Breathing at Ease A Guide to Cough - Assist and Secretion Management University of Michigan Medical Center Adult Assisted Ventilation Clinic Armando Kurili , BS, CRT
Breathing at Ease
A Guide to Cough-Assist and Secretion Management
University of Michigan Medical CenterAdult Assisted Ventilation Clinic
Armando Kurili, BS, CRT
Respiratory System: A Brief Review
• Lungs as vital organs of gas exchange
– Trachea– Bronchial Tube– Bronchioles– Alveoli
They Don’t Work Alone
• Respiratory muscles
– Internal/External Intercostal– Diaphragm– Scalene– Sternomastoids– Abdominal muscles
When Breathing is Interrupted
• Restrictive diseases– Weakened chest wall muscles or abnormalities in
the chest wall• Obstructive disease
– The obstruction or narrowing of the small airways in the lungs, often characterized by difficulty exhaling
• Obesity hypoventilation syndrome (OHS)– Defined by a combination of obesity and a high
level of CO2 in the blood
Finding Solutions for Different Respiratory Conditions
• Airway Clearance• NPPV (Non-Invasive Positive Pressure
Ventilation)• IN (Invasive Ventilation)
Airway Clearance
Secretion clearance
Mucociliary clearance
(mobilization)
Cough clearance
(removal)
High-frequency chest-wall compression
Oscillation devices
Positive expiratory pressure
CoughAssist MI-EBreathing techniques
SuctioningManual assisted cough
Chest physiotherapy
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Secretion Removal Techniques and Devices
• Suction
• Manually-assisted cough
• Cough-Assist
Suctioning
• Invasive procedure
• Misses left main stem bronchus 90% of the time
• Tracheal trauma, suctioning induced hypoxemia, hypertension, cardiac arrhythmias and raised intracranial pressure have all been associated with suctioning
• Can be a painful • Anxiety-provoking procedure
Manually-assisted cough
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A Normal Cough?Requires 3 Phases of Operation
• Inspiration phase85 to 90% of TLC and a cough volume of 2.5 L
• Compression phaseGlottic closure for about 0.2 s. Prevents outflow of inhaled air
• Expulsion phaseContractions of expiratory muscles while glottis is open
Is indispensable for clearing airway secretions and bronchial mucus plugs.
The Cough Assist can be used for two things:
• For Coughing • Can’t generate sufficient flow
• Expanding the Lungs• Unable to air stack• Low Vital Capacity
Life-saving value of Cough-Assist
• Late-1940s, Henry Seeler working for US Air Force
• In 1952, Barach. Mechanical Cough Chamber
• In 1953, Cof-Flator. First portable device
• In 1993 FDA, Approved In-Exsufflator, JH Emerson CO,
Application of Cough-Assist
• Patients with an ineffective cough due to neuromuscular disorders
• Patients with paralysis of the respiratory muscles such as a high spinal cord injury
• Patients that have an ineffective cough due to respiratory fatigue associated with intrinsic lung disease
• Patients in respiratory failure due to neuromuscular disease and in the acute and chronic care setting
– Avoid intubation– Decrease hospitalization and complications from pneumonia and
respiratory infection– Facilitate extubation and decannulation– Prevent post-extubation failure
Inhale + Exhale + Pause = Cycle
Suggested Cough-Assist T70 MI-E Treatment
Repeat cycle 4-6 times
Rest 20-30 seconds
Repeat sequence 4-6 times
Patients that may benefit from a Cough Assist are
• Muscular Dystrophy• Spinal Muscular Atrophy• Amyotrophic Lateral Sclerosis• Spinal Cord Injuries• Myasthenia Gravis• Post Polio• COPD patients with a weak and ineffective cough
Summary• Used via:
• facemask, mouthpiece, endotracheal or trach
• Maximal effectiveness:• at pressures of 40 to -40 cm H2O
• Increase peak cough expiratory flows:• more than 80%1
• Recommended use to:• reduce recurrent respiratory infections
• Patients prefer Cough-Assist to suctioning for comfort and effectiveness
Questions?