A VAI with amyotrophic lateral sclerosis and a TT is unable to develop clear secretions from his airway. Which of the following should be considered to manage this patient's airway clearance problem?

1. Manual chest compression and TT suctioning
2. Autogenic drainage and postural drainage
3. Positive expiratory pressure
4. Mechanical insufflation-exsufflation (MI-E)

a. 1 and 4 only
b. 1, 2, and 3 only
c. 2 and 3 only
d. 1, 2, and 4 only

ANS: A
Because this patient has ALS and is ventilator dependent, removing the patient will not enable the RT to perform PEP therapy or autogenic drainage. Assisted coughing with manual chest compression helps to mobilize secretions into an area in the larger airways that can be suctioned. MI-E also is appropriate for a patient, such as this one, who is unable to generate enough expira-tory flow for a cough.