Airway Clearance Interventions Flashcards
Define obstructive lung disease.
Obstructive lung disease is characterized by chronic inflammation and narrowed airways.
- Making it difficult to exhale air completely.
- Examples
- COPD
- Emphysema
- Asthma
- Chronic Bronchitis
- Bronchiectasis
- Cystic Fibrosis
What is the purpose of postural drainage?
Postural Drainage:
- Uses gravity to drain secretions from specific lung segments toward central airways for easier removal.
- Improves ability to clear out secretions in lower lobes thatcannot be cleared with cough or other breathing techniques.
- Often combined with other airway clearance techniques.
Define percussion and vibration in airway clearance.
Percussion:
- Involves rhythmic clapping on the chest to loosen mucus.
- Should last for several minutes and should not be painful (3-5 min/lobe, 100-480/minute).
- Purpose to loosen up mucus and increase mucociliary clearance
Vibration:
- Applies a fine, tremulous action during exhalation to aid mucus clearance.
- Completed for 3-5 exhalations
What is…
- Active Cycle of Breathing (ACB) = ?
- Phases = ?
Active Cycle of Breathing (ACB):
- A series of breathing maneuvers performed to independently clear secretions and improve thoracic expansion.
- Phases:
- (1) Breathing control: Performs diaphragmatic breathing at normal tidal volume for 5-10 seconds
- (2) Thoracic expansion exercises: 3-4 deep, slow, relaxed inhalations to inspiratory reserve volume with passive exhalation. Can include 3 second hold at top of full inhalation.
- (3) Forced expiratory technique: 1-2 huffs at mid to low lung volumes
What is…
- Autogenic drainage = ?
- Phases = ?
Autogenic Drainage:
- A controlled breathing technique to mobilize secretions without coughing or postural drainage, using varying lung volumes and expiratory flows.
- More beneficial for patients who cannot tolerate postural drainage patients or increased thoracic pressure.
Phases:
1) Unsticking phase (Small Breath):
- Slowly breath in through the nose at low-lung volumes followed by a 2-3 second breath hold to allow collateral ventilation to get to air behind the secretions
- Then exhale down into expiratory reserve volume
- Repeat 2-3 times
2) Collecting Phase (Medium Breath):
- Tidal volume breathing, interspersed by 2-3 second breath-holds
- Repeat 2-3 times
3) Evacuating Phase (Large Breath):
- Deeper inspiration from low-to-mid inspiratory reserve volume
- Hold breath for minimum of 3 seconds, then an active but not forced expiration through an open glottis
- Huffing technique can be used as well in this phase
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What does hypoxemia mean?
Hypoxemia refers to low oxygen levels in the blood
- PaO2 (partial pressure of oxygen) < 55 mmHg, or
- SaO2 (oxygen saturation of hemoglobin) < 88% on room air
What is the purpose of a directed cough?
A directed cough aims to expel mucus and secretions from the airways by using a series of controlled breathing and coughing techniques.
What is a contraindication for postural drainage?
- elevated intracranial pressure
- recent spinal surgery
- pulmonary embolism
- rib fractures
- active hemorrhage
What is high-frequency airway oscillation?
High-frequency Airway Oscillation:
- Devices that combine positive expiratory pressure and high frequency airway vibrations to mobilize mucus secretions in the airways
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Common devices: acapella and flutter
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Define the Trendelenburg position in airway clearance.
Trendelenburg Position:
- Optimal for facilitating secretion drainage from the lower lobes of the lung
- Supine with foot of bed elevated so head is declined below feet.
What are the main goals of airway clearance techniques?
- Optimize airway patency
- Increase ventilation and perfusion matching
- Promote alveolar expansion and ventilation
- Improve gas exchange
- Clear out secretions
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What are the primary components of a directed cough?
Effective cough stages:
- Inspiration greater than tidal volume, maximal inhale as possible
- Closure of glottis with holding breath for 2-3 seconds.
- Contract the abdominal and intercostal muscles to produce increased intrathoracic pressure against the closed glottis.
- Sudden opening of the glottis and forceful expulsion of the inspired air by coughing sharply 2-3 times
How does the huff technique differ from a cough?
- Huff: Good alternative to cough if coughing is too painful
- Steps to huffing
- Sit up in upright position
- Take a deep breath in through an open mouth
- Hold for 1-2 seconds
- Forcefully and quickly exhaling 2-3 bursts of air without glottis closure
- Tips for huffing
- Huffing sound as if patient was saying “Hu-Ff” or “Ha Ha Ha” (Hu = vibration of mucus / Ff = abdominal contraction)
- Longer sounds help for smaller airways, shorter sounds help with larger airways
- Splinting can be used to assist with tolerance
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What are the phases of the Active Cycle of Breathing (ACB)?
The phases include:
- breathing control
- thoracic expansion exercises
- forced expiratory technique
What are contraindications for percussion and vibration techniques?
Contraindications include recent thoracic surgery, burns, open wounds, osteoporosis, and active bronchospasms.
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How does high-frequency airway oscillation improve airway clearance?
It combines positive expiratory pressure and vibrations to mobilize mucus and enhance secretion clearance.
What is the role of supplemental oxygen in pulmonary interventions?
Supplemental oxygen:
- improves oxygen saturation
- supports exercise tolerance
- reduces dyspnea
in patients w/ hypoxemi
How would you differentiate between the huff and cough techniques?
- Huffing uses forceful exhalation without glottis closure, reducing pain and strain.
- Coughing involves glottis closure and higher intrathoracic pressure to expel mucus.
What are the differences between Active Cycle of Breathing (ACB) and autogenic drainage?
ACB incorporates controlled breathing, thoracic expansion, and forced expiration, while autogenic drainage relies on varying expiratory airflow without coughing or postural changes.
When would postural drainage be contraindicated?
Postural drainage is contraindicated in conditions like elevated intracranial pressure, recent spinal surgery, active hemorrhage, or pulmonary embolism.
Which airway clearance technique would you choose for a patient with osteoporosis?
Gentler techniques like huffing or autogenic drainage are preferred to avoid the potential harm caused by percussion or vibration.
How would you modify airway clearance for a postoperative patient with incisional pain?
Use splinting with a pillow to support the incision during coughing or huffing and opt for techniques that minimize thoracic pressure, such as autogenic drainage.
Why is the Trendelenburg position used in airway clearance, and when should it be avoided?
It uses gravity to drain lower lung segments but should be avoided in cases of uncontrolled hypertension, CHF, or risk of aspiration.
How does high-frequency airway oscillation differ from manual percussion?
- High-frequency oscillation uses devices like acapella to combine positive expiratory pressure with vibrations.
- Manual percussion involves rhythmic clapping with the hands.
What is the purpose of combining percussion with postural drainage?
- Percussion loosens mucus, making it easier for gravity in postural drainage to move secretions toward the central airways.
Why might a patient with chronic bronchitis benefit from autogenic drainage?
It allows secretion mobilization without coughing, reducing strain and improving secretion clearance in patients with mucus hypersecretion.
What are the key considerations when titrating supplemental oxygen during activity?
Monitor oxygen saturation levels (≥90%), adjust flow rates as needed, and use breathing exercises like pursed-lip breathing to optimize oxygen use.
How would you instruct a patient to perform a directed cough?
Guide them to:
- Inspiration greater than tidal volume, maximal inhale as possible
- Closure of glottis with holding breath for 2-3 seconds
- Contract the abdominal and intercostal muscles to produce increased intrathoracic pressure against the closed glottis
- Sudden opening of the glottis and forceful expulsion of the inspired air by coughing sharply 2-3 times
What are the phases of autogenic drainage, and what is the purpose of each?
Phases include unsticking (small breaths to mobilize secretions), collecting (tidal breathing to move secretions upward), and evacuating (large breaths to clear secretions).
Why might a patient prefer high-frequency airway oscillation over traditional techniques?
It is less physically demanding, more comfortable, and can be performed independently, making it suitable for patients with limited mobility.
How do you decide the order of lung segments to treat in postural drainage?
Prioritize the most affected segments based on patient symptoms, imaging findings, and auscultation results.
How can a therapist ensure infection control during airway clearance?
Use gloves, masks, and other barriers, and handle sputum with care to prevent transmission of infections.
What are the expected outcomes of supplemental oxygen therapy during exercise?
Improved oxygen saturation, reduced dyspnea, and enhanced exercise tolerance with safe SpO2 levels maintained.
When would you choose the Active Cycle of Breathing (ACB) over postural drainage?
Choose ACB for patients who can actively participate and prefer independent techniques without the need for specialized positions.
How does pursed-lip breathing benefit patients during airway clearance?
It helps maintain airway patency, reduces work of breathing, and promotes efficient exhalation to support secretion clearance.
What adjustments are needed for a patient with anxiety during airway clearance?
Use calming techniques, avoid positions that may increase discomfort, and provide clear explanations to reduce fear and enhance participation.
Why is it important to monitor vitals before, during, and after airway clearance?
To assess patient response, ensure safety, and adjust techniques or intensity to avoid adverse effects such as hypoxemia or fatigue.
A patient with cystic fibrosis reports difficulty clearing mucus. Which airway clearance technique would you recommend, and why?
High-frequency airway oscillation, such as using the acapella device, because it combines positive expiratory pressure and vibrations to mobilize mucus effectively.
During a postural drainage session, the patient complains of dizziness. What is your immediate response?
Stop the session, assess vitals, reposition the patient to a more upright posture, and investigate potential causes like hypotension or discomfort.
A patient has a recent history of rib fractures. Which airway clearance techniques should you avoid?
Avoid percussion and vibration techniques due to the risk of causing further injury or discomfort.
A patient with COPD is unable to tolerate prolonged activity due to dyspnea. What adjustments would you make?
Incorporate interval training with frequent rest periods and focus on techniques like pursed-lip breathing to manage dyspnea.
A patient recovering from abdominal surgery finds coughing painful. What alternative technique could you suggest?
Huffing, as it avoids glottis closure and reduces intrathoracic pressure, making it less painful while still clearing secretions.
How would you assess the effectiveness of postural drainage?
Monitor for increased sputum production, improved breath sounds, better oxygen saturation, and patient-reported ease of breathing.
A patient with asthma experiences bronchospasms during percussion. What should you do?
Discontinue percussion, provide a bronchodilator if prescribed, and consider alternative techniques like autogenic drainage or ACB.
A patient with significant mucus retention in lower lung segments cannot tolerate Trendelenburg positioning. What is your plan?
Use alternative positions for lower lung drainage and incorporate techniques like autogenic drainage or ACB to assist clearance.
What instructions would you give to a patient using an acapella device for airway clearance?
Seal lips around the mouthpiece, inhale slowly to 75% capacity, hold for 2-3 seconds, exhale through the device for 3-4 seconds, and repeat for 10-20 breaths followed by 2-3 coughs or huffs.
A patient reports increased fatigue after airway clearance sessions. How would you modify the treatment?
Shorten session duration, reduce intensity, allow more rest periods, and monitor the patient’s response closely during therapy.
A postoperative patient develops hypoxemia during therapy. What immediate actions would you take?
Stop therapy, provide supplemental oxygen as prescribed, perform breathing exercises like pursed-lip breathing, and reassess before continuing.
How would you handle a situation where a patient refuses airway clearance due to discomfort?
Discuss alternative techniques, address their concerns, and adjust the therapy plan to accommodate their comfort and preferences.
What adjustments are needed for a patient with high anxiety during airway clearance sessions?
Use calming techniques, avoid complex or stressful procedures, and provide clear explanations to build trust and reduce anxiety.
A patient’s oxygen saturation drops below 88% during activity. What steps should you take?
Pause the activity, provide supplemental oxygen, allow the patient to rest, and monitor SpO2 until it stabilizes above 90%.
A patient using autogenic drainage struggles with the unsticking phase. What advice would you offer?
Encourage small, slow breaths through the nose, followed by a 2-3 second hold to allow collateral ventilation before exhaling slowly to expiratory reserve volume.
How would you evaluate the success of an airway clearance program for a patient with chronic bronchitis?
Assess sputum production, ease of breathing, improved oxygen saturation, and patient-reported quality of life improvements.
