Assisted cough - Physiotherapie zur Verbesserung der Sekretexpektoration

Zusammenfassung

Pulmonale Komplikationen gehören zu den häufigsten Todesursachen bei Patienten mit ausgeprägter Schwäche der Inspirations- und/oder Exspirationsmuskulatur. Ein zu geringes Atemzugsvolumen (< 1500 ml) sowie ein schwacher Hustenspitzenfluss (< 160 l/min) führen zur Sekretretention, und stellen ein hohes Pneumonierisiko dar. Bei akuten und chronischen Infektionen der Atemwege mit vermehrter Sekretproduktion als auch bei Aspirationen stellt der Husten einen unverzichtbaren Mechanismus dar. Der Husten ist nur dann ausreichend wirksam, wenn alle seine Phasen gut funktionieren oder unterstützt werden können. Als nichtinvasive Unterstützung der Inspiration werden manuelle Hyperinflation, Air stacking, Glossopharyngeal breathing oder mechanische Insufflation angewendet. Als sichere und effektive Methoden zur Unterstützung der Exspiration haben sich die manuelle Thorax- und Abdomenkompression, manuelle Selbstunterstützung sowie die mechanische Insufflation-Exsufflation erwiesen. Durch den Einsatz dieser nichtinvasiven Unterstützungsmethoden kann das Risiko der pulmonalen Komplikationen in der genannten Patientengruppe deutlich senken.

Abstract

Pulmonary complications are the most common causes of mortality in patients with severe inspiratory and/or expiratory muscle weakness. An inspiratory tidal volume below 1500 ml and a peak cough flow below 160 L/min result in mucus retention and increase the risk of pneumonia. An intact cough function is pivotal for airway clearance during acute and chronic airway infections with increased mucus production as well as for protection against endotracheal aspirations. Effective cough requires that all of its phases work or are effectively supported. Non-invasive assistance of inspiration can be provided by manual hyperinflation, air stacking, glossopharyngeal breathing or mechanical insufflation. Safe and effective methods of expiration assistance include manual thorax and abdominal compression, manual self-assistance as well as mechanical insufflation-exsufflation. The use of these non-invasive inspiratory and expiratory muscle aids can decrease the risk of pulmonary complications in patients with severe ventilatory muscle weakness.

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