Use of air stacking and abdominal compression for cough assistance in people with complete tetraplegia

Spinal Cord. 2014 May;52(5):354-7. doi: 10.1038/sc.2014.19. Epub 2014 Mar 11.


Study design: Cross-sectional.

Objective: To assess cough using air stacking (AS) to assist inspiratory volume with abdominal compression (AC) during expiration in patients with American Spinal Injury Association Impairment Scale (AIS) A.

Setting: Large tertiary hospital in Chile.

Methods: Peak cough flow (PCF) was measured during four different interventions: spontaneous maximal expiratory effort (MEE); MEE while receiving AC (MEE-AC); MEE after AS with a manual resuscitation bag (AS-MEE); and MEE with AS and AC (AS-MEE-AC).

Results: Fifteen in-patients with complete tetraplegia (C4-C6) were included. Median age was 33 years (16-56). PCF during the different interventions was PCF for MEE was 183±90 l min(-1); PCF for MEE-AC was 273±119 l min(-1); PCF for AS-MEE was 278±106 l min(-1) and PCF for AS-MEE-AC was 368±129 l min(-1). We observed significant differences in PCF while applying MEE-AC and AS-MEE compared with MEE (P=0.0001). However, the difference in PCF value was greater using the AS-MEE-AC technique (P=0.00001).

Conclusion: Patients with spinal cord injury (SCI) presented an ineffective cough that constitutes a risk factor for developing respiratory complications. The application of combined techniques (AS-MEE-AC) can reach near normal PCF values. This is a low-cost, simple and easily applied intervention that could be introduced to all patients with tetraplegia.

MeSH terms

  • Adolescent
  • Adult
  • Analysis of Variance
  • Chest Wall Oscillation / methods*
  • Chile
  • Cough / etiology*
  • Cough / therapy*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Peak Expiratory Flow Rate
  • Quadriplegia / complications*
  • Respiration, Artificial* / instrumentation
  • Respiratory Therapy / instrumentation
  • Respiratory Therapy / methods*
  • Time Factors
  • Young Adult