Orange mucus from cough assist? To high a pressure?

[JohnHMich]

We are doing the anomalous symptom of the day lately. Today there was a cough assist useage that brought up bloody and orange mucus. We have been having trouble with secretions and have been trying different controls to limit and thin them. The nurse doesn't think its pneumonia. There was a suggestion that the mucus can attach to an inflamed part of the airway and bring up blood that way.

Does that mean we should dial down the cough assist pressure? She reports no pain during either inspiration or expiration.

 

[lgelb]

That can be new blood, old blood, a sinus infection...I would look at humidification settings on her BiPAP and humidity in the room, and maybe crank both up a notch. I would make sure you have new HVAC filters and in her BiPAP. And if she shows any other signs of infection (pain, fever, confusion, irritability, etc.) I would contact her PCP to consider an empirical antibiotic. Not knowing how much blood we are talking about, I would certainly double-check that she is getting enough B vitamins, iron and the like, just like always.

But since you have been trying different things to thin secretions, getting some dried blood out of the way could actually be good since it is an irritant.

Do you use a baby aspirator on the nostrils? You can put a little saline or NasoGel in there, too, and try to see if there is something in the nostrils to suck out gently. We all get wads of gunk from time to time, but she can't expel them on her own. If nasal pressure builds up, that affects breathing and how the lungs respond to the CA as well.

If the mucus continues after tinkering and time, yes, that could be the time to reduce CA pressure in small notches if/as she tolerates it. The irritation doesn't disappear in perfect synch with the cause, so it's fresh blood that we would be most concerned about and probably more aggressive about trying to adjust the settings to reduce. Orange is more dried, of course.

You can send a pic of what she's coughing up to her PCP as a baseline.

Best,
Laurie