Airway clearance - Lecture 3

Question 1

Factors that temporarily reduce MCC:

Answer 1

Post surgery drugs
Medications
Artificial airways
Lack of sleep
Dehydration (systemic or airways)
High FiO2 concentration
hypoxia
positive pressure ventilation

Question 2

Factors that reduce cough effectiveness

Answer 2

Respiratory mm weakness
abdominal mm weakness
airway narrowing
pain
reduced cough reflex
reduced consciousness
reduced lung volume

Question 3

3 factors that reduce mucocilliary escalator:

Answer 3

1. altered rheotological properties
2. impaired mucociliary clearance
3. impaired cough reflex/mechanism

Question 4

2 ways rheotological/mucous properties is altered:

Answer 4

1. Increased viscosity (dehydration systemic or airway only, cystic fibrosis)
2. increased volume (inflammation, infection, foreign body in airway)

Question 5

2 ways mucociliary clearance is impaired: (cillia specific)

Answer 5

1. Ciliary dysfunction (Primary cilliary dyskinesia, general anaesthetic)
2. Cilliary destruction (smoking, chronic inflammatory disorders)

Question 6

Signs of impaired airway clearance:

Answer 6

Subjective report
increased WOB
repeated chest infections
fever and tachycardia
palpation - chest expansion reduced over atelectasis
- tactile fremitus
cough - moist or dry/hacking
- may be paroxysmal
- may be productive or not
auscultation - low pitched wheeze/crackles on expiration
- decreased BS due to reduced lung volumes
- bronchial BS over atelectasis
CXR - shows consolidation
Reduced SpO2

Question 7

Management of reduced airway clearance:

Answer 7

aerosol therapy
cough
ex/mobilisation
ACBT
PEP
Autogenic drainage
Gravity assisted postural drainage
manual chest wall techniques - percussion and vibration
NIV/PEP devices
MHI/VHI
Suction