Airway Clearance Techniques 2

Question 1

Positive Expiratory Pressure (3)

Answer 1

¬ Only used to MOBILISE

¬ Reinflates collapsed parts of lung by collateral ventilation

Question 2

Positive Expiratory Pressure (3)

Selecting Resistance

Answer 2

¬ Size (numbered 1>5; 1 = smallest hole)
o Smaller > greater PEP generated
o Larger > less PEP generated

¬ Patients expiratory flow
o Greater flow > greater PEP generated
o Less flow > less PEP generated

¬ Test
o 6-8 Breaths with PEP
o Pressure of 10-20chH2O
o I:E = 1:3 > Check for NO inc. WOB (accessory/abdominal muscle use) or SOB

Question 3

Positive Expiratory Pressure (3)

PEP: Duration

Answer 3

Stable pulmonary disease
- 10-15 mins x 1-2/day (e.g. 8 sets of 10 breaths)

Hospitalisation/Post-Op
- Shorter sessions, more frequent

Question 4

Positive Expiratory Pressure (3)

PEP: High Pressure

Answer 4

¬ Forced expiration (FVC) against PEP mask

¬ Expiratory pressure of 50-120cmH2O

Question 5

Positive Expiratory Pressure (3)
PEP: High Pressure
2

Answer 5

Disadvantages
• If incorrect resistance deterioration
• Spirometry equipment for regular reassessment
• High expiratory effort for patient

Not Recommended for Patients with:
•	Venous clotting when PE likely
•	Cardiac disease
•	Malnourishment
•	Weakness

Question 6

PEP: Oscillating

Flutter

Answer 6

• Small portable pipe-like device
• Endobronchial pressures = 18-35cmH2O
• Tilt to optimum position: 8-16Hz (natural pulmonary resonance = cilial beat)
• Vibration of bronchial wall (ensure not occurring at cheeks)
• Cannot inspire through device

Question 7

PEP: Oscillating

Acapella

Answer 7

• Oscillatory PEP
• Can inspire though device
• Oscillations independent of gravity

Question 8

PEP: Oscillating

Bubble

Answer 8

• Inexpensive
• Fun, but not limited to paeds
• PEP principles
• Previously DIY, now commercialised

Question 9

Autogenic Drainage (4)
Phase 1

Answer 9

1. Unstick > LOW volume from smaller airways
   a. Inspire, hold 3 sec, expire fully through mouth (sigh), use abdominal muscles

3.

Question 10

Autogenic Drainage (4)
Phase 2

Answer 10

Collect > MID volume from middle airways

a. Inhale slowly to higher (tidal) volume
b. Expire only to TV

Question 11

Autogenic Drainage (4)
Phase 3

Answer 11

Evacuate > HIGH volume from central airways
a. Inspire to higher lung volume
b. Can use huff or cough to remove secretions
NB. Suppress cough until end of routine.

Autogenic Drainage: Duration
Time consuming: 20-45 mins Rx (twice daily)