INSUFLATION-MECHANICAL EXSULFATION AS AN AID TO RESPIRATORY MUSCLES

The published data suggest that MI-E can improve the intermediate outcome of peak cough expiratory flow. Data regarding its role in the clinical management of the patient consist of case series. In some studies, patients have served as their own control, with a decreased incidence of hospitalization among patients who switch from tracheostomy to a noninvasive approach, which may include MI-E as one component. While controlled trials would ideally further delineate who is most likely to benefit from MI-E, particularly those who would benefit from having such a device in the home, such trials are logistically difficult. The heterogeneous nature of the patients, even among those with similar diseases, almost mandates a case by case approach for these patients. For example, the clinical utility of MI-E would not only depend on the physiologic parameters of lung function, but also on the tempo of the disease course, the availability of home caregivers, and patient preference and motivation. The non-investigational status for the MI-E device is based on these considerations. 2004 Update A search of the literature for the period of 2003 through July 2004 did not identify any published articles that would prompt reconsideration of the policy statement. Therefore, the policy statement is unchanged. <a id="