Airway clearance techniques
Secretion clearance techniques include suctioning, manually-assisted cough (MAC), and mechanical insufflation-exsufflation devices. Invasive suctioning has been the long time standard for removing secretions that cannot be coughed out. Suctioning is effective in removing secretions from the upper tracheo-bronchial tree. Tracheotomies and endotracheal tubes allow for quick and easy access. Another secretion clearing technique is the manually assisted cough (MAC). MAC is safe and easy to learn and to teach. It consists of coordinating either abdominal or chest thrusts with the cooperative patient’s cough effort to increase peak cough flow. Mechanical Insufflation- Exsufflation or MI-E also know as CoughAssist.
This therapy works noninvasively to removed retained secretions. A gradual hyperinflation is provided with positive pressure followed by a rapid shift to a negative pressure which simulates a cough. This therapy can be administered by mask, mouthpiece or invasively through a tracheostomy tube.
Secretion mobilization techniques are intended to mobilize the mucus in the peripheral airways so they can be removed more easily. An advantage of secretion mobilization methods is that they don’t require the patient’s cooperation and thus can be used on infants, young children, and patients who are incapable of participating in the therapy. One basic secretion mobilization technique is chest physical therapy, which consists of a secondary individual applying external mechanical maneuvers, such as chest percussion, postural drainage, and vibration, to augment mobilization and clearance of airway secretions. HFCWO therapy vests are also available that apply vibratory forces that oscillate through the chest wall into the lungs to loosen and mobilize secretions.
The frequency of application and the preferred techniques for this type of airway clearance needs to be customized to each patient and will need to be re-evaluated regularly throughout the patient’s disease course. In general, though, patients will need assistance in clearing their airways daily.