Respiratory Physiotherapy

Question 1

Goal

Answer 1

Matching ventilation to perfusion.
Identifying what is unbalancing it and how to balance it again.
V/Q = 1 (RRxVt)/(HRxSV) (10x500ml)/(70x70ml)
High ratio: alveoli ventilated but perfusion impaired.
Low ratio: lungs perfused but not adequately ventilated (shunt)

Question 2

Mucociliary Activity - Insufficient humidity and Gravity

Answer 2

Insufficient humidity increases mucus production and slows down ciliary movement, increases airway irritation/infection.
Secretion does not follow gravity, can’t place patient in an elevated feet position (pus and blood can be drained).

Question 3

Cough

Answer 3

Sharp contraction of expiratory muscles create intrathoracic pressure of at least 100mmHg, sudden opening of glottis, exploding gas out at 500km/h.
Violent swings in pleural pressure. Dynamic airway compression initiated in trachea, extends peripherally as lung volume decreases.

Question 4

Equal Pressure Point

Answer 4

Airway pressure equal to intrathoracic pressure during forced expiration. Airways collapse if EPP is within respiratory zone (no cartilage).
In severe obstruction, the airway resistance is much greater and pressure drop much steeper so the EPP will be reached in resp. zone.

Question 5

Intrathoracic Airways - Conducting Zone and Respiratory Zone

Answer 5

Conducting zone:
- Trachea
- Two main bronchi
- Lobar bronchi
- Segmental Bronchi
- Terminal bronchiole
Respiratory zone:
- Respiratory bronchiole
- Alveoli
Highly sensitive to collapse due to not having cartilage.

Question 6

Dependant Zone

Answer 6

Gravity and weight of lung increase pleural pressure (less negative) at the base, reducing alveoli volume, allowing increased gas exchange.
Changes with changing position.

Question 7

Physiotherapy Techniques for Deep Lung (Alveoli)

Answer 7

Slow Inspiration techniques:
Incentive Spirometry
EDIC: Exercise with controlled inspiratory debit
RIM: Resistive inspiratory maneuver
SIGHS: Sniffs

Question 8

Physiotherapy Techniques for Intermediate Bronchi

Answer 8

Slow expiration techniques:
ELTGOL
ELDr
DA: Autogenic Drainage

Question 9

Physiotherapy Techniques for Proximal Bronchi

Answer 9

Forced expiration techniques:
FET: Forced expiratory technique
AFE
TD, TP: Assisted cough

Question 10

Physiotherapy Techniques for Extrathoracic Airways

Answer 10

Forced inspiration techniques:
DRR: snorting

Question 11

Collateral Channels

Answer 11

Used to treat collapsed alveoli with slow inspiration and hold. Gives time to balance the pressure between the affected and non-affected alveoli.
Promotes a homogeneous ventilation in emphysema.

Question 12

Respiratory Failure

Answer 12

I: Lung failure, gas exchange failure manifested by hypoxemia.
II: Pump failure, ventilatory failure manifested by hypercapnia. (chest wall, resp. muscles, CNS).

Question 13

Outcomes Associated to Alveoli (7)

Answer 13

PaO2 - SpO2
PaCO2
Breathing pattern
RR
——— mBORG
DLco

Question 14

Cardiorespiratory Functional Tests (3)

Answer 14

6MWT
CPET
Isokinetic test

Question 15

Systemic Response to Respiratory Physiotherapy - Tissue Level

Answer 15

↑ vascularity, myoglobin in muscles. ↑ O2 extraction capacity.

Question 16

Systemic Response to Respiratory Physiotherapy - Cardiovascular Level

Answer 16

Exercise induced bradycardia.
↑ VO2max
↓ submaximal HR, BP, myocardial O2 demand, SV, Q.
↓ myocardial work, perceived exertion.
↑ Plasma volume, vascularity of myocardium.

Question 17

Systemic Response to Respiratory Physiotherapy - Respiratory Level

Answer 17

↑ capacity for gas exchange
↑ cardiopulmonary efficiency
↓ submax min ventilation
↓ work of breathing