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Neuromuscular Compromise and Respiratory Failure — Pharmacologic Airway Clearance — Clinical Pathway: Inpatient and PICU

Neuromuscular Compromise and Respiratory Failure Clinical Pathway — Inpatient and PICU

Pharmacologic Airway Clearance

Consider adding these mucolytic agents to assist with secretion mobilization after first and second-line mechanical airway clearance strategies have been started. All of the medications are used based on clinical judgment and do not have literature supporting their use in patients with neuromuscular disorders.

For all agents, re-evaluate use after several doses to ensure that secretion production has not increased. For patients with lower respiratory infections, treat with antibiotics as needed.

Medications

Class Name Indications Considerations
Mucolytic
(Humidifiers, Cellular)
  • Normal saline
  • 3% hypertonic saline
  • To be used in conjunction with IPV therapy:
    • Recommend normal saline
    • 3% saline may be used if there are thick secretions
  • Re-evaluate daily — discontinue when secretions become thin
    • Hydrates “normal” mucus, is a bronchial irritant, and can cause secretion volume to increase
    • Do not use more frequently than Q6
    • Increases risk for bronchoconstriction (Consider albuterol in this case)
  • Mucus extraction device (MI-E/CoughAssist) should be readily available in case secretions are mobilized into large airway
  • Dornase alfa (Pulmozyme)
  • Purulent AND thick mucus
  • Persistent atelectasis
  • Note: there is no indication for chronic use
  • Use of this medication is OFF-LABEL
  • Discontinue if not purulent mucus
Bronchodilator
(Short Acting)
  • Albuterol
  • L-albuterol
No indication for use unless evidence of bronchoconstriction/wheeze with positive response after administration
  • Administer PRN or as per home regimen

 

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