Pegaso – Cough Assist Devices

Assisted Cough – 4 Modes

Cough assistance therapy is essential for individuals with ineffective coughs, as it helps mobilise and eliminate broncho-pulmonary secretions from the larger airways. The Pegaso may also be used as an exsufflation as part of Respiratory Physiotherapy.

• Auto-Sync – Synchronises every insufflation with the patient’s inspiratory effort.
• Manual Cough Assistant – Allows manual control of the in/exsufflation cycles. 
• Automatic Cough Assistant – Generates in/exsufflation cycles automatically with the clinician-set therapy times.
• Easy-Start – Synchronises the first insufflation cycle with the patient’s effort and continues following cycles in automatic mode.

The steps for the calibration are as follows:  

1. Turn the Pegaso on and as soon as the logo Dima Italia appears on the screen, press the buttons UP, DOWN, and MENU simultaneously. The device will go to a TEST page and will inform you if the hardware components are OK or have failed, as per pic below.

2. If everything is OK, from here you can go to the TECHNICAL MENU. Press I and Start simultaneously and the screen should change to the screen pictured below.

3. Once on this screen, connect the circuit, filter, and mask to the device, leaving the mask open, press the E button to begin the calibration. At the end of the test, the current flow is indicated in the right-upper corner in white it should read a zero value, if not press the MENU button to memorise the new Offset.
4. Once these steps are complete push the up button to restart the device and complete the calibration. 

Intrapulmonary Percussive Ventilation (IPV) is a form of high frequency positive pressure ventilation usually applied via a facemask, used for peripheral airway clearance. It delivers small “sub-physiological” tidal volumes at a very high rate superimposed on the individual’s underlying breathing pattern. 

• The high frequency airflow oscillation results in internal percussion of the lungs, improved ventilation, lung recruitment and the mobilisation of secretions from the peripheral airways. (1,2,3(opens in a new tab)) On the Percussor setting, the Pegaso A-Cough Perc® delivers 50-600 breaths per minute (frequencies ranging between 0.83 – 10Hz).
•  The inspiratory to expiratory ratio, flow, airway pressures and frequency must be titrated to provide varying levels of ventilatory support required by each individual and to optimise secretion mobilisation and airway clearance. 
• With IPV the correct settings ensure the expiratory flow rate is greater than the inspiratory flow to promote the proximal movement of secretions. 
• As the high frequency oscillations superimpose the patient’s own respirations, synchronisation is not required hence it can be used in patients who are unable to actively participate in airway clearance. (3(opens in a new tab)) 

 IPV is a peripheral airway clearance or “sputum mobilising” technique and is used as one part of an airway clearance treatment.  

When considering the 4 stages of Airway clearance (4(opens in a new tab)), IPV can aid in getting air behind secretions and mobilising secretions towards the proximal airway where a “Cough Augmentation” or proximal Airway clearance technique may then be used. 

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IPV can be considered for individuals who are having frequent or prolonged respiratory illnesses where other peripheral airway clearance techniques are insufficient in clearing or maintaining resolution.(5(opens in a new tab)) The British Thoracic Society guideline for respiratory management of children with neuromuscular weakness recommends that the use of IPV be considered in children where there is difficulty in clearing secretions or persistent atelectasis despite the use of other airway clearance techniques. (6(opens in a new tab)) 

The primary clinical indications for IPV are: 

• Retained peripheral secretions or secretion-related persistent atelectasis not responding to other airway clearance techniques 
• When increased ventilatory support is required during a respiratory illness and de-recruitment is likely if this support is not adequately provided during airway clearance manoeuvres. 
• Where chest wall pain, reduced bony integrity (osteopaenia or osteoporosis), and/or significant alterations in chest wall shape (e.g. severe scoliosis) make the use of other airway clearance techniques uncomfortable, unsafe or ineffective. 
• IPV is indicated for home use when an individual has retained peripheral secretions regularly, leading to frequent or prolonged respiratory illnesses and hospital admissions despite other peripheral airway clearance techniques. 

In some instances, there are social and/or compassionate grounds for choosing IPV over other airway clearance methods. If an individual, a family or carer experience barriers that prevent the application of peripheral ACT (Airway Clearance Techniques) and the use of a device may improve access to or quality and consistency of care, then IPV may be indicated.  

Common conditions that IPV is beneficial for:

• Neuromuscular diseases such as Duchenne Muscular Dystrophy (DMD), Spinal Muscular Atrophy (SMA), Congenital Myopathy and Congenital muscular dystrophy. Motor Neutone Disease (MND)/Amyotrophic Lateral Sclerosis(ALS)
• Spinal Cord Injury 
• Complex Neurodisability e.g. Cerebral Palsy (GMFCS V), Rhetts Syndrome, Neurodegenerative conditions 
• Severe Non-CF Bronchiectasis and Chronic Suppurative Lung Disease (CSLD)
• Traumatic Brain Injury (TBI)
• Polio
• Myasthenia Gravis
• Chronic Obstructive Pulmonary Disease (COPD) – in the presence of secretions
• Specific applications in a range of acute respiratory conditions in hospital setting. 

Evidence to date supports that IPV is safe to use in all ages from infant to child and adult. 

Respiratory muscle weakness and bulbar dysfunction (poor swallow) does not limit its use. 

• IPV should not be: 
• • used where an individual has an undrained Pneumothorax or is in terminal cardiac failure.
  • prescribed in the absence of sputum hypersecretion 
  •  prescribed without regular, structured follow up by the prescriber or someone capable of titrating the settings in the community or institution 

• The need for IPV should be carefully considered in those with severe cardiomyopathy due to the likelihood of generating PEEP, increased Work of Breathing (WOB) and unpredictable cardiac preload/afterload effects.

Yes, Pegaso is available for rent or purchase through BMedical. 
Let our team know if you require a quote for an NDIS application.

Within Australia all Respiratory Equipment applied for through National Disability Insurance Scheme (NDIS) must be endorsed by a Respiratory Consultant at a Specialist Centre or a Physiotherapist who specializes in respiratory care of Neuromuscular and complex respiratory patients. 
Let our team know if you require a quote for an NDIS application.

• All Filters, circuits and interfaces (eg face mask) are single patient use so should not be shared between individuals.  
• If sharing a device between individuals, each person should have their own filter/circuit and mask/interface with the device wiped down with appropriate antibacterial wipes in between individuals.  

Turn on the device at the rocker switch and immediately hold down the menu button until you hear a beep and the red lock icon is flashing. Use the up arrow to change the icon to a green unlock and then use the menu button to navigate to the next screen to change your settings. 

Go to percussion mode, the mode change function, where the upper down arrow is, must be sent to manual rather than automatic. Therefore, every time you change it back from percussion, it goes to the mode that’s programmed in the percussion mode. 

When running the Pegaso-plus on battery mode, you may hear a variation in the sound of the device. It is normal to notice the sound wax and wane while in use and is not a defect in the device.

Yes, there is a trolley available for the Pegaso device (item code PM00000351). 

The battery will generally last for 3 hours from a full charge. 

Some who use home oxygen may require oxygen during their treatment with the Pegaso. This oxygen can be entrained into the Pegaso circuit either using a T-piece adaptor or through the Pegaso expiratory adaptor. 

The Pegaso should be serviced every 2 years.  
To schedule your service- complete the service request form here and be sure to indicate in the notes if you will need a loan device while your Pegaso is being serviced. The team will be in touch to organise your service. 

PEGASO PLUS Manual Rev08_WAVES.pdf

Patients can order consumable replacement kits through: 

www.homemed.com.au/products/pegaso-consumable-replenishment-pack