Breath Stacking & Assisted Cough Demo in Bed | Respiratory Management | Spinal Cord Injury

An Assisted Cough involves the use of a stomach thrust to help build pressure to produce a cough. In this video Sandra and Renata demonstrate how to do the Assisted Cough technique while laying down in a bed – and with one person assisting.

You might find doing Breath Stacking and Assisted Cough in bed works better if you have lower blood pressure or tend to get dizzy when holding your breath.

This demo shows Renata positioning herself for the stomach thrust with one hand and squeezing the bag with her other hand. If you are able to squeeze the bag yourself, you can do the bagging while the person assisting positions themselves for the stomach thrust.

First, you and your assistant need to decide which position will work best for a good thrust – with the assistant standing beside the bed, or with the assistant on the bed. Make sure to establish a signal with your assistant to tell them when your lungs are full – a head nod or a blink, or whatever works for you.

Here is the rest of the process:

  • the assistant will place the palm of the hand below your ribcage and above your belly button
  • when ready, take a large breath in through the mouthpiece
  • hold your air
  • the bag is now squeezed and you inhale with it, taking 2 to 5 successive breaths of bagged air
  • the assistant can count and say “breathe in” each time
  • the assistant – or “bagger” should squeeze the bag with one hand until the lungs feel full and you cannot hold any more air
  • remember, if you feel too full, open your mouth and exhale!
  • once the lungs are full, and just before removing the mouthpiece from your mouth, the stomach thrust is started
  • the assistant then pushes up – with some solid force – but not enough to injure you
  • you need to cough as the mouthpiece is removed
  • the assistant can try saying “Cough!” as a prompt.

If the technique is successful, a high flow of exhaled air will occur as the mouthpiece is removed. If mucus is loosened, you might hear a rattling sound or feel congested. Cough out as much mucous as you can and spit it out into a container or tissue. Repeat the whole process 3 to 5 times or until all the mucous is out. Rest in between cycles. Clean the mouthpiece after use.

After Breath Stacking and Assisted Cough you should do two breath holds. The breath hold is done by giving you successive breaths using Breath Stacking. Instead of coughing at the end, hold your breath for as long as possible (3-5 seconds) before exhaling.

You know you’re doing it right when you have these signs:

  • The chest rises with each squeeze
  • There is no air leaking out around the nose or mouthpiece
  • It is getting harder to squeeze the bag with each squeeze.

Not everybody needs the combined Breath Stacking and Assisted Cough all the time. If you have a cold, that’s when you would add an assisted cough as often as every 10 minutes.

If you think the Breath Stacking and Assisted Cough techniques are something you could benefit from, connect with your healthcare team to discuss lung volume testing and how to get the tools and assistance you’ll need to get started.

Remember: These LVR kits are not intended for use as resuscitation bag.

Do NOT do Breath Stacking if you feel light-headed, you have chest discomfort, an upset stomach or you have low blood pressure.

Additional notes for healthcare providers:

Use of the LVR kit is not recommended in the presence of hemoptysis, recent or current barotrauma, bullous emphysema, severe obstructive pulmonary diseases, hypotension.

  • Do NOT use the LVR kit if the individual has an inflated tracheostomy cuff or endotracheal tube.
  • Individual assessment and precaution should be taken if any of the following exists: severe reflux, IVC filter, Kyphoscoliosis, or Baclofen Pump.
  • An Assisted Cough should not be done for any individuals that are pregnant or that have had recent abdominal surgery or have an abdominal aneurysm.

We hope you enjoy this video series and watching these demonstrations. If you have any questions about what you learn, be sure to reach out to your healthcare team or service and resource providers like Spinal Cord Injury Ontario.

We would like to acknowledge and thank the people with lived experience who contributed their insights and tips to the development of this video series:

  • Ron Rattie, Peer Support Program Coordinator, Spinal Cord Injury Ontario
  • Sandra Burton
  • Matt Sagan, Peer Support Volunteer, Spinal Cord Injury Ontario

We would also like to thank Hamilton Health Sciences staff who provided clinical subject matter expertise, source content and expert review of this video series:

  • Renata Vaughan, RRT Senior Registered Respiratory Therapist, Hamilton Health Sciences Regional Rehabilitation Centre
  • Jennifer Duley, APP Advanced Practice Physiotherapist, Acute Spine Unit, Hamilton Health Sciences.

This series was designed by Marty Doupe, Learning Architect at SCIO.

The Lung Volume Recruitment (LVR) bag and the attachments are available for purchase as a preassembled kit. Here are two vendor options in Canada: – Medigas carries the Mercury Medical Lung Volume Recruitment Kit, product number is TRSM161034502 and price is approximately $60 CAD, – ProResp sells the Mercury Medical LVR kit by the box of 6,

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