From the Guidelines
To clear mucus plugging in patients, recruitment maneuvers such as lung expansion techniques and coughing exercises are recommended [ 1 ]. Specifically, techniques like:
- incentive spirometry
- chest physiotherapy [ 1 ]
- positive expiratory pressure (PEP) therapy [ 1 ]
- huffing [ 1 ]
- autogenic drainage [ 1 ] can be effective. Additionally, manually assisted cough [ 1 ] and mechanical cough assist devices [ 1 ] may be beneficial to patients with severe neuromuscular disease and impaired cough. Some key points to consider when using these techniques include:
- Chest physiotherapy is recommended as an effective technique to increase mucus clearance in patients with CF [ 1 ]
- PEP therapy is recommended over conventional chest physiotherapy because it is approximately as effective as chest physiotherapy, and is inexpensive, safe, and can be self-administered [ 1 ]
- Manually assisted cough should be considered to reduce the incidence of respiratory complications in patients with expiratory muscle weakness [ 1 ]
- Huffing and autogenic drainage can be taught as adjuncts to other methods of sputum clearance [ 1 ]
- Expiratory muscle training is recommended to improve peak expiratory pressure, which may have a beneficial effect on cough [ 1 ] It is essential to note that the effect of nonpharmacologic airway clearance techniques on long-term outcomes, such as health-related quality of life and rates of exacerbations, hospitalizations, and mortality, is not known at this time [ 1 ].
From the FDA Drug Label
Acetylcysteine solution may be administered using conventional nebulizers made of plastic or glass Various intermittent positive pressure breathing devices nebulized acetylcysteine solution with a satisfactory efficiency The recruitment maneuvers used to clear mucus plugging in patients include:
- Nebulization using conventional nebulizers made of plastic or glass
- Intermittent positive pressure breathing devices to nebulize acetylcysteine solution 2
- Direct instillation of acetylcysteine solution into the tracheostomy or a particular segment of the bronchopulmonary tree 2
From the Research
Recruitment Maneuvers for Mucus Plugging
- Recruitment maneuvers are used to clear mucus plugging in patients, including techniques such as chest physiotherapy 3, mechanical insufflation-exsufflation (MI-E) 4, manually assisted cough 4, and lung volume recruitment 4, 5
- These maneuvers can help improve cough efficiency and secretion mobilization in critically ill patients 4
- The use of recruitment maneuvers can also help recruit collapsed alveoli and promote oxygenation in patients with acute respiratory distress syndrome (ARDS) 5, 6, 7
- Different methods of recruitment maneuvers are available, including manipulating positive end-expiratory pressure (PEEP) and peak inspiratory pressure (PIP) 6
- The efficacy of recruitment maneuvers in improving outcomes such as mortality, length of ventilation, and length of stay is still uncertain and requires further research 6, 7
Types of Recruitment Maneuvers
- Chest physiotherapy: involves bedside chest percussion to help clear mucus plugging 3
- Mechanical insufflation-exsufflation (MI-E): uses a device to deliver a positive pressure followed by a negative pressure to help clear secretions 4
- Manually assisted cough: involves a healthcare provider assisting the patient with coughing to help clear secretions 4
- Lung volume recruitment: involves using a technique to recruit collapsed alveoli and promote oxygenation 4, 5