa","year":"2003","journal-title":"Neurology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1183\/09031936.03.00048102","article-title":"Cough augmentation with mechanical insufflation\/exsufflation in patients with neuromuscular weakness","volume":"21","author":"Chatwin","year":"2003","journal-title":"Eur. Respir. J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1378\/chest.126.3.774","article-title":"Effects of Mechanical Insufflation-Exsufflation on Respiratory Parameters for Patients with Chronic Airway Secretion Encumbrance","volume":"126","author":"Winck","year":"2004","journal-title":"Chest"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1553","DOI":"10.1378\/chest.104.5.1553","article-title":"Mechanical insufflation-exsufflation. Comparison of peak expiratory flows with manually assisted and unassisted coughing techniques","volume":"104","author":"Bach","year":"1993","journal-title":"Chest"},{"key":"ref_22","first-page":"1473","article-title":"The addition of mechanical insufflation\/exsufflation shortens airway-clearance sessions in neuromuscular patients with chest infection","volume":"54","author":"Chatwin","year":"2009","journal-title":"Respir. Care"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"187","DOI":"10.4187\/respcare.05663","article-title":"Mechanical Insufflation-Exsufflation Versus Conventional Chest Physiotherapy in Children with Cerebral Palsy","volume":"63","author":"Siriwat","year":"2017","journal-title":"Respir. Care"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1097\/01.PHM.0000151941.97266.96","article-title":"Mechanical Insufflation\u2013Exsufflation Improves Outcomes for Neuromuscular Disease Patients with Respiratory Tract Infections","volume":"84","author":"Vianello","year":"2005","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"R48","DOI":"10.1186\/cc11249","article-title":"Effects of mechanical insufflation-exsufflation in preventing respiratory failure after extubation: A randomized controlled trial","volume":"16","author":"Honrado","year":"2012","journal-title":"Crit. Care"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1471","DOI":"10.4187\/respcare.06253","article-title":"Effects of Mechanical Insufflation-Exsufflation on Airway Mucus Clearance Among Mechanically Ventilated ICU Subjects","volume":"63","author":"Savi","year":"2018","journal-title":"Respir. Care"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1371","DOI":"10.4187\/respcare.08641","article-title":"Effects of Mechanical Insufflation-Exsufflation on Sputum Volume in Mechanically Ventilated Critically Ill Subjects","volume":"66","author":"Bassi","year":"2021","journal-title":"Respir. Care"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1002\/ppul.24614","article-title":"Effect of mechanical insufflation-exsufflation in children with neuromuscular weakness","volume":"55","author":"Veldhoen","year":"2020","journal-title":"Pediatr. Pulmonol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"578","DOI":"10.3389\/fneur.2018.00578","article-title":"Associative Increases in Amyotrophic Lateral Sclerosis Survival Duration with Non-invasive Ventilation Initiation and Usage Protocols","volume":"9","author":"Khamankar","year":"2018","journal-title":"Front. Neurol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"s22","DOI":"10.1136\/thorax-2022-219698","article-title":"Clinical Statement on the prevention and management of community-acquired pneumonia in people with learning disability","volume":"78","author":"Legg","year":"2023","journal-title":"Thorax"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1136\/thx.56.6.438","article-title":"Effect of manually assisted cough and mechanical insufflation on cough flow of normal subjects, patients with chronic obstructive pulmonary disease (COPD), and patients with respiratory muscle weakness","volume":"56","author":"Sivasothy","year":"2001","journal-title":"Thorax"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1815","DOI":"10.4187\/respcare.09150","article-title":"Peak Expiratory Flow During Mechanical Insufflation-Exsufflation: Endotracheal Tube Versus Face Mask","volume":"66","author":"Hyun","year":"2021","journal-title":"Respir. Care"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1266","DOI":"10.1164\/rccm.200612-1841OC","article-title":"Predictors of Ineffective Cough during a Chest Infection in Patients with Stable Amyotrophic Lateral Sclerosis","volume":"175","author":"Sancho","year":"2007","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1508","DOI":"10.4187\/respcare.10173","article-title":"Effects of Mechanical Insufflation-Exsufflation with Different Pressure Settings on Respiratory Mucus Displacement During Invasive Ventilation","volume":"67","author":"Yang","year":"2022","journal-title":"Respir. Care"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"14799731221094619","DOI":"10.1177\/14799731221094619","article-title":"Short-term effect of air stacking and mechanical insufflation\u2013exsufflation on lung function in patients with neuromuscular diseases","volume":"19","author":"Veldhoen","year":"2022","journal-title":"Chronic Respir. Dis."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Hov, B., Andersen, T., Toussaint, M., Mikalsen, I.B., Volls\u00e6ter, M., Markussen, H., Indrekvam, S., and Hovland, V. (2023). User-perceived impact of long-term mechanical assisted cough in paediatric neurodisability. Dev. Med. Child Neurol., Epub ahead of print.","DOI":"10.1111\/dmcn.15543"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1136\/adc.2009.177832","article-title":"Outcome of goal-directed non-invasive ventilation and mechanical insufflation\/exsufflation in spinal muscular atrophy type I","volume":"96","author":"Chatwin","year":"2010","journal-title":"Arch. Dis. Child."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1080\/10790268.2000.11753511","article-title":"Patient Preference for ln-Exsufflation for Secretion Management with Spinal Cord Injury","volume":"23","author":"Garstang","year":"2000","journal-title":"J. Spinal Cord Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"100326","DOI":"10.1016\/j.ensci.2021.100326","article-title":"Pneumomediastinum while using mechanical insufflation-exsufflation after recovery from riluzole-induced interstitial lung disease","volume":"22","author":"Saitoh","year":"2021","journal-title":"eNeurologicalSci"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1097\/PHM.0b013e31817c181e","article-title":"Pneumothorax Associated with Mechanical Insufflation\u2013Exsufflation and Related Factors","volume":"87","author":"Suri","year":"2008","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1538","DOI":"10.1378\/chest.105.5.1538","article-title":"Update and perspective on noninvasive respiratory muscle aids. Part 2: The expiratory aids","volume":"105","author":"Bach","year":"1994","journal-title":"Chest"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1406","DOI":"10.1378\/chest.125.4.1406","article-title":"Use of the Mechanical In-Exsufflator in Pediatric Patients with Neuromuscular Disease and Impaired Cough","volume":"125","author":"Miske","year":"2004","journal-title":"Chest"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1136\/thoraxjnl-2015-207555","article-title":"Laryngeal response patterns influence the efficacy of mechanical assisted cough in amyotrophic lateral sclerosis","volume":"72","author":"Andersen","year":"2017","journal-title":"Thorax"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1196","DOI":"10.4187\/respcare.08960","article-title":"Upper Airway Assessment and Responses During Mechanically Assisted Cough","volume":"66","author":"Andersen","year":"2021","journal-title":"Respir. Care"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1400","DOI":"10.1378\/chest.125.4.1400","article-title":"Efficacy of Mechanical Insufflation-Exsufflation in Medically Stable Patients with Amyotrophic Lateral Sclerosis","volume":"125","author":"Sancho","year":"2004","journal-title":"Chest"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1186\/s13023-015-0267-0","article-title":"Use of mechanical airway clearance devices in the home by people with neuromuscular disorders: Effects on health service use and lifestyle benefits","volume":"10","author":"Mahede","year":"2015","journal-title":"Orphanet J. Rare Dis."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1506","DOI":"10.4187\/respcare.06321","article-title":"Monitoring Cough Effectiveness and Use of Airway Clearance Strategies: A Canadian and UK Survey","volume":"63","author":"Rose","year":"2018","journal-title":"Respir. Care"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1262","DOI":"10.1378\/chest.120.4.1262","article-title":"Predictors of Extubation Outcome in Patients Who Have Successfully Completed a Spontaneous Breathing Trial","volume":"120","author":"Khamiees","year":"2001","journal-title":"Chest"},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Stilma, W., van der Hoeven, S., Reimer, W.S.O., Schultz, M., Rose, L., and Paulus, F. (2021). Airway Care Interventions for Invasively Ventilated Critically Ill Adults\u2014A Dutch National Survey. J. Clin. Med., 10.","DOI":"10.3390\/jcm10153381"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1177\/1751143719870121","article-title":"A survey examining the use of mechanical insufflation-exsufflation on adult intensive care units across the UK","volume":"21","author":"Swingwood","year":"2020","journal-title":"J. Intensiv. Care Soc."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1378\/chest.122.1.92","article-title":"Amyotrophic lateral sclerosis: Predictors for prolongation of life by noninvasive respiratory aids","volume":"122","author":"Bach","year":"2002","journal-title":"Chest"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1097\/00002060-200208000-00004","article-title":"Mechanical insufflation-exsufflation: Pressure, volume, and flow relationships and the adequacy of the manufacturer\u2019s guidelines","volume":"81","author":"Sancho","year":"2002","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1080\/10790268.2010.11689687","article-title":"Mechanical Insufflation-Exsufflation Device Prescription for Outpatients with Tetraplegia","volume":"33","author":"Crew","year":"2010","journal-title":"J. Spinal Cord Med."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1378\/chest.07-1615","article-title":"Physiologic Benefits of Mechanical Insufflation-Exsufflation in Children with Neuromuscular Diseases","volume":"133","author":"Fauroux","year":"2008","journal-title":"Chest"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1097\/01.PHM.0000137309.34404.BC","article-title":"Effect of Lung Mechanics on Mechanically Assisted Flows and Volumes","volume":"83","author":"Sancho","year":"2004","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1488","DOI":"10.3349\/ymj.2016.57.6.1488","article-title":"A Comparison of Cough Assistance Techniques in Patients with Respiratory Muscle Weakness","volume":"57","author":"Kim","year":"2016","journal-title":"Yonsei Med. J."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"135","DOI":"10.4187\/respcare.06882","article-title":"Long-Term Mechanical Insufflation-Exsufflation Cough Assistance in Neuromuscular Disease: Patterns of Use and Lessons for Application","volume":"65","author":"Chatwin","year":"2020","journal-title":"Respir. Care"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1016\/j.arbres.2018.10.011","article-title":"Titration of Mechanical Insufflation-Exsufflation Optimal Pressure Combinations in Neuromuscular Diseases by Flow\/Pressure Waveform Analysis","volume":"55","author":"Lalmolda","year":"2019","journal-title":"Arch. Bronconeumol."},{"key":"ref_59","first-page":"69","article-title":"The clinical use of mechanical insufflation-exsufflation in children with neuromuscular disorders in Europe","volume":"27","author":"Hov","year":"2018","journal-title":"Paediatr. Respir. Rev."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1002\/ppul.24606","article-title":"Optimizing expiratory flows during mechanical cough in a pediatric neuromuscular lung model","volume":"55","author":"Hov","year":"2020","journal-title":"Pediatr. Pulmonol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1560","DOI":"10.1513\/AnnalsATS.201406-264OC","article-title":"Optimum Insufflation Capacity and Peak Cough Flow in Neuromuscular Disorders","volume":"11","author":"Mellies","year":"2014","journal-title":"Ann. Am. Thorac. Soc."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1226","DOI":"10.4187\/respcare.09978","article-title":"Waveforms Analysis in Patients with Amyotrophic Lateral Sclerosis for Enhanced Efficacy of Mechanically Assisted Coughing","volume":"67","author":"Sancho","year":"2022","journal-title":"Respir. Care"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1214","DOI":"10.4187\/respcare.05965","article-title":"Airway Clearance with an Optimized Mechanical Insufflation-Exsufflation Maneuver","volume":"63","author":"Volpe","year":"2018","journal-title":"Respir. Care"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"2346","DOI":"10.1016\/j.apmr.2019.06.012","article-title":"Peak Cough Flow Fails to Detect Upper Airway Collapse During Negative Pressure Titration for Cough-Assist","volume":"100","author":"Lacombe","year":"2019","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1164\/arrd.1983.128.3.511","article-title":"Enhanced Tracheal Mucus Clearance with High Frequency Chest Wall Compression","volume":"128","author":"King","year":"1983","journal-title":"Am. Rev. Respir. Dis."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"596","DOI":"10.4187\/respcare.07202","article-title":"Usefulness of Oscillations Added to Mechanical In-Exsufflation in Amyotrophic Lateral Sclerosis","volume":"65","author":"Sancho","year":"2019","journal-title":"Respir. Care"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"378","DOI":"10.4187\/respcare.08145","article-title":"Mechanical Insufflation-Exsufflation with Oscillations in Amyotrophic Lateral Sclerosis with Home Ventilation via Tracheostomy","volume":"66","author":"Sancho","year":"2020","journal-title":"Respir. Care"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.4187\/respcare.04552","article-title":"Effect of High-Frequency Oscillations on Cough Peak Flows Generated by Mechanical In-Exsufflation in Medically Stable Subjects with Amyotrophic Lateral Sclerosis","volume":"61","author":"Sancho","year":"2016","journal-title":"Respir. Care"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"1100","DOI":"10.1378\/chest.117.4.1100","article-title":"Spinal muscular atrophy type 1: A noninvasive respiratory management approach","volume":"117","author":"Bach","year":"2000","journal-title":"Chest"},{"key":"ref_70","doi-asserted-by":"crossref","unstructured":"Mitropoulou, G., Heinzer, R., Janssens, J.-P., von Garnier, C., and Prella, M. (2023). Home Use of Mechanical Insufflation\/Exsufflation in Adult Patients in Western Switzerland. 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