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