Physiol Res. 2020 Mar 27;69(Suppl 1):S93-S103. doi: 10.33549/physiolres.934407.
Cough is an important mechanism of airway clearance. In patients who present weak and ineffective cough, augmentation techniques aim to assist or simulate the maneuver. These techniques target different phases of the cough cycle, mainly the inspiratory and expiratory phases, through assisted inspiration, assisted expiration and their combination. They include the manual hyperinflation, ventilator hyperinflation, glossopharyngeal breathing, manually assisted cough and mechanical insufflator-exsufflator, each applied individually or in different combinations. The aim of this review is to investigate the effectiveness and safety of cough augmentation techniques. Findings support that all commonly used techniques can theoretically improve airway clearance, as they generate higher cough peak flows compared to unassisted cough. Still, the studies assessing cough augmentation present considerable limitations and the direct comparison of different techniques is challenging. Current evidence indicate that cough peak flow shows higher increase with the combination of assisted inspiration and expiration, and improvement is greater in patients with lower unassisted values. Associated adverse events are infrequent.
咳嗽是气道清除的重要机制。对于咳嗽无力或无效的患者，可采用咳嗽增强技术来辅助或模拟该动作。这些技术针对咳嗽周期的不同阶段，主要是吸气和呼气阶段，通过辅助吸气、辅助呼气及其组合来实现。它们包括手动过度充气、呼吸机过度充气、舌咽呼吸、手动辅助咳嗽和机械通气-呼气装置，这些方法可单独或联合应用。本综述旨在研究咳嗽增强技术的有效性和安全性。研究结果表明，所有常用的技术理论上都可以改善气道清除，因为它们产生的咳嗽峰流速高于非辅助咳嗽。然而，评估咳嗽增强的研究存在相当大的局限性，不同技术的直接比较具有挑战性。目前的证据表明，辅助吸气和呼气的联合使用会使咳嗽峰流速有更大的增加，并且在自主咳嗽能力较低的患者中改善效果更大。相关的不良事件并不常见。
