Due to copyright issues, an electronic copy of the thesis must be ordered from the faculty. For the faculty to have time to process the order, the order must be received by the faculty at the latest 2 days before the public defence. Orders received later than 2 days before the defence will not be processed. After the public defence, please address any inquiries regarding the thesis to the candidate.
Trial Lecture – time and place
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Adjudication committee
- First opponent: Senior Consultant Alessandro Amaddeo, IRCCS - Scientific Institute for Research, Hospitalization and Healthcare, Italy
- Second opponent: Senior Consultant Agneta Markström, Uppsala University, Sweden
- Third member and chair of the evaluation committee: Professor II Charlotte Hedvig Elisabet Tscherning Wel-Wel, University of Oslo
Chair of the Defence
Professor Emeritus Reidun Birgitta Jahnsen, University of Oslo
Principal Supervisor
MD, PhD Vegard Hovland, OUS - Oslo University Hospital
Summary
In paediatric neurodisability, an inefficient ability to cough may lead to severe pulmonary complications due to impaired airway secretion clearance. Mechanical insufflation-exsufflation (MI-E) may assist the cough mechanically; however, both current and optimal MI-E use, considering efficacy, safety, and patient satisfaction, is unknown.
This thesis aimed to determine the following; (1) the prevalence and clinical characteristics of children with neurodisability using long-term MI-E therapy. (2) the effects of MI-E treatment settings on expiratory flows and safety. (3) the MI-E therapy and treatment settings influence on patient perspectives.
Three studies were performed. A cross-sectional study used national registries and questionnaires to assess the prevalence, MI-E use and overall patient satisfaction with MI-E therapy. A lung model study imitating the characteristics of an infant with neuromuscular disorder evaluated the effect of various MI-E settings combinations on expiratory flows. Finally, in a randomised controlled trial in which the children served as their own controls, we measured the cough flows in the MI-E circuit and patient satisfaction during three different setting strategies.
We found a prevalence of MI-E users in the Norwegian neuropaediatric population of 6 per 1000. MI-E was used from infancy, with two-thirds of the children having a neuromuscular disorder and one-third having a condition in the central nervous system.
The highest cough flows were measured using high symmetric in-and exsufflation pressures. However, the children reported a personalised setting using lower in- than exsufflation pressures, as the most comfortable.
Considering efficiency, safety and patient satisfaction, several MI-E setting strategies could be applied. A note of comfort should be made in children with a percutaneous feeding tube and high spontaneous cough flow rates. The MI-E therapy was safe and generally reported as beneficial by the children and parents.
Additional information
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