Use of air stacking and abdominal compression for cough assistance in people with complete tetraplegia.

STUDY DESIGN

Cross-sectional.

OBJECTIVE

To assess cough using air stacking (AS) to assist inspiratory volume with abdominal compression (AC) during expiration in patients with American Spinal Injury Association Impairment Scale (AIS) A.

SETTING

Large tertiary hospital in Chile.

METHODS

Peak cough flow (PCF) was measured during four different interventions: spontaneous maximal expiratory effort (MEE); MEE while receiving AC (MEE-AC); MEE after AS with a manual resuscitation bag (AS-MEE); and MEE with AS and AC (AS-MEE-AC).

RESULTS

Fifteen in-patients with complete tetraplegia (C4-C6) were included. Median age was 33 years (16-56). PCF during the different interventions was PCF for MEE was 183±90 l min(-1); PCF for MEE-AC was 273±119  l  min(-1); PCF for AS-MEE was 278±106  l  min(-1) and PCF for AS-MEE-AC was 368±129  l  min(-1). We observed significant differences in PCF while applying MEE-AC and AS-MEE compared with MEE (P=0.0001). However, the difference in PCF value was greater using the AS-MEE-AC technique (P=0.00001).

CONCLUSION

Patients with spinal cord injury (SCI) presented an ineffective cough that constitutes a risk factor for developing respiratory complications. The application of combined techniques (AS-MEE-AC) can reach near normal PCF values. This is a low-cost, simple and easily applied intervention that could be introduced to all patients with tetraplegia.