A spontaneous effective cough is a reflex mechanism utilizing maximum forced exhalation to clear irritants or secretions from the airway. The forced exhalation is preceded by a maximal inspiratory effort followed by closure of the glottis. Contraction of expiratory muscles produces increased intrathoracic pressures against the closed glottis, which culminates in an explosive release of gas at high velocity as the glottis opens. Manually assisted cough is the external application of mechanical pressure to the epigastric region or thoracic cage coordinated with forced exhalation. The contraindications listed must be weighed against potential benefit in deciding to eliminate cough from the care of the patient.
Listed contraindications are relative.
In patients with a bypassed upper airway or other condition that precludes the ability to effectively close the glottis, the effectiveness of the cough may be limited. I personnel may be providers of service after Level II personnel have performed initial assessment of the patient and the first episode of training has been completed. 10.2.1.5 Ability to instruct patient and family or caregiver in techniques and goals of therapy. The Level II provider initially assesses the patient, determines the need for specific coughing techniques, and evaluates response to and effectiveness of cough. 12.1 Cough procedures should be performed as frequently as needed.