Cough Augmentation Techniques in the Critically Ill: A Canadian National Survey

• Published in: Respiratory care 2016-10, Vol.61 (10), p.1360-1368
• Main Authors: Rose, Louise, Adhikari, Neill K, Poon, Joseph, Leasa, David, McKim, Douglas A
• Format: Article
• Language: English
• Subjects: Acute respiratory distress syndrome; Artificial respiration; Canada; Care and treatment; Cough; Critical Illness - therapy; Critically ill; Health aspects; Humans; Insufflation - methods; Intensive Care Units; Lung - physiopathology; Noninvasive Ventilation - methods; Pulmonary Ventilation; Respiration, Artificial - methods; Respiratory Insufficiency - etiology; Respiratory Insufficiency - therapy; Surveys and Questionnaires
• ISSN: 0020-1324; 1943-3654
• DOI: 10.4187/respcare.04775

Critically ill mechanically ventilated patients experience impaired airway clearance due to ineffective cough and impaired secretion mobilization. Cough augmentation techniques, including mechanical insufflation-exsufflation (MI-E), manually assisted cough, and lung volume recruitment, improve cough efficiency. Our objective was to describe use, indications, contraindications, interfaces, settings, complications, and barriers to use across Canada. An e-mail survey was sent to nominated local survey champions in eligible Canadian units (ICUs, weaning centers, and intermediate care units) with 4 telephone/e-mail reminders. The survey response rate was 157 of 238 (66%); 78 of 157 units (50%) used cough augmentation, with 50 (64%) using MI-E, 53 (68%) using manually assisted cough, and 62 (79%) using lung volume recruitment. Secretion clearance was the most common indication (MI-E, 92%; manually assisted cough, 88%; lung volume recruitment, 76%), although the most common units (44%) used it