Management of volume loss Flashcards
What does reduced lung volume mean
Decreased lung volume refers in this case to a ↓ amount of aerated lung
What does reduced lung volume mean to PTs
- Physiotherapy can only be used to directly manage some causes of reduced lung volume
- Only collapse can be directly treated by physiotherapeutic techniques
- When lung volume is not amenable to physiotherapy we can optimise V/Q matching
State causes of reduced lung volume
Atelectasis/collapse • Alveoli • Segment • Lobe • Total lung Others • Consolidation • Thoracic cage restriction, lung tissue restrictive disease will reduce lung volume • Pleural effusion, pneumothorax & abdominal distension compress the lung
Is consolidation treatable by PTs?
Consolidation is not directly treatable Aim to prevent worsening by • Mobilisation • Hydration • Positioning • Education of breathing techniques
What is the significance with atelectasis
• Reduces amount of functioning lung
• Reduces surface area of ventilated lung
• Reduced surface area for gas exchange
○ V/Q mismatch
○ Decreased SaO2 (Low saturations, poor ABG’s)
• Decreased lung compliance & increases airway resistance (balloon analogy)
• Increased WOB
State causes of atelectasis
• Immobility/prolonged bed rest • Poor positioning • Pain • Shallow breathing pattern (narcotics or CNS) • Airway occlusion ○ Mucus plug ○ Tumour in airway ○ Foreign object ○ Airway compression ○ High O2 - absorption atelectasis All above can occur in surgical & medical patient
Benefits of increasing lung volume
• Increase the amount of functioning lung
• Increase surface area
○ Improve V/Q match
○ Increase SaO2 (>95% Sats, PO2 10-14Kpa)
• Increase lung compliance and decrease airway resistance
• Decrease WOB
• Decrease the risk of sputum retention and infection
Treatment options to increase lung volume
- Positioning
- Mobilisation - controlled mobilisation is the therapeutic and prescriptive application of low-intensity exercise in the management of cardiopulmonary dysfunction in acutely ill patients
- Breathing Exercises (TEEs) - always to relaxed breathing exercises first
- Incentive Spirometry (IS)
- IPPB/bird
- NIPPY Clearways/cough assists
- Neurophysiological facilitation
- CPAP
How does IS work
Works to increase ventilation by utilising collateral channels
Indications for IS
Children, post-op pts at high risk of atelectasis, unable to follow instructions of more active techniques
Warnings when using IS
Ensure pain is controlled, wounds post-op (supported cough), cognition/post op drowsiness
How to measure effectiveness of positive pressure techniques
Increase in volume, duration; reassess Ausc, CXR, O2 sats within an hour
Give instructions for IS
Sit upright, hold IS at eye level, tight seal around mouthpiece
Then breathe in through mouth and move the piston as up as you can whilst keeping the indicator between the two arrows
Hold for 3-5 secs and try 10 breaths/hour
Cough as needed but always finish with a breath in to avoid collapse from DC
How does Intermittent Positive Pressure Breathing (IPPB) work
AKA Non-Invasive Positive Pressure Breathing (NIPPB) or the BIRD
How it works:
Works by pressure supported inspiration, Intermittent positive pressure applied during inspiration
Patient triggers inspiration by taking a breath and then a sustained positive pressure is applied to the patients airway to a set pressure level
Pushes patient into IRV
Greater volumes → improved gas exchange, decreased WOB
Followed by passive expiration
Indications IPPB
• Atelectasis / Volume loss when patient is
○ Tired
○ Drowsy - particularly kidney failure pts due to reduced metabolism, GA takes longer to be flushed
○ Weak
○ Neurologically impaired - MS, GBS, MND, muscle dystrophy
• i.e. unable to fully participate in more active treatments
• May also be used to aid secretion clearance
