Protocol

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

Indications
  • Reduced Peak Cough Flow (pcf) < 270 lpm necessary to clear bronchial secretions during an infection
    • PCF can be measured by pneumotach or by simple peak flow meter adapted to a facemask.
  • A maximum expiratory pressure < 60 cm H20
Contraindications
  • Any patient with a history of bullous emphysema
  • Susceptibility to pneumothorax or pnuemo-mediastinum
  • Recent barotrauma, should be carefully considered before use

The above contraindications should be carefully considered before use.

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 H20 and expiratory pressures of between -10 and -15 cm H20 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 sec, enough time to deliver a full deep breath, then rapidly to exhale for 2-3 sec
  • For Auto Mode: slide to the Auto mode. Set the inhale time to 2-3 sec. and the exhale time to 2-3 sec

Slowly adjust the pressures upward with subsequent treatments by 5 cm H20 each cycle on 4-6 breaths until optimal pressures are reached to clear secretions.

  • Typical inhale pressures may vary between 15 cm H20 to 40 cm H20.
    • Optimal inhale pressure may vary from patient to patient depending on lung and chest wall compliance.
  • Optimal exhale pressure may vary between 35cm H20 and 45 cm H20.

Treatment Length and Process
  • A standard treatment consists of applying 4-6 consecutive cycles of insufflation/exsufflation.
  • Visible secretions should be removed via suction from mouth, tracheostomy tube or tubing.
  • The user should then rest for 20-60 seconds and return to their normal mode of ventilation and prescribed oxygen flow if needed.
Using with a Tracheostomy
  • 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.