Feeding and cough assist therapy

Please use this forum for any general discussions or questions you have about noninvasive ventilatory support and mechanical insufflation-exsufflation (MIE).
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curiousgeorge
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Feeding and cough assist therapy

Postby curiousgeorge » Thu Mar 24, 2016 11:30 am

In general, for patients with enterostomy feeds/ oral feeding, do you ask them to
-hold the feeds or be NPO* for 30 min before cough assist therapy
-hold the feeds for 60 min or be NPO for 60 min before cough assist therapy
-do not ask them to hold the enterostomy feeds at all or there is no need to be NPO

In our practice, we have been asking for patients to have their enterostomy feeds held/ NPO for 1 hour before therapy because of concerns related to GERD* secondary to the high pressures but curious to see what you guys are doing as I couldn't really find much in the literature in support of 1 or the other...worried I may be missing something so thought I would check with you guys

(Asked by a caretaker)

*NPO=nothing by mouth
*GERD=gastroesophageal reflux disease

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bachjr
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Re: Feeding and cough assist therapy

Postby bachjr » Thu Mar 24, 2016 11:32 am

Even with bolus feeding, the risk is minimal to none and the real concern is to limit manually assisted cough around meals/feeds.

Mechanical insufflation-exsufflation (MIE) does not cause reflux but abdominal thrusts can. MIE used at optimal pressures, 50 to 60 cm H2O, usually gives optimal flows without an abdominal thrust or concomitant cough. With little kids we use the "CoughTrack" to let them trigger or time it to the kid.

JB
John R. Bach MD
Medical Director, VentilaMed BreatheNVS
Medical Director, Center for Ventilator Management Alternatives
Professor of Physical Medicine and Rehabilitation, Professor of Neurology, Rutgers New Jersey Medical School


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