Assisted Cough
(Quad Cough)By having someone assist you in coughing, your cough will be more forceful and productive and you will be able to both prevent and treat some respiratory complications by bringing up secretions normally present in the lung. Indications for an assisted cough are:
* Weak or ineffective cough, and/or
* Excessive secretionsReasons to avoid an assisted cough are:
* Pain
* Internal problems, such as abdominal complications, where pushing on the abdomen could cause more complications
* Chest injury ( broken ribs)
* Flail chest, where the chest has excessive mobility, usually due to paralysis of the muscles which control it.Method:
Assisted Cough
The Institute for Rehabilitation Research and Development (IRRD)
at The Rehabilitation Centre (Ottawa)
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Browsing Posts tagged muscles
Spontaneous breathing is good!?
- A combination of 18-69 hours of diaphragmatic inactivity and controlled mechanical ventilation results in 53-57% reduction of diaphragm muscle fibers!
- Asynchrony and over-assisting contribute to disappearing muscle… so tailor Ti, Insp Rise, and set rates appropriately!
Wake up and Breathe! (ABC trial)
- Paired sedation and ventilator weaning protocol consisting of daily SATs plus SBTs resulted in patients spending more time off mechanical ventilation, less time in coma, and less time in intensive care and the hospital, and the protocol improved 1-year survival compared with usual care.
The ICU patient remembers…
~20% of ICU patients suffer post-traumatic stress disorder leading to physical & mental health issues.
What they remember? (see Granja article)
1. Daily needle punctures
2. Tracheal tube aspiration
3. Nose tube
4. Bladder tube
5. Noise from conversation
6. Noise from engines and ventilators
7. Pain
8. Bedridden
9. Music in the intensive care unit
10. Comments from doctors and nurses
Lung Weight (Gattinoni lecture)
- A normal lung weighs 800-1200 grams
- An ARDS lung weighs 2000-4000 grams! At least 10-15 cm H2O PEEP to overcome the compressive forces in an ARDS lung.
Subclinical Delirium = Brain Failure?!
- Patients suffering subclinical or transient delirium are more likely to have a longer hospital stay, higher mortality rate and require increased assistance at home.
- Current debates about benzos altering the structure of the brain and increasing incidence of delirium
- Should ICUs move to Remifentanil, Propofol, Dexmedetomidine?
Guillain-Barré Syndrome is the leading cause of nontraumatic acute paralysis in industrialized countries. About 30% of patients have RESPIRATORY failure requiring intensive care unit (ICU) admission and invasive mechanical ventilation. Progressive weakness of both the inspiratory and the expiratory muscles is the mechanism leading to respiratory failure. Aspiration pneumonia and atelectasis are common consequences of the bulbar muscle weakness and ineffective cough.
From the Department of Neurology at the Mayo Clinic, there appears to be diagnostic and clinical techniques in deciding when/if a patient requires admission to the I.C.U.
In the study ( from Vol. 58 No. 6, June 2001 Archives of Neurology) 114 patients with GBS who were admitted to the Intensive Care unit were studied.
In summery the results they found were the following:
Those requiring mechanical ventilation were found to have bilateral facial weakness, or dysautonomia, and bulbar dysfunction. Spirometry values indicated concern with VC <20 ml/kg, MIP ,30 cmH20 and a maximum expiratory pressure of <40 cmH20.
