Physiotherapy Techniques In ICU

Question 1

Discuss the rationale for MHI

Answer 1

Manual hyperinflation

Slow (gas distributed to non dependent region, decreased airway resistance), deep (stretch - surfactant production) inspiration with an inspiratory hold (collateral ventilation, FRC), with a rapid release (increased PEFR to simulate two phase liquid gas flow/huff, lung recoil)

Question 2

List precautions and contraindications to MHI

Answer 2

Undrained pneumothorax
Haemodynamic instability (arrythmias)
High or unstable ICP
Nitric oxide treatment
Acute pulmonary oedema
Hyper inflated lungs

Question 3

Discuss the detrimental effect of hyperinflation on the cardio respiratory system

Answer 3

Risk of barotrauma or volutrauma
Decreased diffusion due to increased alveolar pressure
Disconnection causes de-recruitment
Absorption atelectasis

Question 4

List Pros and Cons for using a self inflating bag for hyperinflation

Answer 4

Easy to learn
One hand
PEEP valve can be added
Low risk of barotrauma

Poor inspiratory hold
Poor tactile feedback
Reduced PEFR

Question 5

List Pros and Cons for using a mapleson circuit for hyperinflation

Answer 5

Good inspiratory holds
PERP valve can be added
Great rapid release
Tactile feedback

Two hands
Difficult to learn
Potential for barotrauma

Question 6

List precautions and contraindications for naso or oropharyngeal and endotracheal suctioning

Answer 6

Pulmonary resection
Haemodynamically unstable
# - sphenoid, base of skull, nasopharynx
CSF Leak into nasal passages
After a meal

Question 7

List detrimental effects of suctioning

Answer 7

Hypoxemia
Atelectasis
Arrythmias
Mucosal trauma
Bronchospasm

Question 8

Discuss role of positioning in ICU

Answer 8

Alter gas distribution
Prevent complications (pressure sores)
Increased compliance