Airway Clearance Therapy Flashcards
Described the primary techniques
used to assist with clearing secretions from the airways.
Chest Physical Therapy
How many secretions does a healthy individual produce in a daily basis and that are cleared by this mucociliary escalator?
10 to 100 mL
Four distinct phases to a normal cough:
- IRRITATION
- INSPIRATION
- COMPRESSION
- EXPULSION
In this phase, an abnormal stimulus provokes sensory fibers in the airways to send impulses to the medullary cough center in the brain.
Irritation phase
In normal adults, the inspiration averages _____
1 to 2 L
During this phase, reflex nerve impulses cause glottic closure and a forceful contraction of the expiratory muscles and normally about 0.2 seconds, and result in a rapid increase in pleural and alveolar pressures, often greater than 100 mm Hg.
Compression phase
Most common disorder that alter mucociliary clearance.
Cystic fibrosis`
Diseases Associated With Abnormal Clearance
- diseases affecting airway patency
- composition and production of mucus
- ciliary structure and function
- normal cough reflex
The primary goal of ACT is to;
- assist the patient to mobilize and remove retained secretions.
When coordinating the sequence of the following
therapies relating to bronchopulmonary clearance,
which should the respiratory therapist do first?
Bronchodilator therapy
Patients with acute conditions in whom ACT may be indicated
include:
- acutely or chronically ill patients with copious secretion
- patients with retained secretions or ineffective cough (coarse crackles, worsening oxygenation and/or ventilation, volume loss on chest radiograph)
- possibly patients with acute lobar atelectasis
- patients with abnormalities
Acute conditions for which ACT is probably not indicated include:
- routine care of chronic obstructive pulmonary disorder (COPD)
- pneumonia without clinically significant sputum production
- routine postoperative care
- uncomplicated asthma
Causes of Impaired Mucociliary Clearance in Intubated Patients
- Endotracheal or tracheostomy tube
- Tracheobronchial suction
- Inadequate humidification
- High FiO2 values
- Drugs
- General anesthetics
- Opiates
- Narcotics
- Underlying pulmonary disease
The most common conditions affecting the cough reflex
musculoskeletal and NMDs, including muscular dystrophy, ALS, spinal muscular atrophy, myasthenia gravis, poliomyelitis, and cerebral palsy
Sputum production must exceed __ to __ ml/day for airway clearance therapy to improve secretion removal significantly
20 to 30 ml/day
Indications for Airway Clearance Therapy
ACUTE CONDITIONS
• Copious secretions
• Inability to mobilize secretions
• Ineffective cough
CHRONIC CONDITIONS • CF • Bronchiectasis • Ciliary dyskinetic syndromes • COPD patients with retained secretions
The best-documented preventive uses of airway clearance therapy include
(1) body positioning and patient
mobilization to prevent retained secretions in acutely ill patients
(2) ACT combined with physical activity to maintain lung function in patients with CF
It is a deliberate maneuver that is taught, supervised, and monitored. It aims to assist in creating a productive cough in patients unable to clear secretions with an effective spontaneous cough
Directed cough
To determine the effectiveness of directed cough techniques, therapists should evaluate the patient for any of the following
outcome changes:
- increased sputum production,
- decreased pulse and respiratory rate,
- clearing of the breath sounds,
- improved oxygen saturation, and
- possibly clearing of infiltrates on the chest radiograph.
To expel secretions the device simulates an effective cough by using positive airway pressure on inspiration to increase tidal volume and then switching to a negative pressure to increase peak expiratory cough flows
Mechanical insufflation-exsufflation (MIE)
To loosen and move secretions into the larger airways the patient breathes in and actively exhales against short, rapid positive airway pressure pulses.
High- Frequency oscillation devices
Patients who participate in physical activity that results in increased tidal volume, heart rate, and cardiac output, and improved physical condition.
Mobilization and physical activity
An effective directed cough is impossible in what patient condition
unresponsive, paralyzed, or uncooperative patients.
This technique consists of one or two forced expirations of middle to low lung volume without closure of the glottis, followed by a period of diaphragmatic breathing and relaxation.
Forced Expiratory Technique ( huff cough )
It is an external application of pressure to the thoracic cage or epigastric region, coordinated with a forced exhalation.
Manual Assisted Cough ( quad-cough )
In this technique, the patient takes as deep an inspiration as possible, assisted as needed by the application of positive pressure using a self-inflating manual resuscitation bag or ventilator. At the end of the patient’s inspiration, the RT exerts pressure under the diaphragm (lateral costal margins or epigastrium) abruptly.
Manual Assisted Cough
Involves gentle diaphragmatic breathing at normal tidal volumes for 5 to 10 seconds with relaxation of the upper chest and shoulders.
Breathing control
ACBT
Active Cycle of Breathing Technique
- consists of repeated cycles of breathing control, thoracic expansion, and FET - combines different techniques that help clear mucus from the lungs - can be performed while sitting or laying down with your hips elevated above your chest.
Is another modification of directed coughing, designed as an airway clearance mechanism that can be performed independently by trained patients.
Autogenic drainage (AD)
this device (also called cough-assist device or “coughlator”) has gained popularity in its use to manage secretions in patients with certain neuromuscular disorders.
Mechanical Insufflation-Exsufflation
This phase of ACBT is designed to help loosen secretions, improve
the distribution of ventilation, and provide the volume needed
for FET.
The thoracic expansion
High-frequency positive airway pressure devices are also
referred to as
intrapulmonary percussive ventilation (IPV).
involves active expiration against a fixed orifice
flow resistor or variable orifice threshold resistor capable of
developing pressures of 10 to 20 cm H2O
Positive Expiratory Pressure (PEP)
