Physical Medicine Interventions for Duchenne Muscular Dystrophy, the Including Avoiding Invasive Airway Tubes

15 be effective for DMD at all ages. Between 2.5 and 5 years of age, most children cooperate and cough on queue with MIE. Whether via the upper airway or via indwelling airway tubes, routine airway suctioning misses the left main stem bronchus about 90% of the time. 17 MIE, on the other hand, provides the same exsufflation (cough) flows in both left and right airways without the discomfort or airway trauma of tracheal suctioning. Patients prefer MIE to suctioning for comfort and effectiveness, and they find it less tiring. 18 Exsufflation flows (MIE-EF) are a substitute for weak cough flows and their extent is read off of the MIE device. Patients usually need MIE devices before requiring portable ventilators for symptoms of hypoventilation in Stage 3. Colds can occur at any time. When they begin, the oximeter must be put onto the finger and the O2 sat monitored continuously. With any decrease below 95% with the patient awake, MIE must be used until the O2 sat returns to normal. This will prevent pneumonia over 90% of the time. 19 Because any patient who can air stack is also able to use NVS via mouthpiece or nasal interface, if such a person is intubated for pneumonia and respiratory failure, they can be extubated directly to CNVS, regardless of whether regaining any strength to breathe at all. Before the patient’s VCs decrease to 70% of predicted normal, they are instructed to air stack 10 to 15 times, at least two or three times daily. Thus, the first respiratory equipment to be prescribed for DMD patients is often a manual resuscitation (Ambu) bag.