Lecture 7 - Physio in ICU Flashcards
What are the strategies to improve gas movement on an Intubated patient?
MHI
Positioning
Mobilization
What are the strategies to improve secretion movement on an intubated patient?
Postural drainage MHI suctioning manual techniques - percs, vibs Mobilization
How does positioning effect gas movement
- increase negative intrapleural pressure in non dependent lung region –> gravity stretches open air spaces
- increased stretch –> decrease surface tension –> increased lung compliance
How does positioning effect secretion movement
drains secretions - head down tilt `
How does MHI effect gas movement and secretion movement?
deep breath - increases volume –> stimulates surfactant –> decreases surface tension and improves compliance
slow inspiration = reduces effect of airway resistance of distribution of ventilation - allows time for air to spread to all areas of lung
Inspiratory hold = allows for collateral ventilation, gets air behind secretion
Rapid release = annular 2 phase gas liquid flow - assists with removal of secretions - increase cough effectiveness - enhances exp flow rate
head down tilt combined with MHI is better for secretion removal
What affect does MHI have on pulmonary compliance
airway resistance is reduced with MHI - improe airway size
What effect does MHI have on arterial oxygenation
greater area for gas exchange
What do you monitor when performing MHI
Sp02 HR/BP/MAP/ECG auscultation airway pressures ETCO2 - CPP and ICP
What are the precautions to MHI and how do you modify?
Unstable Resp system - PEEP >10, Fio2 >0.6
Unstable CV system - Hypotension, bradycardia, tachycardia - deliver small volume, gradually increase breath size, remove hold
undrained pneumothorax - CI
unexplained hemoptysis -CI
stiff lungs - ARDS, large area of collapse - slow insp
hyperinflated patients - ensure complete exp, slow insp
Raised ICP - CI
