Secretion Clearance Treatment

Question 1

Percussion

Answer 1

Application of force to chest wall with cupped hand transfers mechanical energy to move secretions towards opening. May increase lung volume. Loosen thick sticky secretions from the walls allow secretions to move freely to larger airways

Question 2

What are some contraindications to percussion and vibration?

Answer 2

• Rib fracture
• Thoracic injury
• Frank haemotysis
• Rib/lung cancer
• Low BP
• Bronchospasm
• Low platelet levels (bruise)
• Raised ICP

Question 3

Vibrations

Answer 3

Application of oscillatory force to patient’s thorax during expiration which consists of oscillation and compression. Reduces sputum viscosity and stimulates cough. Pressure increases expiration beyond patient’s capacity which increases air behind secretions

Question 4

Active Cycle of Breathing (ACBT)

Answer 4

Breathing: reduces breathing rate, minimise energy, relaxed, slow breathing

TEE: encourages lung expansion, gets air behind secretions. Improves alveolar ventilation via collateral channels so maintains lung volume

Huff: generates high expiratory airflow, prevents airway collapse that can happen during forceful cough

Question 5

What are some contraindications to ACBT?

Answer 5

Hyperinflated patients (TEE)
- Lungs expand beyond usual size because air is trapped

Question 6

Positive Expiratory Pressure Mask (PEP)

Answer 6

PEP positive pressure acts to splint the airway open during expiration and prevent dynamic collapse of airways. This allows greater expiratory airflow, and therefore better SC.
FRC increased during tidal volume breathing using PEP mask
Residual volume (trapped gas) is decreased

Question 7

What are some indications and contraindications to PEP mask?

Answer 7

+ Persistent lung collapse/atelectasis
+ Particularly useful for patients who have significant reflux

• Undrained pneumothorax
• Frank haemoptysis
• Increased ICP
• Unstable CVS
• Recent lung/eye/face/neck/upper GIT surgery