Why integrated therapy sets the ideal foundation for sustainable airway clearanceBy Dr. David Birnkrant, Director of MetroHealth Division of Pediatric Pulmonary Medicine


For years, the standard of care to achieve lung ventilation and airway clearance involved two separate devices,
starting with a mask ventilation system that would expand the lungs. The benefit of the mask was that the patient
didn’t have to have invasive ventilation via a tube down their windpipe. The mask worked well as long as a patient
didn’t have secretions. But any phlegm that a patient couldn’t cough out could become an airway barrier. In that
case, you also need a mechanically assisted cough device to help remove the phlegm.
Here’s the catch: You have to take the patient off the mask ventilator to place the cough device, too often making
the patient breathless and exhausted as we try to clear that pervasive phlegm. So how do you get maximum
results from both a non-invasive lung ventilator and a mucus-clearing cough assistor? Combine them into one
device that helps a patient create a productive cough and get ventilated air, with a seamless way to alternate
between the two.

That was my inspiration for an integrated therapy device—a device that is not only customized with regard to
intensity, but also highly portable. Its portability means patients in the intensive care unit who are prescribed this
device can take it with them when they return home, confident that they can continue their integrated therapy.
What’s more, if they do have to return to the ICU, they can take the device with them as part of their continuity of

Taking the concept even further, I created algorithms that would allow a clinician to control the therapies
remotely. This means that a patient’s care can be adjusted quickly to mitigate issues—helping avoid emergency
room visits and hospitalizations. That feature has gained significance beyond what I could have envisioned. With
COVID-19 and the need to minimize exposure to the aerosolized virus, remote control not only helps keep health
care workers safer, it also means that fewer clinicians are needed to manage patients through distanced care.
I’ve long had a passion for thinking differently, such as this integrated device that enables remote-control to
intensify therapy as needed. Fortunately, I’ve found a like-minded team in ABM Respiratory Care. The company
welcomes the innovations I’ve been imagining. For example, their devices separate the ventilation circuit from the
mucus clearance channel, to keep the patient’s inhaled air clean, and free of pathogens.
It’s exciting to think about the advances to come that will help not just prolong life, but really improve the quality
of life of patients and their caregivers in this difficult clinical space.

Dr. Birnkrant was recently interviewed on ABM Respiratory Care’s podcast, Innovations for Lung Health. Click here
to listen to the podcast.