Ch 12 Airway Clearance

Quad cough?

•Manual Assisted Cough

Vibration of the chest wall

*The Vest* Transmit energy through the chest wall to loosen or move bronchial secretions

Cough assist

- insufflator-exsufflator •High frequency chest wall oscillation w/cough

•PEP or Acapella device

Acapella device •Huff cough

Percussion

Loosen secretions from the bronchial walls

Indications for CPT?

Acute Lobar Atelectasis •Cystic Fibrosis •Neuromuscular disease or injury •Lung Abscess

ACT

Airway clearance techniques include maneuvers to improve the effectiveness of the cough

Evulation of Therapy?

Amount of secretions expectorated •Hydration status •Changes in sputum production •Breath sounds •Vital signs •Chest x-ray •Blood gases •Lung mechanics

EZ pap?

Can be used in children of all ages Younger children/neonates can use a mask Older children can easily blow into a mouthpiece Requires less coordination and can still provide a very effective treatment

Length of treatment?

For patient with CF or bronchiectasis •30 to 45 minutes •For patients with severe dyspnea •May require rest periods •Most ACT pediatric patients •15 to 20 minutes

FET PEP

Forced expiration technique Positive expiratory pressure

HFCC

High frequency chest compression

Complication of Therapy?

Hypoxemia Airway obstruction & respiratory arrest IVH - intracranial complications Rib fractures & bruising Airway trauma - related to ETT & SXN Nausea & vomiting - ACT should be performed in between meals not right after

Hyperinflation Technique?

Incentive Spirometry •IPPB •EZPAP •CPAP •Used to treat/ reverse atelectasis

IPPB?

Intermittent Positive Pressure Breathing •Indicated in the older patients who cannot effectively perform the IS •Only one contraindication - Tension PTX •Can possibly have many complications with children who are unable to follow directions

IPV

Intrapulmonary percussive ventilation

Therapy modifications?

Medical or surgical procedures •Implanted devices •Brittle bones •Trendelenburg •Gastroesophageal reflux •Intracranial trauma or surgery •Increased intracranial pressure •Abdominal distention •Cardiopulmonary failure

Incentive Spirometry

Not common for use in infants due to lack of coordination •Can use blowing bubbles instead •Small children starting at 4 years old or older •Need to be able to follow directions to avoid hyperventilation •Procedure same as in adults •Use small words to provide instruction

major components of Chest Physiotherapy

Postural drainage •Percussion •Vibration of the chest wall •Coughing

Future of Airway clearance?

Prevention and normalization of physiologic airway clearance mechanisms •Customized therapy for the best outcome

CPT of young children

Secure the patient's confidence and cooperation Continuity of therapists Pain control is essential for an effective treatment Train cough/splint with pillow for patients that are old enough

Contraindications?

Severe asthma exacerbations where bronchoconstriction and hypoxemia are uncontrolled •Bronchiolitis (smaller airways effected) shows no decrease in the length of stay •Post-cardiac surgery has better outcomes with deep breathing exercises Frank hemoptysis •Empyema: a collection of pus in the space between the lung and the inner surface of the chest wall (pleural space). •Foreign body aspiration •Untreated pneumothorax

Documentation of therapy?

Technique used •Lobes treated •Position of the patient •Suctioning •Pretreatment and post-treatment breath sounds •Vital signs •Amount and quality of the sputum

CPT of a Newborn?

Treatment length of 5 minutes is sufficient Typically performed on non-intubated patients to allow for maneuvering of patients Cup percussor vs vibratory techniques in preterm patients? Preferred vibration method in preterm neonates

Frequency of treatment?

Typically every four to six hours •Frequency needs to be evaluated at least every 48 hours •Decrease the frequency as the patient gets better •Discontinue if patient is not planning on going home on the therapy to check for stability •Most modalities (cup percussor, acapella) are easily taken home and taught to caregivers

Indications for Cough Assist machine?

Used in patients who have a weak cough Informational video Performed on true patient

define postural drainage

Uses gravity to move secretions from peripheral airways to the larger bronchi making them easier to cough out

AD

autogenic drainage - breathing techniques

pt positions

see slide