Secretion Removal

Ms. MB has had trouble with choking while eating. When questioned, she reports trouble with food going ‘down the wrong tube’, and difficulty coughing it back up again. Additionally, overnight and for the first hour after wakening in the morning, she complains of secretions at the back of her throat which cause respiratory distress. These episodes cause anxiety, and periodically result in oxygen desaturation which can persist for up to a minute, or until the secretion has been cleared.
Why is it important to perform secretion removal in persons with SCI?
1. People with spinal cord injury are at risk for retention of secretions because of an increased prevalence of pneumonia compounded by lower expiratory flows during cough.
What are the techniques available to remove lung secretions and what is the evidence associated with each?
1. Techniques available for lung secretion removal are mechanical insufflation/exsufflation coupled with manual respiratory kinesitherapy using passive and active movement
2. There is limited evidence that suggests improving inspiratory and expiratory muscle force is important to maximize expiratory flow during cough.
3. Cough effectiveness can be enhanced by a variety of methods including manual assistance by a caregiver and/or electrical stimulation triggered by the person with SCI.
4. Hand-held expiratory pressure devices may enhance secretion removal in people with SCI.

Figure 9. The CoughAssist In-Exsufflator used with a tracheostomy. Source: Respironics, Murrysville, Pennsylvania.

For more information please see: Secretion Removal