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A Novel Pharyngeal Clearance Maneuver for Initial Tracheostomy Tube Cuff Deflation in High Cervical Tetraplegia

Ehsanian, Reza, MD, PhD1,2; Klein, Christina, MD3; Mohole, Jyodi, BS1; Colaci, Joshua, RRT-RSPT1; Pence, Benjamin T., DO1; Crew, James, MD1; McKenna, Stephen, MD1,2

American Journal of Physical Medicine & Rehabilitation: April 17, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/PHM.0000000000001192
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Mechanical insufflation-exsufflation (MIE), or “cough-assist” is a commonly used method of clearing tracheal and pulmonary secretions in patients with respiratory insufficiency secondary to spinal cord injury (SCI). This report presents a novel technique termed the Pharyngeal Clearance Maneuver (PCM) which utilizes a modified application of the MIE 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 SCI 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 utilized as needed prior to 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 due to ventilator pump failure (e.g. spinal muscular atrophy, congenital myopathies, obesity hypoventilation, amyotrophic lateral sclerosis, muscular dystrophy, and acute inflammatory demyelinating polyneuropathy).

1Rehabilitation Research Center at Santa Clara Valley Medical Center, San Jose, CA,

2Department of Neurosurgery, Stanford University

3PM&R Section, Department of Orthopedic Surgery, Stanford University;

Disclosures: The authors of this manuscript have no financial interest in the subject under discussion. No funding was provided for this report.

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