Physiotherapy Techniques Flashcards
Airway Clearance Techniques
In the presence of many respiratory diseases and following anesthesia and surgical procedures, airway clearance TQs may be required to enhance mucociliary clearance.
There is yet no evidence to support the use of any one airway clearance TQ over any other.
Active Cycle of Breathing Techniques (ACBT)
Effective in the clearance of bronchial secretions and improves lung fx without ↑ hypoxaemia or airflow obstruction.
It is a cycle of:
- Breathing control
- Tx expansion ex’s (TEE)
- Forced Expiration TQ (FET)
The endpoint of a tm session is when an effective huff to low lung volume has become dry sounding and non-productive. The sicker pt may not reach this endpoint before tiring and should stop before becoming exhausted with any airway clearance TQ.
Autogenic Drainage (AD)
Aims to maximize airflow within the airways, to improve ventilation and the clearance of mucus.
Usually undertaken sitting or in supine.
Three phases:
> Unstick: breathing at low lung volumes is said to mobilize peripheral mucus.
> Collect: breathing around the individual’s tidal volume collects mucus from middle airways.
> Evacuate: breathing around high-lung volumes expectoration of secretion from central airways is promoted.
When sufficient mucus has been collected in the large airways it may be cleared by coughing or huffing.
Chest clapping
A rhythmical rate that is comfortable for both pt and PT is probably the most appropriate. There is no evidence that alteration in the rate ↑ or ↓ the mobilization of bronchial secretions.
Oscillating Positive Expiratory Pressure
These devices combine an oscillation of the air within the airways during expiration and a variable positive expiratory pressure.
Three most common:
> Flutter: 4-8x slow breath in (slightly deeper than normal) → breath hold 3-5” → breath out through Flutter (slightly faster than normal)
> R-C cornet: used in similar way to Flutter. It is recommended to use it for 10-15’. As effective as Flutter in airway clearance; beneficial in the management of people with COPD; and equivalent in the long-term to the ACBT, AD, Flutter and PEP in people with cystic fibrosis.
> Acapella: as the Cornet, it’s gravity-independent. Similar performance characteristics than the Flutter.
Positive Expiratory Pressure (PEP)
Pressure should be 10-20 cmH2O during mid-expiration.
Different types:
- Inspiratory resistance-positive expiratory pressure (IR-PEP)
- Bubble PEP
- High-pressure PEP
Breathing control
Is normal tidal breathing using the lower chest and encouraging relaxation of the upper chest and shoulders.
Useful positions are:
- High side lying
- Relaxed sitting
- Forward lean standing
- Relaxed standing
- Keeling position
Gravity-Assisted Positioning
Can be used to:
- Assist clearance of bronchial secretions
- Improve ventilation and perfusion
Clearance of bronchial secretions
> Demonstrated that ↑ expectoration in non-cystic fibrosis bronchiectasis.
> In pt with cystic fibrosis the upper lobes are frequently most affected and positions other than sitting may be indicated only occasionally.
> In pt with very tenacious secretions, gravity is unlikely to help and a comfortable position is more beneficial.
> It is inappropriate to use head-down tipped positions after meals, cardiac failure, severe hypertension, cerebral oedema, aortic and cerebral aneurysms, severe haemoptysis, abdominal distension, gastro-oesophageal reflux and after recent surgery or trauma to the head or neck.
Incentive spirometry
Indicated for pt at risk of inspiratory muscle fatigue and/or severely impaired respiratory muscle fx.
Not effective after abdominal or cardiac surgery, or for the prevention of postoperative pulmonary complications.
Inhalation: Metered Dose Inhaler (MDI)
To gain max effect from pressurized MDI (pMDI):
- Shake well so the drug is evenly distributed.
- Inhaler held upright and the cap is removed.
- Pt breathes out gently but not fully and then, with mouth around mouthpiece, the device is pressed to release drug as soon as inspiration begins.
- Breath should be slow and deep and inspiration held for 10” if possible, before breathing out gently through the nose.
Inhalations of drugs: considerations
> For nebulized antibiotics and pentamidine a one-way valve is recommended (to prevent small quatities of the drug remaining in the atmosphere)
> If inhaled antibiotics are prescribed for upper respiratory tract, mask should be used and breathe through nose.
> Hypertonic saline (3-7%) assists in the clearance of secretions.
> The mucolytic rhDNase should not be mixed with any other inhaled medication and shouldn’t be delivered using an ultrasonic nebulizer.
> Acetylcysteine is inactivated by O2 so, if nebulized, the driving gas should be air.
Bronchodilator testing
Technique:
> Max inspiration is essential
> Expiration should be short and sharp
> Best of three “blows” is recommended
> Sufficient rests (at least 15”) should be allowed between “blows”
> Same position, sitting or standing, should be used each time
Inspiratory Muscle Training (IMT)
The optimal frequency of training is: 2-3 times/week for 4/52 and then maintenance by continuing training 1-2 times/week.
Muscle strength at 80-90% of max inspiratory pressure.
Strength-endurance at 60-80%
Endurance at 60%
Oxygen Therapy
Variable performance device: supplies a flow of O2 that is less than pt’s minute volume. The inspired O2 concentration (FiO2) will vary with the rate and volume of breath.
Commonly used devices are the nasal cannulae and the simple facemask.
Fixed performance device: should be used when accurate delivery of O2 concentrations is required, especially at low concentrations.
A Venturi system allows a relatively low flow of O2 to entrain a large volume of air and the mixed gas is conveyed to the facemask. With a 24% Venturi mask the usual setting of 2 l/min flow of O2 will entrain approx 50 l/min of air, giving a total flow of approx 52 l/min.
