Secretion management in patients with ineffective airway clearance with non-invasive mechanical ventilation use: Expert guidance for clinical practice


  • Vijay Hadda | Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute Of Medical Sciences, New Delhi, India.
  • Tejas Menon Suri Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute Of Medical Sciences, New Delhi, India.
  • Sourabh Pahuja Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute Of Medical Sciences, New Delhi, India.
  • Mohamad El-Khatib Department of Respiratory Therapy, American University of Beirut Medical Center, Beirut, Lebanon.
  • Laura D. Ciobanu Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, Iasi, Romania.
  • Bruno Cabrita Pulmonology Department, Hospital Pedro Hispano, Matosinhos, Portugal.
  • Habib Md Reazaul Karim Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Raipur, India.
  • Igor Barjaktarevic Division of Pulmonary and Critical Care, David Geffen School of Medicine at University of California, Los Angeles, CA, United States.
  • Claudia Crimi Respiratory Medicine Unit, A.O.U. “Policlinico-Vittorio Emanuele”, Catania, Italy.
  • Giancarlo Garuti Santa Maria Bianca Hospital, Mirandola (MO), Italy.
  • Saurabh Mittal Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute Of Medical Sciences, New Delhi, India.
  • Pawan Tiwari Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute Of Medical Sciences, New Delhi, India.
  • Karan Madan All India Institute of Medical Sciences, New Delhi, India.
  • Anant Mohan Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute Of Medical Sciences, New Delhi, India.
  • Zuhal Karakurt Respiratory Intensive Care Unit, Sureyyapasa Chest Diseases and Surgery Hospital, Istanbul, Turkey.
  • Antonio Esquinas Intensive Care Unit, Hospital Morales Meseguer, Murcia, Spain.


Non-invasive ventilation (NIV) is a mainstay of management of chronic respiratory failure in many disorders which are known to cause abnormal airway secretion clearance. Currently, there is no guidance regarding either the secretion handling during NIV use or the role of NIV in secretion management in these patients. The aim of this document was to provide an overview of the various techniques available in the management of respiratory secretions and their use in conjunction with NIV. Literature search was performed using the keywords, “(secretion OR secretions) AND (noninvasive ventilation OR NIV)” on PubMed and EMBASE. The search yielded 1681 and 509 titles from PubMed and EMBASE, respectively. After screening, 19 articles were included in this review. Suggestions of the expert panel were formulated by mutual consensus after reviewing the relevant literature. The draft of the expert panel’s suggestions was circulated among all authors via electronic mail for comments. Any conflicts were resolved by mutual discussion to achieve agreement. The final document was approved by all. This document by the International Network for Airway Secretions Management in NIV describes various airway secretion clearance techniques. It provides the expert panel’s suggestions for the use of these techniques in conjunction with NIV for patients with muco-obstructive and neuromuscular disorders. 



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Physiotherapy - Reviews
Non-invasive ventilation, airway secretions, muco-obstructive disorders, chest physiotherapy, neuromuscular disorders, cystic fibrosis, airway clearance techniques
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How to Cite
Hadda, Vijay, Tejas Menon Suri, Sourabh Pahuja, Mohamad El-Khatib, Laura D. Ciobanu, Bruno Cabrita, Habib Md Reazaul Karim, Igor Barjaktarevic, Claudia Crimi, Giancarlo Garuti, Saurabh Mittal, Pawan Tiwari, Karan Madan, Anant Mohan, Zuhal Karakurt, and Antonio Esquinas. 2021. “Secretion Management in Patients With Ineffective Airway Clearance With Non-Invasive Mechanical Ventilation Use: Expert Guidance for Clinical Practice”. Monaldi Archives for Chest Disease, June.

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