What’s new in management and clearing of airway secretions in ICU patients? It is time to focus on cough augmentation
An effective clearing of the airways requires a balance between production and removal of respiratory secretions through the muco-ciliary escalator. In ICU patients, both sides of the balance can be impaired. The amount of respiratory secretions can be increased from infection, aspiration, or swallowing disorders. The removal of respiratory secretions can be reduced by upper airway dysfunction and/or respiratory muscle weakness. Many pre-existing or ICU-acquired situations, like chronic neuromuscular disease (NMD), ICU-acquired neuromuscular weakness, sepsis, delirium or conscious level decline due to brain damage may compromise optimal glottis functioning or respiratory muscle strength  and, hence, promote unbalance between production and removal of respiratory secretions. Important pathophysiological consequences of this unbalance include increased airway resistance and work of breathing, hypoxemia, atelectasis, and superinfection. Any caregiver in the ICU, whether...
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Conflicts of interest
The authors declare no conflict of interest.