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Acute Rehabilitation > Treatments for Gas Exchange > Flashcards

Treatments for Gas Exchange Flashcards

1
Q

Role of education in treating gas exchange

A

Role of Physio
Risk factor management
Relaxation techniques
Wound support - pain inhibition

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2
Q

Why is positioning important?

A

Prolonged bed rest can reduce muscle strength and increase deconditioning, reduce functional residual capacity and increase atelectasis, reduce mechanics of the diaphragm.

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3
Q

what are the benefits of upright positioning?

A

It has the highest FRC and therefore improves lung volume, gas exchange, oxygenation, decreases work of breathing, facilitates diaphragmatic breathing, increases ventilation and perfusion.

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4
Q

What is the purpose of specific positioning?

A

Re-expand areas of localised atelectasis

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5
Q

What is closing capacity?

A

Lung volume at which the small airways start to close (increases with age and smoking)

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6
Q

what is the impact of having a higher CC than FRC?

A

Reduced gas exchange, reduced oxygen levels as there is small airway closure during tidal breathing

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7
Q

Why do you put the affected lung at the top in side-lying?

A

It is the non-dependent, unhealthy lung and therefore requires gravitational assistance for drainage of secretions.

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8
Q

Benefits of Prone positioning and who would it be used for?

A

ventilated patients, improves FRC & lung volumes, reduces airway resistance, increases lung compliance and chest wall compliance.

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9
Q

When would the forward lean posture be beneficial

A

acute dyspnoea by reducing respiratory effort by stabilising the thorax and accessory muscles and optimizes diaphragmatic function

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10
Q

Why do we use deep breathing as a technique?

A

Increases alveolar ventilation and minute ventilation by increasing alveolar stretch, reducing surface tension and increasing lung compliance.

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11
Q

Why do we want to reduce inspiratory flow rate?

A

Slow goes low, improves distribution of ventilation to the dependent regions of the lungs

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12
Q

What are the collateral ventilatory pathways?

A

Pores of Kohn (intra-alveolar)
Channels of Lambert (bronchiole-alveolar)
Channels of Martin (inter-bronchiole)

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13
Q

Types of breathing techniques?

A

Deep breathing
Controlled breathing
Rectangular breathing
Pursed lip breathing

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14
Q

Purpose of Controlled breathing? / when to use

A

Allowing patient to relax their upper chest and shoulders. Reduce hyperventilation.

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15
Q

Rectangular breathing purpose?

A

short inhalation, long exhalation. helps with breathlessness, anxiety and panic.

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16
Q

What does pursed lip breathing do?

A

The position of the lips creates a back pressure producing a small amount of positive end-expiratory pressure (PEEP)
↑ airway patency
↑ surface area for gas exchange
↑ CO2 removal
↓ workload of breathing.

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17
Q

How does IPAP help with breathing?

A

Assists the patients own inspiratory effort. Increasing IPAP will reduce work of breathing & improve tidal volume (usual set up is around 10 cm H2O)

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18
Q

How does EPAP help with breathing?

A

Acts as PEEP. Increasing EPAP will recruit alveoli and improve O2 saturation.

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19
Q

What is pressure support?

A

The difference between EPAP and IPAP

20
Q

What are the benefits of secretion clearance?

A

Reduce the risk of infection, avoid deterioration of breathing mechanics, improve ventilation/ gas movement.

21
Q

What are the different types of airway clearance techniques

A

Cough and huff
Breathing exercises (ACBT, Autogenic drainage)
Positioning
Manual techniques (percussions and vibrations)
Devices
Exercise
Invasive options- suctioning

22
Q

What are the common adjuncts to assist with secretion clearance

A

bronchodilators
mucolytics
nebulisers

23
Q

What do bronchodilators do?

A

Target smooth muscles in the bronchioles of the lung, causing dilation and opening of the airway. Indicated for patients with bronchoconstriction.

24
Q

What to Nebulisers do?

A

device that converts liquid medication into air droplets suitable for inhalation

25
Q

What are the treatments used before physio and after physio?

A

before: mucolytics and bronchodilators
after: antibiotics, corticosteroids and saline.

26
Q

What is the physiology behind airway clearance techniques?

A

Increases in expiratory airflow
Increasing lung volumes
Oscillation of airflow – manually or intermittent resistance

27
Q

What are the 3 Basic patterns of gas-liquid flow which are relevant for mucus clearance from the lungs.

A

Slug flow: large bubbles of air pass through the airways which can get behind the plug and force it out.
Annular flow: when the increase in expiratory flow rate moves secretions which line the airway in a wave like pattern towards the oropharynx.
Mist flow: when very fast expiratory flow rate shears the secretions off the walls of the airway in small particles (mist) towards the oropharynx.
Cough is the only time we will get a mist flow.

28
Q

2 Huff types and their uses

A

Low volume huff: help to move secretions that are lower in the airways. normal breath in, then an active long breath out until the lungs feel quite empty

High volume huff: moves secretions in upper airways. normal breath in and short/sharp breath out.

29
Q

Sequence of Active Cycle Breathing Technique

A

controlled breathing 20-30 sec, 3-4 deep breaths & repeat. can follow with a huff and cough if needed following controlled breathing.

30
Q

What is ACBT trying to achieve?

A

Clearance of secretions by unsticking, collecting and evacuating them.

31
Q

Types of Oscillation?

A
  1. Intermittent positive pressure applied to the chest wall manually (percussion & vibrations)
  2. Applying intermittent resistance to airflow at the mouth (oscillating PEP devices)
32
Q

What is the purpose of percussions?

A

Imparts mechanical energy to airways to
- Cause oscillation of airflow within the airways
- ↑ expiratory flow rate
- Stimulate cilial beat

33
Q

What is the purpose of expiratory vibrations?

A

Aims to increase secretion clearance by:
- Increasing peak expiratory flow rate to move secretions
- Increase annular flow of mucus
- Increase mucus transport by decreasing viscosity of mucus
- Eliciting spontaneous coughs

34
Q

what is PEP?

A

PEP temporarily increases FRC via progressive recruitment of collapsed alveoli via collateral ventilation

35
Q

what are Oscillating PEP devices

A

provides the combination of positive expiratory pressure with high frequency oscillations
e.g. acapella

36
Q

what is the oscillation frequency shown to be effective for secretion movement?

A

13

37
Q

Benefits of mobility & exercise

A
  • increases collateral ventilation and expiratory air flow velocity- essentially allows air to get behind secretions and helps move them out of the lungs.
  • Increase strength & quality of a cough
  • Increases mucociliary transport and airway clearance.
38
Q

What type of suctioning is used for lower airways?

A

open or closed tracheal

39
Q

what type of suctioning is used for upper airways?

A

oropharangeal and nasopharangeal suctioning options

40
Q

Precautions to providing percussions?

A

ribs/flail chest/unstable sternum
Undrained pneumothorax
Over malignant tumour
Over new skin grafts, burns, surgical incisions,
Severe bronchospasm
Osteoporosis
Low platelets <150 x 109

41
Q

What are some indications for suctioning?

A

Auscultation of lung sounds i.e. course crackles or wheezing.
Decreased O2
Increase in peak airway pressures on mechanical ventilation.
sawtooth wave form on the ventilator.
secretions in artificial airway
increased coughing or RR

42
Q

Risks associated with suctioning?

A

Hypoxia, HBP, Bronchoconstriction, Tissue trauma, Lung injury.

43
Q

Considerations for treatment selection

A

Availability and cost
Long v Short term treatment options
Compliance
Cognitive status
Comorbidities
Sputum volume and consistency
Patient condition

44
Q

Reasons a patient may have a secretion impairment?

A

Pain
Weakness/fatigue
Weak cough
Secretions are not high enough in the airway
Airway obstruction

45
Q
A

Acute Rehabilitation (4 decks)

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