Assisted Coughing

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Top Contributors - George Prudden, Rachael Lowe, Laura Ritchie and Claire Knott  

Description

In conditions such as spinal cord injury or neuromuscular disease an individual may require assistance to cough using manual techniques or a medical device. Manual assisted cough is the compression of the diaphragm by another person to replace the work of abdominal muscles in order to facilitate a cough. A medical device can be used to assist coughing effort by a positive pressure breath followed by a rapid change to negative pressure.[1]

Indication

Prevention and treatment of sputum retention

Clinical presentation

  • Subjectively 'chesty'
  • Aubible secretions at the mouth
  • Crackles heard on auscultation
  • Tactile fremitus
  • Hypoxemia

Contraindications

Manual assisted cough Cough assist device
Direct pressure should be avoided to rib fractures or surgical sites. Undrained pneumothorax

Frank haemoptysis

Vomiting

Facial fractures

CVS instability

Raised intracranial pressure (ICP)

Recent upper GI surgery

Lung abscess

[1]

Precautions

Manual assisted cough Cough assist device
Immediately following surgery

Paralytic ileus

Rib fractures

Raised ICP

Undrained pneumothorax

Osteroporosis

Pain

Unstable spine

Oxygen dependency

Bronchospasm

Emphysema

Patient complience

Airway obstruction

[1]

Cough assist device troubleshooting

Please also see non-invasive ventilation for more information on positive pressure devices

Resources

http://www.icid.salisbury.nhs.uk/ClinicalManagement/SpinalInjuries/Pages/AssistedCoughing.aspx

References

  1. 1.0 1.1 1.2 Harden, B. (2004). Emergency physiotherapy: An on-call survival guide. 1st ed. Edinburgh: Churchill Livingstone.