Lung Expansion Therapy

Question 1

Headings

Answer 1

Definition
Modalities
Mechanism

1.Incrntive spirometery-physiological basis,indications, contraindications , complications

2.positive airway pressure -
Cpap-def,principle, indication, contraindications, complications ,nasal vs full face mask

3.intermitent positive airway pressure
Definition,physiological,indication, contraindications

Question 2

Definition

Answer 2

Lung expansion therapy includes variety of respiratory care modalities designed to prevent or correct atelectasis
They are also known as hyperinflation /volume expansion therapy

Question 3

Modalities used in lung expansion therapy

Answer 3

Incentive spirometry
Intermittent positive airway pressure
Positive airway pressure

Question 4

Mechanism

Answer 4

Sigh mechanism
The automatic periodic inhalation of large tidal volume to prevent atelectasis
Normaly a person sighs about 6-10 times per hour
Positive atelectasis can occur if this mechanism is impaired or lost

Question 5

Incentive spirometry

Answer 5

The basic maneuver of incentive spirometry is a sustained maximum inspiration (SMI)
An sustained maximal inspiration is slow deep inhalation from frc to total lung capacity followed by 5 to 10 sec breath hold a sustained maximal inspiration is this equalent to performing an inspiratoryncapacity maneuver it is designed to mimic natural sighing

Physiological basis -
During an inspiratory phase of spontaneous breathing,the drop in PPL is caused by expansion of thorax is transmitted to alveoli . With palv negative pressure gradient is created btw airway opening and alveoli this transrespiratory pressure gradient causes gases to flow from the airway into the alveoli within certain limits the greater the transrespiratory pressure the more lung expansion will occur

Indications
Presence of pulmonary atelectasis
Presence of condition predisposition to pulmonary atelectasis
Upper abdominal surgery.thoracic surgery
Surgery in patient’s with COPD
Dysfunction diaphrgm

Contraindications
Inability if patient to perform SMI maneuver
Lack of pt corperation
Inability if patient to breath

Complications
Ineffective in absence of correct techniques
Hyperventilation
Exacerbation of broncospasm
Hyposemia
Barotrauma
Fatigue
Pain in post operative patient

Question 6

Positive airway pressure

Answer 6

There are 3 current approaches PAP therapy
Pep epap cpap.while pep and epap creates expiration positive pressure only.cpap maintains a positive airway pressure throughout both inspiration and expiration they aim at recruitment of alveoli by increasing frc

Question 7

Cpap

Answer 7

The application of positive airway pressure to the spontaneously breathing patient throughout
the repiratory cycle at pressure of 5-20!cm h20
Cpap elevates and maintains high alveolar pressure throughout throughout full breathing cycle
It recruits collapsed alveoli by ab increase in frc,decreased work of breathing to increase compliance

Indication
Postoperative atelectasis
Cardiogenic pulmonary edema
Refractory hypoxemia
Obstructive sleep apnea

Contraindications
Hemodynamic instability
Hypoventilation
Nausea
Facial trauma
Untreated pneumothorax
Elevated intracranial pressure

Complications
Increased work of breathing caused by apparatus
Pts with ventilatory insufficiency
Barotrauma especially in pts with emphysema
Vomiting and aspiration in pts with adequate gag reflex
Gastric distention

Question 8

Ippb

Answer 8

The delivery of airflow as low as deep sustained inspiration by a mechanical device providing controlled positive pressure breathing during inspiration
The application of inspratory positive pressure to a spontaneously breathing patient as an intermittent or short term therapeutic modality

Question 9

Principle

Answer 9

Ippb reverses the normal spontaneous pressure gradient .positive pressure at airway opening creates the needed pressure gradient to cause gas flow into the lungs palv rises during inspiratory phase of ippb as flows the gas from the airway into the alveoli,positive pressure at the airway opening creates the need to cause gas flow into the lungs .palv rises during the inspiratory flow the gas from the airways into the alveoli.posituve airway pressure is transmitted from the alveoli to pleural during inspiratory phase of an ippb treatment causing PPL to rise somewhat during inspiration depending on the mechanical properties of the lung PPL may actually exceed above atmospheric pressure during a portion of inspiration.as with spontaneous breath the stored potential energy of recoil force cause passive exhalation as gas flows from alveoli out uto the airway opening palv drops to atmospheric level while PPL is restores

Question 10

Indication

Answer 10

Treatment of atelectasis
neednto improve lung expansion.
Inability to clear secreation-limuted ventilation innefevtive cough
Short term non invaseve ventilatory support for hypercapnic patients

Question 11

Contraindications

Answer 11

Icp>15 mm hg
Hemodynamic instability
Recent facial ,oral,skull surgery
Tracheoesosophageal fistula
Recent esophageal surgery
Active hemoptysis
Nausea air swallowing
Tension pneumothorax