Which therapy is most effective for a patient with depressed diaphragmatic muscle strength needing assistance in expectorating secretions?

Insufflation/exsufflation therapy, also known as mechanical insufflation-exsufflation (MI-E), is particularly effective for patients who have weakened respiratory muscles, such as those with depressed diaphragmatic muscle strength. This therapy provides a method to assist with both the delivery of positive pressure to inflate the lungs (insufflation) and a subsequent rapid negative pressure to help expel secretions (exsufflation).

The mechanism of action involves delivering a positive pressure breath followed by a rapid reversal of pressure. This mimics the natural cough reflex, promoting effective clearing of secretions from the airways. For patients with compromised ability to generate sufficient cough force, as seen in those with weakened diaphragm function, this therapy can significantly enhance secretion clearance.

While other therapies listed may also have a role in managing secretions, they do not specifically target the needs of patients with weakened diaphragmatic muscles as effectively as insufflation/exsufflation therapy does. For instance, PEP therapy primarily helps keep airways open and facilitate airflow, but it does not provide the same level of mechanical support for cough initiation. Intrapulmonary percussive ventilation is useful for mobilizing secretions but may not provide adequate assistance to those with severe muscle