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Pathophysiology and prevention of sputum retention 

Pathophysiology and prevention of sputum retention
Chapter:
Pathophysiology and prevention of sputum retention
Author(s):

John J. Marini

and Paolo Formenti

DOI:
10.1093/med/9780199600830.003.0119
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date: 25 February 2020

Retention of airway mucus is one of the major problem that confronts post-operative and critically-ill patients, as well as the caregivers that address it. Retained secretions increase the work of breathing and promote hypoxaemia, atelectasis, and pneumonia. The airway-intubated patient is at particular risk of retaining mucus, as the presence of the tube interrupts normal flow of airway secretions toward the larynx by the mucociliary escalator and coughing effectiveness is degraded by a glottis that is stented open and cannot close effectively. Clearance of mucus is aided by using sufficient gas stream and total body hydration to reduce sputum viscosity and lubricate secretion plugs. Airway suctioning, a routine, but inherently traumatic experience for the patient, may clear the central airway, but leave peripheral airways unrelieved of their secretion burden. Prone positioning appears to confer an advantage regarding secretion drainage and clearance. Physiotherapy techniques may be useful in re-establishing and maintaining airway patency.

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