Which patients are most likely to benefit from mechanical insufflation-exsufflation (MIE)?

Mechanical insufflation-exsufflation (MIE) is a technique primarily beneficial for patients who have difficulty clearing secretions from their airways due to inadequate cough effectiveness. This is particularly common in patients with neuromuscular disorders, such as amyotrophic lateral sclerosis (ALS) or muscular dystrophy, where the muscle weakness can impair the ability to generate sufficient cough force to clear mucus.

In these patients, MIE works by delivering positive pressure breaths to inflate the lungs, followed by negative pressure exsufflation that mimics the natural expulsion of air during a cough. This process helps to mobilize and clear secretions, reducing the risk of infection, improving ventilation, and enhancing overall respiratory function.

Other conditions, such as asthma, pneumonia, and pulmonary embolism, do not typically lead to the same degree of secretion clearance issues associated with neuromuscular disorders. Asthma often involves bronchoconstriction rather than effective cough impairment, pneumonia may require different interventions such as antibiotics or bronchodilators, and while pulmonary embolism can cause respiratory distress, it does not primarily involve the inability to clear secretions as seen in neuromuscular disorders.