Managing Excessive Mucus After Tracheostomy: Effective Strategies and Solutions

Q: Managing Excessive Mucus After Tracheostomy: Effective Strategies and Solutions

Hello： 1. <br>Excessive phlegm indicates that there may be chronic inflammation or allergies in the airways; please have the physician adjust the medication accordingly (allergies or inflammation may not resolve quickly). <br>2. <br>If the phlegm is too thin, reduce the use of ex

What should I do if I have excessive secretions after a tracheostomy that I can't clear?

My mother suffered a ruptured intracranial aneurysm in September last year, which required emergency surgery after intubation.
She spent 21 days in the intensive care unit before transitioning to a tracheostomy.
After being weaned off the ventilator, she was moved to a regular ward and received supplemental oxygen.
Following a series of brain surgeries and recovery, her oxygen saturation reached 95% without supplemental oxygen; however, she still produced a significant amount of sputum, leading to her discharge with a tracheostomy and a nasogastric tube.
After discharge, her cough became more forceful; even while lying flat in bed, she could expel sputum to her feet and cough it out from her mouth and nostrils.
Although she attempted to swallow, she was unable to do so.
Despite being turned and having her back tapped twice daily, as well as sitting up at the bedside once a day, she continued to require suctioning, sometimes up to 28 times a day.
This constant need for suctioning has led to feelings of despair, as we are uncertain when it will end.
Regarding mucus clearance, we have been using a specialized mucus clearance cup and have modified our approach multiple times over the past six months based on healthcare professionals' recommendations, with each method lasting 14 days:
1.
Bisolvon + 0.9% NS (1:1) twice a day → sputum became increasingly thin, with persistent coughing and suctioning.
2.
Bisolvon + 0.9% NS (1:1) once a day → sputum became increasingly thick, with persistent coughing and suctioning.
3.
Bisolvon + 0.9% NS (1:1) once a day + distilled water + 0.9% NS (1:1) once a day → sputum became increasingly thin, with persistent coughing and suctioning.
4.
Distilled water + 0.9% NS (1:1) twice a day → sputum became increasingly thin, with persistent coughing and suctioning.
5.
Distilled water three times a day → sputum became increasingly thin, with persistent coughing and suctioning.
6.
Distilled water once a day → sputum became increasingly thick, with persistent coughing and suctioning.
7.
Combivent + 0.9% NS (1:1) three times a day → still under observation.

A-Hui, 20~29 year old female. Ask Date: 2020/04/15

Dr. Yang Wenda reply Pulmonology

Hello: 1.
Excessive phlegm indicates that there may be chronic inflammation or allergies in the airways; please have the physician adjust the medication accordingly (allergies or inflammation may not resolve quickly).
2.
If the phlegm is too thin, reduce the use of expectorants or steam inhalation; conversely, if the phlegm is too thick, increase the frequency.
3.
Avoid consuming overly sweet or cold foods (such as melons, tomatoes, bananas, and pineapples) in juice form.

Reply Date: 2020/04/15

More Info

Managing excessive mucus production after a tracheostomy can be a challenging and frustrating experience, especially for patients who have undergone significant medical interventions, such as your mother. The presence of excessive mucus can stem from various factors, including the underlying condition that necessitated the tracheostomy, the presence of a tracheostomy tube itself, and the body's response to these changes. Here are some effective strategies and solutions to help manage this issue.

Understanding Mucus Production
Mucus serves as a protective barrier in the respiratory system, trapping pathogens and particles. However, after a tracheostomy, the normal mechanisms of mucus clearance can be disrupted. The tracheostomy tube bypasses the upper airways, which normally humidify and filter the air, leading to changes in mucus consistency and production. Additionally, the presence of a foreign object (the tube) can stimulate increased mucus production as the body attempts to protect itself.

Strategies for Managing Excessive Mucus
1. Hydration: Ensuring adequate hydration is crucial. Increased fluid intake can help thin mucus, making it easier to clear. Encourage your mother to drink plenty of fluids, unless contraindicated by her medical condition.

2. Humidification: Using a humidifier in her room or a heated humidifier attached to the tracheostomy can help maintain moisture in the airways. This can prevent mucus from becoming too thick and difficult to expel.

3. Chest Physiotherapy: Continue with techniques such as postural drainage, percussion, and vibration to help mobilize mucus. This can be particularly effective when combined with deep breathing exercises.

4. Medications: It seems you have tried various combinations of medications to manage mucus. Bisolvon (bromhexine) is a mucolytic that can help thin mucus, while saline solutions can help hydrate the airways. If these have not been effective, it may be worth discussing with her healthcare provider the possibility of trying other mucolytics or bronchodilators, such as Combivent, which can help open the airways and facilitate mucus clearance.

5. Suctioning: Regular suctioning may be necessary to clear excessive mucus. It’s important to ensure that this is done in a sterile manner to prevent infections. If your mother is experiencing discomfort or complications from frequent suctioning, consult her healthcare provider for alternative methods or frequency adjustments.

6. Positioning: Encourage her to change positions frequently. Sitting upright can help facilitate better lung expansion and mucus clearance. If she is able, encourage her to engage in light physical activity, as this can also aid in mucus clearance.

7. Dietary Considerations: Some patients find that certain foods can exacerbate mucus production. It may be beneficial to monitor her diet and reduce intake of dairy products or other known mucus-producing foods.

8. Follow-Up Care: Regular follow-up with her healthcare team is essential. If her symptoms persist or worsen, further evaluation may be necessary to rule out any underlying issues, such as infections or complications related to the tracheostomy.

Conclusion
Managing excessive mucus after a tracheostomy requires a multifaceted approach that includes hydration, humidification, chest physiotherapy, and possibly medication adjustments. It’s essential to work closely with her healthcare team to tailor a management plan that addresses her specific needs and conditions. While the process can be frustrating, with the right strategies in place, there is hope for improvement in her quality of life and respiratory function.

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