Airway Clearance Techniques

Question 1

Active Cycle of Breathing

Answer 1

Active breathing exercises coupled with the “huff cough” to assist in airway clearance in pts with asthma

Question 2

Three phases of ACB

Answer 2

1) Breathing control: 5-10 seconds relaxed breathing
2) Thoracic expansion exercise: 3-4 deep, slow breaths to inspiratory capacity with percussion/vibration/shaking combined to exhalation
3) Forced expiratory technique: 1-2 huffs with adduction of arms to compress thorax

Question 3

Autogenic Drainage

Answer 3

Idea is to improve airflow in small airways and “get behind the mucous” to move it
No use of postural drainage positions, coughing, or equipment
Pt must breathe at 3 volumes; Avg treatment time is 30-45 minutes

Question 4

Three lung volumes of AD

Answer 4

1) “Unsticking phase”: inspire at low-lung volumes followed by 2-3 second hold to get air behind secretions, then exhale to expiratory reserve volume
2) “Collecting phase”: tidal volume breathing interspersed by 2-3 second breath holds
3) “Evacuation phase”: deeper inspirations with breath holding followed by a huff

Question 5

Directed Coughing and Huffing

Answer 5

Compensates for pt’s inability to produce maximal forced exhalation; huffing allows for decreased potential for airway collapse

Question 6

High-Frequency Airway Oscillation

Answer 6

Uses Acapella or Flutter devices that use positive expiratory pressure (PEP) and high frequency airway vibrations to mobilize mucous

Question 7

High-Frequency Airway Oscillation Procedure

Answer 7

Place mouthpiece in mouth and inhale slowly to 75% of full breath
Hold breath for 2-3 seconds
Exhale through the device for 3-4 seconds; repeat 10-20 breaths
Follow with 1-3 coughs/huffs to expel mucous

Question 8

Postural Drainage

Answer 8

Different positioning of pt specific to lung segments for gravity assistance in draining bronchial secretions toward central airways for expulsion

Question 9

Percussion

Answer 9

aka cupping

Rhythmic striking of specific lung segment for several minutes for drainage

Question 10

Vibration

Answer 10

Mechanical or manually over leg segment to be drained during EXHALATION

Question 11

Contraindications for trendelenburg position with PD (5)

Answer 11

1) Uncontrolled HTN
2) Distended abdomen
3) Esophageal surgery
4) Recent gross hemoptysis related to lung carcinoma treated surgically or with radiation
5) Uncontrolled airway at risk for aspiration i.e. current tube feeding or recent tube feeding