COMPARING AIRWAY CLEARANCE EFFECTIVENESS USING A SUCTION MACHINE AND THE COUGH-ASSIST MACHINE FOR PATIENTS IN ACUTE REHABILITATION

Cardiopulmonary Physical Therapy Journal, Dec 2003 by Massery, M, Sammon, K, Menon, S, Cahalin, L

Purpose/Hypothesis: To compare tracheal suctioning (invasive) to the Cough-Assist machine (non-invasive), to determine if the Cough-Assist: 1) was at least as effective as traditional suctioning at clearing secretions for patients who require mechanical assistance, 2) produced less caustic effects to the patients' airways and lungs, and 3) was preferred by the patients over suctioning. Number of Subjects: 19 patients (mean age 37 years) with primarily neurologic diagnoses, undergoing acute inpatient rehabilitation, using suctioning as their primary means of airway clearance, participated in this study. Materials/Methods: Treatments alternated between tracheal suctioning and the CoughAssist (mean 8.3 treatments). Vital signs and pulmonary function tests were measured with each treatment. Interviews were conducted at the entry and exit from the study. Results: 153 total treatment sessions (109 CoughAssist, 44 tracheal suctioning). Paired T-tests for pre/post treatment vital signs and PFTs. Cough Assist: statistical improvement in oxygen saturation (O2 sals) (p=.002) 96%. to 97%; forced expiratory volume in 1 second (FEV1) from .84 to .91 L/1 sec (p =.009); and peak expiratory flow rate (PEFR) from 80.5 to 89.2 L/min in (p=.02). Tracheal suctioning: similar statistical improvement in PEFR from 82.4 to 93.0 L/min (p=.02), but not FEV1 or PEFR, no improvement in O2 sats, slight rise in diastolic blood pressure 77 to 80 mmHg (p=.02). In the entry interview, 64% reported suctioning effectively cleared secretions, but 73% felt that it was uncomfortable. In the exit interview, only 36% felt that suctioning cleared their secretions, while 91% reported that the Cough-Assist did clear them. Overall, 84% preferred the Cough-Assist, 8% preferred suctioning, 8% liked both. Subjects stated the Cough-Assist was more comfortable, more productive, and less painful to their airway. Conclusions: In this study, the Cough-Assist was shown to be at least as effective as tracheal suctioning for airway clearance, showed less caustic effects, and was preferred by the patients 10:1 over tracheal suctioning. No clinically significant adverse effects were noted. Clinical Relevance: The Cough-Assist should be considered a viable alternative to tracheal suctioning in the rehabilitation setting. Further research should explore long term outcomes, different diagnostic categories, and different medical environments.

M Massery1, K Sammon2, S Menon3, L Cahalin4. 1Rocky Mountain University of Health Professions, Provo UT, The Yoga and Therapy Studio, Inc., Chicago IL, 3Advanced Therapy and Rehabilitation, Skokie IL, 4Dept. of Physical Therapy, Northeastern University, Boston MA.