{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T16:54:56Z","timestamp":1790355296576,"version":"4.1.0"},"reference-count":45,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2023,4,1]],"date-time":"2023-04-01T00:00:00Z","timestamp":1680307200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Respir Care"],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Daily application of mechanical insufflation-exsufflation (MI-E) is used increasingly in patients with neuromuscular diseases (NMDs) to prevent pulmonary congestion and thereby respiratory tract infections, although its beneficial effect remains uncertain. We, therefore, conducted a systematic review, registered in PROSPERO (CRD42020158278), to compile available evidence for daily MI-E use in subjects with NMDs and stable respiratory condition.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>We performed a systematic comprehensive search of MEDLINE, Embase, CINAHL, and Web of Science up to December 23, 2021. We excluded articles studying the effect of MI-E in case of acute respiratory failure or infections and studies comparing different MI-E devices and settings. Studied outcomes were prevalence and severity of respiratory infections, lung function, respiratory characteristics, and patient satisfaction. We performed a meta-analysis using DerSimonian-Laird random effects model and assessed methodological quality by using the Alberta Heritage Foundation for Medical Research tool.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      A total of 3,374 records were screened, of which 25 were included, studying 608 subjects. One randomized controlled trial (RCT) found a trend toward reduced duration of respiratory infections compared to air stacking (AS) that was not statistically significant. Long-term effects on pulmonary function tests (PFT) results were reported in one RCT and one retrospective study, with mixed results regarding vital capacity. Most studies compared PFT results before and immediately after MI-E use. Meta-analysis showed an overall beneficial effect of MI-E on cough peak flow (CPF) compared to unassisted CPF (mean difference 91.6 L\/min [95% CI 28.3\u2013155.0],\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001). Subject satisfaction was high, though possibly influenced by major bias.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>There is limited evidence available to support beneficial effects of daily use of MI-E in clinically stable subjects with NMDs, with the possible exception of increased CPF immediately after MI-E application. Lack of longitudinal studies preclude conclusions regarding long-term effects. The very limited data comparing MI-E to AS preclude comparisons.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4187\/respcare.09664","type":"journal-article","created":{"date-parts":[[2023,3,24]],"date-time":"2023-03-24T22:55:15Z","timestamp":1679698515000},"page":"531-546","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":12,"title":["Evidence for Beneficial Effect of Daily Use of Mechanical Insufflation-Exsufflation in Patients With Neuromuscular Diseases"],"prefix":"10.1177","volume":"68","author":[{"given":"Esther S","family":"Veldhoen","sequence":"first","affiliation":[{"name":"Pediatric Intensive Care Unit and Center of Home Mechanical Ventilation, Wilhelmina Children\u2019s Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roosmarijn","family":"van der Wal","sequence":"additional","affiliation":[{"name":"Pediatric Intensive Care Unit and Center of Home Mechanical Ventilation, Wilhelmina Children\u2019s Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura P","family":"Verweij-van den Oudenrijn","sequence":"additional","affiliation":[{"name":"Pediatric Intensive Care Unit and Center of Home Mechanical Ventilation, Wilhelmina Children\u2019s Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roelie M","family":"W\u00f6sten-van Asperen","sequence":"additional","affiliation":[{"name":"Pediatric Intensive Care Unit, Wilhelmina Children\u2019s Hospital, University Medical Center Utrecht, Utrecht, the Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael A","family":"Gaytant","sequence":"additional","affiliation":[{"name":"Center of Home Mechanical Ventilation, Department of Pulmonology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cornelis K","family":"van der Ent","sequence":"additional","affiliation":[{"name":"Department of Pediatric Pulmonology, Wilhelmina Children\u2019s Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W Ludo","family":"van der Pol","sequence":"additional","affiliation":[{"name":"Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik HJ","family":"Hulzebos","sequence":"additional","affiliation":[{"name":"Child Development and Exercise Center, Wilhelmina Children\u2019s Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2023,4,1]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.06510913"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2018.01.012"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.04676"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.118.5.1390"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(18)30025-5"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.nmd.2017.11.004"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2012-201964"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.03.00048102"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.braindev.2015.08.010"},{"issue":"4","key":"e_1_3_2_11_2","first-page":"CD013170","article-title":"Cough augmentation techniques for people with chronic neuromuscular disorders","volume":"4","author":"Morrow B","year":"2021","unstructured":"Morrow B, , Argent A, , Zampoli M, , Human A, , Corten L, , Toussaint M. 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