From the Rehabilitation Research Center at Santa Clara Valley Medical Center, San Jose, California (RE, JM, J. Colaci, BTP, J. Crew, SM); Department of Neurosurgery, Stanford University, Stanford, California (RE, SM); and PM&R Section, Department of Orthopedic Surgery, Stanford University, Stanford, California (CK).
Am J Phys Med Rehabil. 2019 Sep;98(9):835-838. doi: 10.1097/PHM.0000000000001192.
Mechanical insufflation-exsufflation, or "cough assist," is a commonly used method of clearing tracheal and pulmonary secretions in patients with respiratory insufficiency secondary to spinal cord injury. This report presents a novel technique termed the pharyngeal clearance maneuver, which uses a modified application of the mechanical insufflation-exsufflation device to mobilize "secretion burden" at the portion of the trachea above the tracheostomy cuff during cuff deflation. Utilization of this strategy may reduce the risk of aspiration, infection, and respiratory compromise for patients with high cervical spinal cord injury in the acute rehabilitation setting. It is of particular benefit for those whose cuffs are being deflated for the first time and who may have large secretion volumes above the cuff. It can be further used as needed before speaking trials and swallow therapies. We anticipate that the pharyngeal clearance maneuver may be used in other populations with impaired cough and need for invasive ventilator support because of ventilator pump failure (eg, spinal muscular atrophy, congenital myopathies, obesity hypoventilation, amyotrophic lateral sclerosis, muscular dystrophy, and acute inflammatory demyelinating polyneuropathy).
机械通气-呼气，或“咳嗽辅助”，是一种常用于清除因脊髓损伤导致呼吸功能不全的患者的气管和肺部分泌物的方法。本报告介绍了一种称为咽清除手法的新技术，该技术使用改良的机械通气-呼气设备，在气管切开套管充气时，将“分泌物负担”移动到气管的套管上方部分。在急性康复环境中，对于高位脊髓损伤的患者，使用这种策略可能会降低吸入、感染和呼吸功能障碍的风险。对于首次进行套管放气且套管上方分泌物较多的患者尤其有益。在进行言语试验和吞咽治疗之前，也可根据需要进一步使用。我们预计咽清除手法可用于因呼吸机泵故障（例如脊髓性肌萎缩症、先天性肌病、肥胖低通气、肌萎缩侧索硬化症、肌肉营养不良症和急性炎症性脱髓鞘性多发性神经病）而咳嗽功能受损且需要侵入性呼吸机支持的其他人群。
