Airway Clearance - Physiotherapy Flashcards
What are the active sputum clearance techniques?
- Mobilisation
- Positive expiratory pressure (PEP)
- Breathing exercises (ACBT)
What are the passive sputum clearance techniques?
- Postural drainage
- Percussion & vibrations
- High frequency oscillating vests (HFOV)
What are the effects of mobilisation?
- Increased flow rates
- Higher FRC (functional residual capacity)
- Moving more gas - more pressure behind cough
What does PEP involve?
- Using positive pressure of blowing to create a back pressure in the airways
- Using collateral ventilation to force air behind sputum in collapsed airways
- I.e. uses lateral channels as a back door to get around sputum
- Holds airways open whilst providing expiratory flow
What devices are used for PEP?
- Bubble PEP
- TheraPEP, PariPEP
- Oscillating PEPs - Acapella, Flutter
What type of patient would a TheraPEP/PariPEP be used for?
Someone with chronic disease requiring ongoing PEP therapy, e.g. chronic bronchitis, CF
What is the function of an oscillating PEP?
- Creates positive pressure
- Plus adds vibration during exhalation
When would you use specific breathing exercises?
When mobilisation isn’t enough and/or you can’t use PEP
What are the specific breathing exercises for the larger and smaller airways?
Larger: Cough & high volume huff
Smaller: Forced expiratory technique (FET) & active cycle of breathing technique (ACBT)
What is forced expiratory technique (FET)?
- 1-2 huffs from mid-low lung volume
- Followed by breathing control (period of relaxed, controlled breathing to reduce the possibility of airway closure, desaturation or fatigue)
What is the active cycle of breathing technique?
- Technique to clear bronchial secretions
- Cycles of breathing control, thoracic expansion exercises (TEE) & FET (1-2 huffs, breathing control)
When would you begin using passive airway clearance techniques?
When the patient is too tired to continue active techniques or cannot participate in active techniques
What does postural drainage involve?
- Uses gravity to position affected lung segment uppermost
- Sputum should drain into larger airways to be coughed out
- Combined with other techniques
What does percussion/vibration involve?
- Tapping or shaking chest wall to loosen sputum from airways
- Cupped hand and rhythm essential for percussion
- Time vibrations with exhalations
What should you do if active and passive techniques don’t work?
Consider more invasive techniques (learning in CI2)
