Cough assist

Question 1

What is the difference between “The bird” or “IPPB” and mechanical insufflation / exsufflation or “cough assist”?

Answer 1

IPPB delivers pressure to lungs
Cough assist subtracts negative pressure to facilitate cough

Question 2

What are the indications to use cough assist? (5 answers)

Answer 2

Retained secretions
Neuro muscular conditions
Post exturbation/surgery
Low tidal volumes
fatigue

Question 3

What are the indications to use the bird? (4 answers)

Answer 3

Atelectasis
Ineffective cough (low lung volumes)
Increased WOB
Retained secretions

Question 4

What are the contraindications of the bird? (11 answers)

Answer 4

Pneumothorax (pressure issue)
Rib #
Raised ICP (Risk of bleed)
Haemodynamic instability
Recent oesophegeal surgery
Recent facial, oral or skull surgery
Air swallowing
Haemoptysis (pressure could affect bleeding more e.g. tumour)
Bullae or surgical emphysema (Could cause pneumothorax)
Active untreated TB
Nausea

Question 5

What are the contraindications of cough assist? (12 answers)

Answer 5

Pneumothorax (pressure issue)
Rib #
Raised ICP
Barotrauma
Pneumoectomy
CVS instability
Haemoptysis
Pulmonary oedema
Bullous or surgical emphysema
PEEP > 10
Recent lobectomy
Recent upper GI surgery

Question 6

Can you name the three phases of a cough?

Answer 6

Inspiratory phase
Glottic closure
Expiratory expulsion