airway clearance adjuncts Flashcards
what is ACBT?
-active cycling breathing technique
-use to mobilise and clear excess secretions
what are the 3 main phases of ACBT?
-breathing control
-deep breathing exercises
-huffing or forced expiratory technique
why do we need to use airway clearance techniques?
-for infection & inflammation
-airway obstruction
-ineffective cough reflex
-parenchyma damage
-airways have become blocked up with thick mucous
what is the purpose of airway clearance?
-to loosen thick sticky mucous, so it can be cleared easily from the lungs
what does normal airway clearance need?
-open airway
-effective cough
-functional mucocilary escalator
explain the ACBT technique
-Breathing control - normal breathing for 20/30 seconds (in through nose and out through mouth)
-Then 3-4 deep breaths (fill the bottom of the lungs as best as they can) can ask them to put hands at bottom of lungs
-Breathing control (normal breathing)
-3-4 deep breaths
-Breathing control
-Huffing - put a tissue in front of them - get them to blow on the tissue
-Then cough if needed
for clearing secretions, should ACBT be used on it own?
it is recommended to use another manual clearance technique as well as ACBT
how can we make ACBT more effective?
- Get the patients sitting up or standing - it will be more effective EXCEPT for spinal cord patients (gravity will help push diaphragm up a little)
what is autogenic drainage?
-utilises different speeds of breathing to move mucous
-each phase is 2-3 mins to complete and total treatment is 20-45 mins (v time consuming)
what kind of pts can AD be used for?
Cf or non CF bronchiectasis patients
describe the 3 phases of AD
-phase 1 - moving mucous from small airways (unsticking)
-phase 2- moving mucous from small airways to medium sized airways (collecting)
phase 3- moving mucous from medium sized airways to the large airways for expectoration (evacuation)
what is positive expiratory pressure?
-a person breathes through a mask or a handheld mouthpiece. PEP devices allow air to flow freely as you breathe in, but not when you breathe out. You must breathe out harder against the resistance.
-reduces airway collapse caused by bronchiectasis
what are indications for positive expiratory pressure?
-CF
-bronchiectasis
-large volume of secretions
-mucousal swelling
-
what are examples of contraindications for positive expiratory pressure?
-inner ear pathology
-nose blood history (epistaxis)
-oesophageal surgery
-nausea
-recent trauma to skull, face or mouth
-active haemoptysis (blood in sputum)
-high ICP (as holding breath can raise pressure further)
what does PEP technique involve?
-mask is used
-1 way valve to which expiratory resistors are attached
-flow dependent to mobilise secretions
-patient exhales against fixed expiratory resistance generating pressures during expiration that usually ranges from 10-20cm H20
what are the risks of introducing PEP to patients with a bacterial infection eg CF pts?
-people forget to tell them how to clean the device
-when pts come back, it is so full of bacteria
-need to think if the pt is going to be compliant with cleaning the device
describe inspiratory muscle training
-form of resistance / weight training
-diaphragm and intercostal muscle training
-evidence suggests reduced dyspnoea on exertion and increases exercise tolerance
what is important to consider about inspiratory muscle training?
NEED to consider the FIIT principles
reps, sets etc
what kind of pts can IMT be used?
-cystic fibrosis
-COPD
-heart failure
-asthma
-stroke etc
what is non invasive ventilation (NIV)
delivery of oxygen (ventilation support) via a face mask
what kind of patients can we use NIV for?
-used with COPD
-sleep apnoea - obstructive
-type 1 resp failure (hypoxia)
-nocturnal support for advanced CF
-neuromuscular conditions eg MND
what does CPAP stand for?
-continuous positive airway pressure
describe CPAP
-provides continuous pressure throughout entire resp cycle
-face mask is worn
-increases functional residual capacity
-prevents airway closure
what does BIpap stand for?
-bilevel positive airway pressure
what is IPAP and EPAP?
IPAP - inspiratory positive air pressure
-EPAP - expiratory positive airway pressure
what are the aims of BiPAP?
-slow daytime hypercapnia
-improve hypoxemia
-stabilise hypercapnia
-decreases work of breathing
what are indications for BiPAP?
-sputum retention
-atelectasis
-blood gas abnormality
-resp muscle weakness
-inability to engage with ACBT
what are the contraindications for BiPAP?
-CVS instability
-upper airway obstruction
-head injury / increased ICP
-severe haemoptysis
-upper GI surgery
-facial trauma or surgery
-undrained pneumothorax
-kung transplant / surgery
what does IPPB stand for?
-intermittent positive pressure breathing
what is manually assisted cough?
-when the PT uses manual technique to mimic the action of the diaphragm
-compression of the diaphragm
what does the manual assisted cough technique involve?
-pt is sitting/ half lying w/ head elevated
-position heel of your hands off the patient ribs, above belly button
-patient breathes max involuntary inhalation and hold breath in
-on cough, pt initiates a cough as the physio applies one forceful push in and up through the abdomen
what are examples of contraindications for manual assisted cough?
-undrained pneumothorax
-vomiting
-facial fractures
-osteoporosis - could fracture a rib
-CVS instability
-raised ICP
-recent upper GI surgery
what is self manual assisted cough?
-ask them to sit and lean forward
-pt does inward and upward movement
-however, pt might not have strength to do this
what is an example of a patient population that could use a cough assist device?
neuro patients eg MND, spinal cord injury, stroke
what are indications for the use of cough assist device?
-peak cough flow of less than 180L/min are unlikely to clear secretions
-audible secretions at the mouth
-crackles heard on auscultation
-non productive cough
-poor inspiratory efforts
what is a normal peak cough flow?
should be 500-800L/min
how does a cough assist device work?
-applies a positive pressure to fill the lungs, quickly switching to a negative pressure to produce a high expiratory flow rate and stimulate a cough
how is a cough assist device applied?
-mask
-mouth piece
-endotracheal tube
what is MI:E?
A mechanical insufflator-exsufflator (MI-E) device
-used to assist coughing in patients
what are indications for use of MI:E?
-redcued peak cough flow
-neuromuscular disease eg ALS, muscular dystrophy, MS, myasthenia gravis
what is breathstaking?
-the process of stacking breaths to recruit lung fields and improve oxygenation via taking a deep inhalation facilitating peak expiratory flow and peak cough flow
what is the equipment needed for breath staking?
-mask w/ 1 way valve
-ambu bag
-10ml syringe
-may or may not need a nose clip
-info leaflet for patient
what are the instructions for breath staking use?
-person sitting comfortably, up straight
-+/- nose clips
-put mouth piece in or hold face mask
-take a deep breath in whilst squeezing bag
-hold breath
-immediately take another breath on top of first breath
-take 3-4 breaths in this way
-remove mask and breath out / cough
what are indications for breath stacking?
-paralytic or restrictive disorders
-MND
-MS
polio
what is rib springing?
-a compressive technique
-stimulates deeper inspiration
-stimulates a cough
-mobilises secretion
what pts is rib springing suitable vs not suitable for?
-suitable - pts w/ atelectasis, paralysis
-not suitable - rib fractures, undrained pneumothorax, osteoporosis
what is high frequency chest wall oscillation?
-where pulses of pressure are applied to chest wall by an inflatable vest
-helps to expel mucous like mini coughs
what are indications for HFCWO?
CF or NM conditions
what are examples of inhaled therapies that can be used before ACT’s?
-bronchodilators eg salbutamol
-mucolytics
-airway hydrators
-inhaled steroids / anti-biotics
what are things to consider when choosing an adjunct?
-age and condition of pt
-severity of lung disease
-compliance to treatment
-ease of use/ comfort
-cost / availibility
