Mechanical insufflation-exsufflation (MI-E) may be considered medically necessary in patients with neuromuscular disease or spinal cord injury and impaired ability to cough and who require ventilatory assistance.
MI-E may either be offered on a temporary basis in patients with noninvasive intermittent positive pressure ventilation (IPPV) who are suffering from a respiratory tract illness, or may be used on a more chronic basis in an attempt to avoid the option of tracheostomy and suctioning. In patients with a tracheostomy, MI-E may be offered in lieu of suctioning. In general, an impaired ability to cough has been defined as a peak cough expiratory flow of less than 2– 3L per second. The presence of chronic obstructive pulmonary disease, bullous emphysema, known susceptibility to pneumothorax or pneumo-medisatinum, or exposure to recent barotrauma is considered relative contraindications to MI-E.