Abdominal thrust

Figure 3 PCF measured from the MIC with an abdominal thrust timed to glottic opening in a sitting position in neuromuscular patient. Abbreviations PCF, peak cough flow MIC, maximum insufflation capacity.

The patient with partial or eomplete abdominal muscle paralysis is unable to produce an effeetive eough. The abdominal thrust is an assisted coughing technique that consists of the assoeiation of two teehniques the costophrenic compression and the Heimlich maneuver. The eombination of deep lung insufflations to the MIC followed by the manually assisted eough with abdominal thrust (Fig. 8) has been shown to increase significantly PCF s values in restrietive patients (47,64). 

Figure 8 Manually assisted cough with abdominal thrust to measure PCF in sitting position. Abbreviation. PCF, peak cough flow.

Except after a meal, an abdominal thrust is applied in conjunction with the insufflation-exsufflation mechanically assisted coughing (MAC) (66). MI-E can be provided via an oronasal mask (Eig. 11), a simple mouthpiece, or via a translaryngeal or tracheostomy tube. When delivered via the latter, the cuff, when present, should be inflated (73). 

The use of MI-E via the upper airway can be effective for children as young as 11 months of age. Patients this young can become accustomed to MI-E and permit its effective use by not crying or closing their glottises. Between two and one-half and five years of age most children beeome able to cooperate and cough on queue with MI-E. Exsufflation-timed abdominal thrusts are also used for infants (75,76). 

Abdominal compressions should not be used for 1 to 1.5 hours following a meal, however, chest compressions can be used to augment PCF. Chest thrusting techniques must be performed with caution in the case of an osteoporotic rib cage. Unfortunately, since it is not widely taught to health care professionals, manually assisted coughing is underutilized (67). 

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