Ch.44 Egans Flashcards
What is abnormal clearance?
Any abnormalities that alter:
• airway patency
• mucociliary function
• strength of breathing muscles
• thickness of secretions
• cough reflex
Can impair airway clearance leading to retention of secretions
Retention of secretions results in:
• full obstruction or mucous plugging (atelectasis)
• partial obstruction
What are causes of impaired mucociliary clearance in intubated pt’s?
What is the primary goal of ACT?
To assist the pt to mobilize and remove retained secretions.
Removal of these retained secretions may:
Improve gas exchange, promote alveolar expansion, and reduce WOB
What are the indications for ACT?
What are the 5 general approaches to ACT?
Can be used alone or in combination
1. CPT
2. Coughing and related expulsion techniques
3. PAP
4. High frequency oscillation devices
5. Mobilization and physical activity
What is the initial assessment of need for ACT?
What are some ACT techniques and devices?
• CPT includes percussion and PD
• Active cycle of breathing
• Autogenic drainage
• MIE
• PEP or OPEP
• High frequency positive airway pressure devices
• HFCWC
• Mobilization & physical activity
What are some contraindications to the use of CPT?
• Empyema
• PE
• ICP > 20mmHg
• Bronchospasm
• Osteoporosis
What is the Triple “S” rule?
What are 5 complications with PD?
• Hypoxemia
• Increased ICP
• Pulmonary hemorrhage
• Bronchospasm
• Arrhythmias
What is HFCWC?
An external (chest wall) application vest airway clearance system.
How does HFCWC work?
Generator inflates and deflates the vest creating pressure pulse against the thorax that cause chest wall oscillations and move secretions forward.
What are the 2 parts to HFCWC?
- variable air pulse generator
- a non stretch inflatable vest that wraps around the pts entire torso
What are some key factors in selecting an airway clearance strategy?
What are assessment outcomes after ACT?
For volume controlled what do you set?
Vt, FiO2, PEEP, Flow
What is controlled in volume controlled?
Volume
Pressure ______ during volume controlled?
Varies
T or F Volume and flow are constant during volume control?
True
T or F Pressure changes during volume controlled?
True
What can you run the risk of during volume controlled?
Barotrauma
What happens during pressure controlled?
Pressure is constant and volume and flow will change
What is the inspiratory pressure in pressure controlled?
Vt
What do you set for pressure controlled?
RR, FiO2, PEEP, Ti
What is the flow range for pressure controlled? What do we usually start with?
40-80; 60
What are some common methods for delivering inspiration?
What are ventilator control functions during inspiration?
Box 3.3
