Airway Clearance - more than just a cough!

This study day is suitable for all members of the MDT.  You do not need to be a member of the Intensive Care Society to attend. Just sign up, create an ICS account as a non-member and register.

Have you always wondered what Physios are doing? Or, as a Physio, have you wondered how your techniques are working?  

Over the course of the day, you will gain an understanding of the importance of effective airway clearance within the ICU population. You will learn about different airway clearance strategies, the physiology of how they work and the evidence base for use in the ICU setting.   

Speakers to include Ema Swingwood, George Ntoumenopoulos, Allaina Eden, Rebecca Vokes, Becky Haylett, Arun Joseph, Thomas Lunn and Bronwen Connolly.


Preliminary Programme

Chairs: Becky Haylett and Allaina Eden


Title of Talk


10:00-10:05 (5’)

Welcome and introduction

Becky Haylett


10:05-10:35 (30’)



The physiology of airway clearance-why is it important? 


  • This talk will provide a brief overview of cough and the physiology and purpose of airway clearance techniques. George will examine how we can assess and determine the presence of retained secretions (including the use of lung ultrasound and waveform analysis).



George Ntoumenopoulos; Sydney, Australia.

(pre-recorded session)


10:35-11:05 (30’)


Magic hands

  • We will describe manual techniques in the ICU to include percussion, expiratory vibrations, expiratory rib cage compressions and manually assisted cough and examine the associated literature. Are these relevant and useful techniques?


Harriet Shannon, London


11:05-11:35 (30’)


Making the ventilator do the work 


  • The talk will describe how the ventilator is used to manipulate and optimise airway clearance. Techniques covered will include ventilator hyperinflation and recruitment manoeuvres with a comparison to manual hyperinflation.


Rebecca Vokes, Southampton.

11:35-11:55 (20’)



11:55-12:25 (30’)

When all else fails…. grab the cough assist


  • The use of Mechanical Insufflation Exsufflation in the intubated population will be discussed in this session, including a summary of evidence and discussion of optimal timing of use - have we got this right? We will conclude by considering how visualisation may facilitate the optimisation and troubleshooting of MI-E.


Ema Swingwood, Bristol and Sarah Wallace, Manchester

12:25-12:55 (30’)

Checking the drug chart and pharmacology: help or hindrance?  


  • This talk will consider how medications can complement/hinder ACT. This will include discussion on mechanisms of action and timings of administration of key drugs. An overview/update of the MARCH trial will also be included.


Bronwen Connolly, Belfast

12:55-1:30 (35’)



1:30-1:35 (5’)

Introduction to afternoon session

Allaina Eden, Papworth


1:35-2:05 (30’)



Laryngeal dysfunction and the impact on airway clearance

  • This talk will explore the multi-factorial causes of laryngeal dysfunction and discuss the subsequent impact on airway clearance in the ICU setting


Sarah Wallace, Manchester


2:05-2:35 (30’)


To cough or not to cough? ACTs and ECMO 


  • We will highlight the importance of ACT in the ECMO cohort; discussing the optimal timing of intervention and important considerations to optimise this patient group.


Thomas Lunn, Bristol

2:35-2:45 (10’)




2:45-3:15 (30’)


Extubation outcomes


  • Our final session will discuss how to better assess ‘readiness to extubate’ with focus on the brain injured patient.  The second half of the talk will focus on the clinical application of the evidence to date.


Arun Joseph, Oxford


3:15-3:55 (40’)


Panel discussion and Q&A

Led by Becky and Allaina

3:55-4:00 (5’)

Closing remarks




Bronwen  Connolly

Bronwen Connolly

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Allaina Eden

Allaina Eden

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Arun Joseph

Arun Joseph

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Thomas  Lunn

Thomas Lunn

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George Ntoumenopoulos

George Ntoumenopoulos

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Ema Swingwood

Ema Swingwood

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Rebecca Vokes

Rebecca Vokes

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Sarah Wallace

Sarah Wallace

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