CoughAssist

Please refer to the CoughAssist Product User Manual for complete product description, including indications and contraindications for use. Once it has been determined that the CoughAssist treatment is clinically appropriate, the following can be used as a suggested protocol.

Indications: 
For use with any patient unable to cough or clear secretions effectively due to reduced peak expiratory flow.

Those who might benefit from the use of the CoughAssist MI-E include any patient with an ineffective cough due to muscular dystrophy, myasthenia gravis, poliomyelitis, or other neurologic disorder with some paralysis of the respiratory muscles, such as spinal cord injury. It may also be used to treat ineffective cough due to other bronchopulmonary diseases, such as emphysema, cystic fibrosis and bronchiectasis. It is effective for both trached and non-invasively ventilated patients.

Contraindications:

• Any patient with a history of bollous emphysema
• Susceptibility to pneumothorax or pneumomediastinum
• Recent barotraumas

The above contraindications should be carefully considered before use.

Warnings and cautions: 
Refer to the CoughAssist User Guide.

Implementation of CoughAssist: 
Attach CoughAssist user circuit to the CoughAssist output including a bacterial/viral filter, smoothbore tubing and an appropriate interface: mask, mouthpiece, or trach adapter. If a mask is used, it should be of appropriate size to provide for a tight seal.

Begin with inspiratory pressures between +10 and +15 cm H₂O and expiratory pressures of between –10 and –15 cm H₂O to allow an introduction/acclimation period to the device.

Verify initial pressures or any changes in pressure requirements by occluding the circuit in a clean manner and cycling from inhale to exhale.

• This should be done several times while viewing the pressure gauge.

Settings and modes: 
Start with either the Manual Mode or Auto Mode

• For Manual Mode: slide the manual toggle from inhale to exhale 4-6 times holding the inhale pressure for 2-3 seconds, enough time to deliver a full deep breath, then rapidly to exhale for 2-3 seconds.
• For Auto Mode: slide to the Auto Mode. Set the inhale time to 2-3 seconds and the exhale time to 2-3 seconds.

Slowly adjust the pressures upward with subsequent treatments by 5 cm H₂O each cycle of 4-6 breaths until optimal pressures are reached to clear secretions.

• Typical inhale pressures may vary between 15 cm H₂O to 40 cm H₂O.

  - Optimal inhale pressure may vary from patient to patient depending on lung and chest wall compliance.

• Optimal exhale pressure may vary between 35 cm H₂O and 45 cm H₂O.

Treatment length and process:

• A standard treatment consists of applying 4-6 consecutive cough cycles of insufflation/exsufflation.
• Visible secretions should be removed via suction from mouth, tracheostomy tube or tubing.
• User should then rest for 20-60 seconds and return to normal mode of ventilation and prescribed oxygen flow, if needed.
• The cough cycles, alternating with rest periods, can be repeated 4-6 times for a full treatment.

Using with a tracheostomy:

• The CoughAssist treatment can be applied through a tracheostomy tube by using a 15 mm trach adaptor or by adapting to inline suction catheter that would allow for easy removal of secretions from the trach tube.
• Higher exhale pressures may be required to overcome the increased resistance of a tracheostomy or endotracheal tube.
• When treating with the CoughAssist through a trach tube, it is advisable to use a means for trapping any secretions that may potentially accumulate in the treatment circuit.

  - Standard water traps, sputum traps, or extension tubing with corrugated inner walls can serve well for this purpose.