Artificial Coughing for Patients With Respiratory Paralysis

Abstract

Summary A simple machine by which exsufflation with negative pressure (E.W.N.P.) can be performed to provide an artificial cough is described. Artificial coughing by this means allowed the control of lung complications in 20 patients with respiratory paralysis in whom retained bronchial secretions were an important problem. Massive collapse was relieved on eight occasions in seven patients. Prophylactic coughing makes possible the removal of a tracheotomy tube from patients with negligible respiratory muscle power. E.W.N.P. produces changes essentially similar to those occurring during normal human coughing and does not appear to have any harmful effect on the lungs or circulation. Besides patients with respiratory muscle weakness, artificial coughing is likely to be of greatest value in conditions in which there is prolonged unconsciousness.

Mechanical Insufflation Exsufflation, Syringomyelia, and Headache

“…However, typical positive pressures for coughing are greater than 200 cm H 2 O, whereas MIE creates airway pressures of 60 to −60 cm H 2 O via oronasal interfaces or simple mouthpieces. 16 These markedly lower intrathoracic pressures are why this patient could comfortably use MIE for airway clearance but not spontaneous coughing.…”

“…Likewise, this patient’s spontaneous cough caused her head to ache whereas airway clearance by MIE did not. Colebatch 16 noted that the negative pressure applied to the airways is analogous to the positive pressure on the surface of the lungs during a spontaneous cough. However, typical positive pressures for coughing are greater than 200 cm H 2 O, whereas MIE creates airway pressures of 60 to −60 cm H 2 O via oronasal interfaces or simple mouthpieces 16 .…”

“…Colebatch 16 noted that the negative pressure applied to the airways is analogous to the positive pressure on the surface of the lungs during a spontaneous cough. However, typical positive pressures for coughing are greater than 200 cm H 2 O, whereas MIE creates airway pressures of 60 to −60 cm H 2 O via oronasal interfaces or simple mouthpieces 16 . These markedly lower intrathoracic pressures are why this patient could comfortably use MIE for airway clearance but not spontaneous coughing.…”

Inappropriate weaning and late onset ventilatory failure of individuals with traumatic spinal cord injury

“…Its capacity to eliminate the need for bronchoscopy in ventilator supported indi viduals has been previously established. [34][35][36][37][38] Case 8 demonstrated a need for continued evaluation following acute rehabilitation. The need for nocturnal ventilatory assist ance is uncommon for adults with greater than 1500 ml or 30% -40% of predicted supine VC unless there are complicating medical conditions, obesity, kyphoscoliosis, malnutrition, or sleep disordered breath ing.…”

Airway Secretion Management and General Pulmonary Rehabilitation Considerations for Patients with Neuromuscular Ventilatory Failure

“…Bacterial colonization and possibly the planting of virulent microorganisms deeper in the airway by the suction catheter may be responsible for the greatly increased risk of nosocomial pneumonia seen in this population (5)(6)(7). Without the timely and effective use of noninvasive methods of airway secretion clearance, there is an unnecessarily high risk of pulmonary morbidity and resort to bronchoscopy (2,(9)(10)(11)(12), whereas with appropriate management the need for ongoing ventilatory support can be delayed or its use curtailed, and crisis situations and hospitalizations can be avoided (13).…”