• The use of a pressure generating insufflation/exsufflation device (in-exsufflator) (ex, CoughAssist®, E-70 or CA-3000), designed to rapidly fill and empty air from the lungs, is required if your child needs help both on inspiration and on expiration in order to effectively mobilise, cough and clear his secretions.
• This cough assist technique can be used regularly to prevent complications and respiratory infections as it augments the force of your child’s cough and helps clear secretions.
• Below is a suggested method that can serve as a guide; discuss any other specifications that may be required for your child with the healthcare team.

Considerations:

• Insufflation/exsufflation devices can be adjusted in many ways:
  • manual mode: allows the parent to manually control the length of the inspirations/expirations;
  • automatic mode: the length of inspiration/expiration is automatically controlled by the unit settings. Use of this mode frees up the parents hands as they apply the technique;
  • cough track: this option helps synchronise the treatment with the child’s inspiratory efforts.
  • The addition of the oscillation option available only on certain models (: CoughAssist®, E-70) is very effective in dislodging secretions.
• All in-exsufflator devices run on electrical power; only the CoughAssist®, E-70 has an internal battery.
• This technique is possible in children with or without tracheostomy.
• Based on your child’s condition and the results of tests (pulmonary function tests), your healthcare team may recommend the use of this technique alone or with expiratory aid techniques, techniques to be used at the same time to help your child cough better.
• Good handwashing is essential before and after providing care to your child.
• Ensure the comfort of your child during the care by using different positioning techniques and distraction techniques.

• 3 to 5 maneuvers per session (1 maneuver = 1 inspiration/1 expiration/1 abdominal thrust, 1 lateral thoracic compression or 1 thoracic compression, if applicable/pause for 30 seconds), if applicable.
• If the secretions are not sufficiently cleared: 5 to 8 maneuvers or until your child clears the secretions with an effective cough.
• 2 to 4 sessions per day regularly or more if needed, according to your child’s healthcare team.
• It is suggested that each session not last more than 10 minutes in order to avoid hyperventilation and dizziness.
• It is suggested that you wait 10 minutes between each session.
• Apply the technique before meals or at least 2 hours after a meal in order to avoid stomach discomfort and food reflux or vomiting.