Evaluation of the Accuracy of a Mechanical Insufflation-Exsufflation Device’s Cough Peak Flow Measurement
Bibliographic record
Abstract
Background: Mechanical insufflation-exsufflation (MI-E) is used to augment secretion clearance in neuromuscular patients with weakened cough strength. Cough peak flow (CPF) is a measure of cough function that is used to assess a patient’s ability to clear secretions, with thresholds set that categorize cough as effective, ineffective or severely ineffective. MI-E is prescribed according to these thresholds, and CPF is used to assess titration of MI-E settings. The Clearway2 (Breas Medical, Stratford-upon-Avon, United Kingdom) displays a real-time CPF, measured by an internal pneumotachograph. This study sought to assess the agreement and repeatability of this displayed CPF, against the reference CPF measurement by a calibrated pneumotachograph. Methods: This study consisted of two phases (1) lung model (Group A) and (2) acutely unwell individuals with neuromuscular conditions (Group B) and clinically stable individuals with neuromuscular conditions (Group C). Simultaneous CPF measurements were recorded from the MI-E device (CPF MI-E ) and a calibrated pneumotachograph (CPF), which was inserted into the MI-E circuit. Bland-Altman analysis was used to assess agreement between methods of measurement, and repeatability was assessed using a repeated measures analysis of variance. Results: During phase 1, 805 simulated coughs were evaluated with the Clearway2. The mean bias toward CPF MI-E was 33 L/min (95% limits of agreement 6–60 L/min). During phase 2, the mean bias increased to 66 L/min (95% limits of agreement 13–119 L/min). CPF MI-E and CPF both had good repeatability in all groups. Conclusions: The Clearway2 MI-E device provided a real-time CPF measurement that was repeatable and systematically higher than CPF. It may therefore be a useful tool to measure change longitudinally, or in response to changes in MI-E settings, in an individual patient. Caution is advised if using the CPF MI-E to assess cough efficacy against clinical thresholds.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".