Assisted Coughing: Difference between revisions
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== Description == | == 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.<ref name=":0">Harden, B. (2004). ''Emergency physiotherapy: An on-call survival guide''. 1st ed. Edinburgh: Churchill Livingstone.</ref> | The cough assist helps to clear secretions by applying a positive pressure to fill the lungs, then quickly switching to a negative pressure to produce a high expiratory flow rate and simulate a cough. It is known as ‘manual insufflation-exsufflation’ and can be applied via a mask, mouthpiece, endotracheal or tracheostomy tube. | ||
It is most useful in patients with an ineffective cough due to muscle weakness, in conditions such as [[Duchenne Muscular Dystrophy|muscular dystrophies]], [[Myasthenia Gravis|myasthenia gravis]], SMA, Spinal cord lesions, MND etc. | |||
In conditions such as [[Spinal Cord Injury|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.<ref name=":0">Harden, B. (2004). ''Emergency physiotherapy: An on-call survival guide''. 1st ed. Edinburgh: Churchill Livingstone.</ref> | |||
== Indication == | == Indication == | ||
* A patient unable to clear secretions effectively due to muscle weakness | |||
* Peak cough flows of >180 L/min are unlikely to be effective at clearing secretions | |||
* Can be useful in preventing respiratory complications due to secretion retention and poor tidal volumes | |||
== Clinical presentation == | == Clinical presentation == | ||
* Subjectively 'chesty' | * Subjectively 'chesty' | ||
* | * Audible secretions at the mouth | ||
* Crackles heard on auscultation | * Crackles heard on auscultation | ||
* Tactile fremitus | * Tactile fremitus | ||
* Hypoxemia | * [[Hypoxaemia|Hypoxemia]] | ||
* Non productive cough | |||
* Poor inspiratory efforts | |||
== Contraindications == | == Contraindications == | ||
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<ref name=":0" /> | <ref name=":0" /> | ||
== Cautions == | |||
* Cardiovascular instability | |||
* Coagulopathy | |||
* High Oxygen requirements | |||
* Asthma or air trapping | |||
* Full tummy! | |||
== Side effects == | |||
* Abdominal distension | |||
* Chest soreness | |||
* Fatigue | |||
* Oxygen desaturation | |||
== Technique/Treatment == | |||
* Gain consent | |||
* Carry out any chest physio techniques prior to cough assist to optimise treatment and position patient as indicated. | |||
* Explain procedure and accustom patient to mask with machine off. | |||
* Switch machine on and allow patient to feel with their hand | |||
* Set pressures low to begin with (10-15cmH2O) to allow patient to acclimatise | |||
* Choose manual or automatic mode and build up pressures as tolerated to gain adequate secretion removal. Always start with the inspiratory phase | |||
* Oxygen can be entrained via nasal specs or t-piece if needed. | |||
* Encourage patient to cough with the breath out | |||
* 5 breaths in and out at a time followed by 30-60 sec rest. Repeat up to 10 times as needed. Usually 3-5 ‘cycles’ are enough to produce a cough | |||
* Cough assist is for intermittent use and should not be used for >5 mins | |||
* Observe post treatment and reassess for improvement | |||
* Document treatment details and effects | |||
== Cough assist device troubleshooting == | == Cough assist device troubleshooting == | ||
Revision as of 13:14, 13 January 2019
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Top Contributors - Kim Jackson, George Prudden, Adam Vallely Farrell, Lucinda hampton, Rachael Lowe, Claire Knott, Angeliki Chorti and Laura Ritchie
Description[edit | edit source]
The cough assist helps to clear secretions by applying a positive pressure to fill the lungs, then quickly switching to a negative pressure to produce a high expiratory flow rate and simulate a cough. It is known as ‘manual insufflation-exsufflation’ and can be applied via a mask, mouthpiece, endotracheal or tracheostomy tube.
It is most useful in patients with an ineffective cough due to muscle weakness, in conditions such as muscular dystrophies, myasthenia gravis, SMA, Spinal cord lesions, MND etc.
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[edit | edit source]
- A patient unable to clear secretions effectively due to muscle weakness
- Peak cough flows of >180 L/min are unlikely to be effective at clearing secretions
- Can be useful in preventing respiratory complications due to secretion retention and poor tidal volumes
Clinical presentation[edit | edit source]
- Subjectively 'chesty'
- Audible secretions at the mouth
- Crackles heard on auscultation
- Tactile fremitus
- Hypoxemia
- Non productive cough
- Poor inspiratory efforts
Contraindications[edit | edit source]
| 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 |
Precautions[edit | edit source]
| 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 |
Cautions[edit | edit source]
- Cardiovascular instability
- Coagulopathy
- High Oxygen requirements
- Asthma or air trapping
- Full tummy!
Side effects[edit | edit source]
- Abdominal distension
- Chest soreness
- Fatigue
- Oxygen desaturation
Technique/Treatment[edit | edit source]
- Gain consent
- Carry out any chest physio techniques prior to cough assist to optimise treatment and position patient as indicated.
- Explain procedure and accustom patient to mask with machine off.
- Switch machine on and allow patient to feel with their hand
- Set pressures low to begin with (10-15cmH2O) to allow patient to acclimatise
- Choose manual or automatic mode and build up pressures as tolerated to gain adequate secretion removal. Always start with the inspiratory phase
- Oxygen can be entrained via nasal specs or t-piece if needed.
- Encourage patient to cough with the breath out
- 5 breaths in and out at a time followed by 30-60 sec rest. Repeat up to 10 times as needed. Usually 3-5 ‘cycles’ are enough to produce a cough
- Cough assist is for intermittent use and should not be used for >5 mins
- Observe post treatment and reassess for improvement
- Document treatment details and effects
Cough assist device troubleshooting[edit | edit source]
Please also see non-invasive ventilation for more information on positive pressure devices
Resources[edit | edit source]
http://www.icid.salisbury.nhs.uk/ClinicalManagement/SpinalInjuries/Pages/AssistedCoughing.aspx
