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

Abstract

Individuals with neuromuscular disease and restrictive pulmonary syndromes can benefit from the use of air stacking of mechanical insufflations, manually assisted coughing, and mechanical insufflation-exsufflation for the clearing of airway secretions that would otherwise put the patient at risk for atelectasis, pneumonia, and acute respiratory failure. Some neuromuscular patients can also use glossopharyngeal breathing to increase air stacking volumes. For many patients, mechanical insufflation-exsufflation, which may be used via an anesthesia mask or an endotracheal or tracheostomy tube, may be the only highly effective noninvasive method for clearing airway secretions. Peak cough expiratory flows (PCEF) generated during mechanical exsufflation can equal those that can be generated during the vigorous coughs of physically intact adults and exceed those that can be generated by assisted and unassisted coughing. No untoward effects or complications have been described for neuromuscular patients using this technique. Indications for the use of chest physical therapy and other benefits of using regular deep insufflations in a general rehabilitation program are also explored.