W7 Workshop: Treatment for gas exchange impairments Flashcards
What are some of the other treatments we can use for Gas exchange (C02 & 02) impairments other than oxygen therapy & ventilation (non-invasive & invasive)?
- Relaxation techniques
- Lean forward positioning
- Breathing exercises
- Mobility and exercise
What can happen as a result of depression and anxiety?
How can we treat this?
Increased breathlessness
Reduced activity
Social isolation
The cycle continues, leading to further depression & anxiety
Treatment: relaxation and breathing control to slow hyperventilating presentations (improve gas exchange and V/Q mismatch)
What can happen with prolonged bed rest and supine positioning?
- Decreaes muscle strength & ↑ deconditioning
- Decrease FRC and ↑ atelectasis
- Decrease mechanics of diaphragm
When considering lung mechanics, what positions are preferred and why?
Upright postures and standing are preferred
Leads to:
- ↑ oxygenation
- ↑ lung volumes
- ↓ work of breathing
- Facilitates diaphragmatic breathing compared to recumbent/supine positions.
- ↑ V/Q matching (elastic recoil of the lungs and the chest wall is greater, expiratory muscles are at a more optimal region of the length-tension curve and thus can generate expiratory pressures)
- Upright positions/high sitting are also preferred when a patient presents with bilateral complaints.
How can leaning forward/the tripod position help?
a) Lean forward position: sitting with a forward trunk lean posture aims to reduce dyspnea and improve pulmonary function.
b) Tripod position provides head and neck support and is thought to improve dyspnea and decrease airway obstruction by improving neck alignment.
What is purse lipped breathing?
- The technique requires a person to inspire through the nose and exhale through the mouth during a prolonged inspiration (exhale with pursed lips)
What is the mechanism behind pursed lip breathing?
- The position of the lips creates a back pressure producing a small amount of positive end-expiratory pressure (PEEP), preventing airway collapse and reducing the workload of breathing.
- The PEEP supports the patency of the airways and alveoli, increasing surface area and the number of alveoli participating in gas exchange, allowing more CO2 to be removed during expiration.
What is one of the main controlled breathing strategies?
- Controlled breathing refers to the practice of engaging in tidal breathing at regular tidal volume (Vt) and RR. This involves utilising the lower chest while allowing the upper chest and shoulders to remain relaxed.
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When controlled breathing is combined with a forward leaning, what is the result?
Enhance relaxation and can promote an efficient breathing pattern that deters hyperventilation (BTS/ACPRC 2009)
Cues for controlled breathing?
What strategy can help here?
Think 3 R’s – RISE (your abdomen lifts during inhalation), RELAX (ease your abdomen as you exhale) and REST (don’t rush the next breath)
Rectangular Breathing is a visual strategy to help with breathlessness, anxiety and panic. It can be used in combination with either pursed lip breathing or breathing control (short breath in, long slow breath out)
How do we train inspiratory muscles?
Encourage patients to perform slow inspiration and expiration – “slow goes low” - to ventilate alveoli in the lower zones of the lungs.
What is the role of mobility and exercise
What can it improve?
- There is very strong evidence (Level A evidence) to support for Pulmonary rehabilitation (PR). PR involving aerobic and endurance training of muscles of ambulation, as well as strengthening of the upper and lower limb is recommended.
- Pulmonary rehab can ↑ health-related QOL, ↑ exercise capacity, ↑ respiratory muscle strength and ↓ exertional dyspnea.
What are some common parameters you would expect to change if your intervention was effective?
What parameters would you expect to change if your intervention was effective?
* Basal lateral expansion
* Reduced accessory muscle use
* Reduced SOB (+ respiratory rate)
* Increased pulse oximetry
* More breath sounds in the bases (during auscultation)
* Spontaneous secretion clearance
Explain what happens if our FRC is less than our CCV, how can we correct this via positioning?
When our FRC is less than our CC (Closing capacity), alveoli will collapse (resulting in reduced gas exchange). Best positioning is standing and upright!
In side-lying how should we position the dependent and non-dependent regions?
Side-lying can be altered with dependent and non-dependent regions. If unwell, affected area upward because we want to shift the pleural pressure gradient. In healthy, dependent at the bottom, non-dependent at the top (this would be similar in side-lying). But in some with a collapse/or lack of ventilation the distribution will be different, affected lung should be uppermost.
