Cough-assisting techniques

In this chapter we will discuss recommendations from the hterature regarding dec-aruiulation as well as our personal clinical experience. We will comment on the pathophysiology of ventilator dependence, the determination of candidates for weaning from ventilation and tracheostomy, and a stepwise approach to decannulation. Lastly, we will discuss the choices of noninvasive ventilatory supports and techniques that clinicians may utilize, such as lung volume recruitment (LVR), assisted coughing and mechanical airway clearance. 

Bach JR. Mechanical insufflation-exsufflation. Comparison of peak expiratory flows with manually assisted and unassisted coughing techniques. Chest 1993 104(5) 1553-1562. 

Techniques for controlling and assisting the mobilization of secretions from the airways have long been advocated for use in the patient with impairment in mucociliary clearance or an ineffective cough mechanism. The goals of this therapy are to reduee airway obstruction, improve mucociliary clearance and ventilation, and optimize gas exehange. 

Approaches to preventing airway secretion retention include pharmacotherapy to reduce mucus hypersecretion or to liquefy secretions, and the application of chest physiotherapy (CPT) techniques. (CPT) can be defined as the external application of a combination of forces to increase mucus transport that include PD, special breathing exercises, manual chest vibration and percussion, autonomous instmmental techniques, and manually assisted coughing. 

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). 

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). 

Whitney J, Harden B, Keilty S. Assisted cough a new technique. Physiotherapy 2002 88(4) 201-207. 

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