• Aline Rafaele Barros Silva, Sandra Adriano Fluhr, Andrezza de Lemos Bezerra, Marco Aurélio de Valois Correia Júnior, Eduardo Ériko Tenório de França, and Flávio Maciel Dias de Andrade.
• Rev Bras Ter Intensiva. 2012 Mar 1;24(1):58-63.

ObjectiveMechanical ventilation is associated with retained airway secretions. Manually assisted cough contributes to the displacement of bronchial mucus, whereas positive end-expiratory pressure increases collateral ventilation and maintains airway patency. This study aimed to assess the effects of manually assisted cough, either alone or added to increased positive end-expiratory pressure and inspiratory time (optimized manually assisted cough), on the expiratory peak flow and respiratory system mechanics in mechanically ventilated patients.MethodsIn this controlled and randomized clinical trial, respiratory mechanics and expiratory peak flow were assessed in male and female patients undergoing either tracheal suctioning alone, manually assisted cough followed by tracheal suctioning or optimized manually assisted cough followed by tracheal suctioning.ResultsThirty-five patients completed the trial. Respiratory system resistance was significantly reduced after optimized manually assisted cough (16.0 ± 3.6 versus 12.4 ± 3.1 cmH2O/L/s; p = 0.04). The expiratory peak flow during optimized manually assisted cough was significantly higher in comparison with the values observed during manually assisted cough (112.3 ± 15.6 versus 95.8 ± 18.3 Lpm; p < 0.05). Both values were significantly higher than the values observed in the group undergoing tracheal suctioning alone (52.0 ± 7.6 Lpm; p < 0.001).ConclusionOptimized manually assisted cough increases the expiratory peak flow in comparison with manually assisted cough; in addition, this procedure reduces respiratory system resistance.

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