Physics exam 1 , ch. 44

Ch. 44 Airway clearance therapy

What is airway clearance therapy?

Noninvasive techniques that focus on mobilizing secretions for better gas exchange

What does normal clearance require?

Patent airway, functioning mucousillary elevator, an effective cough

Four phases of a cough

Irritation

Inspiration

Compression

Expulsion

Phase 1 of a cough : Irritation

inflammatory- infection

mechanical- foreign bodies

chemical- inhaled gases

thermal- cold or hot air

Phase 4 of a cough: expulsion

The glottis opens , nasopharynx is closed off so the secretions come out of the mouth

Phase 3 of a cough

Compression

Phase 2 of a cough

inspiration

Abnormal clearance abnormalities

Anything that alters airway patency, mucocilary function, strength of breathing muscles, thickness of secretions, cough reflex

Diseases associated with abnormal airway clearance

Compression of airway lumen, cystic fibrosis, bronchiectasis

Causes of impaired mucociliary clearance in intubated patients

Trache tube, tracheobronchial suction, too dry, high FiO2, drugs, anesthetics, opiates, narcotics, pulmonary disease

Acute airway clearance indications

secretions, can’t mobilize secretions, ineffective cough, labored breathing, course inspiratory and expiratory crackles, tachypnea, tachycardia and fever, Chest radiograph with atelectasis

Chronic conditions airway clearance indications

Cystic fibrosis, Bronchiectasis, COPD patients with retained secretions

Airway clearance methods

Chest Physical therapy, coughing with expulsion techniques , PAP positive airway pressure and PEP positive expiratory pressure, high frequency compression, mobilization and physical activity

What is a HUFF cough?

Forced expiratory technique FET, two forced expirations with compression , the glottis is closed , most useful in patients with COPD, CF and bronchiectasis

What is Mechanical Insufflation exsufflation MIE

Device that applies 30 to 50 cm H2O for 1 to 3 seconds in the airway and then revers it for 5 cycles

What is the purpose of positive airway pressure?

To mobilize secretions and treat atelectasis

Applications of positive airway pressure

CPAP- continuous positive airway pressure

EPAP- expiratory positive airway pressure

PEP- positive expiratory pressure

How are PAP adjuncts used in airway clearance

Used in combo with other techniques

What does PEP stand for?

Positive expiratory pressure

How does a PEP device generate positive pressure?

The patient exhales through a fixed or variable expiratory flow resistor

What expiratory pressure does a PEP device generate

10-20 cm H2O

What is a vibratory/ oscillatory PEP

PEP that incorporates during active expiration, creating flow osciliations in additon to positive expiratory pressure

Name examples of PEP/ vibratory PEP devices

Flutter, TheraPEP, Acapella, Aerobika, RC- Cornet

What are the two types of high frequency compression/ oscillation methods

External chest wall application, airway application

What is a vest airway clearance system?

A system that uses a vest to create chest wall oscillations

How does a vest airway clearance system work?

A generator inflates and deflates the vest, creating pressure pulses against the thorax that produce chest wall oscillations and help move secretions forward

What is the airway application of high frequency compression and oscillation

Intrapulmonary percussive ventilation IPV

What is Intrapulmonary percussive ventilation IPV?

A pneumatic device that delivers a rapid series of pressurized gas mini bursts to the airway

What rate does the IPV deliver its pressurized gas mini bursts?

100-225 cycles/ minute or 1.7-5 Hz

What does physical activity do to tidal ventilation

It increases tidal ventilation

What cardiovascular changed occur with physical activity?

Increased heart rate and increased cardiac output

What is another benefit of exercise/ mobilization

improved physical condition

PEP pressure range

10-20 cm H2O

IPV frequency

100-225 cycles/min or 1.7-5 Hz

What is the difference between PEP and vibratory PEP

PEP provides positive expiratory pressure, vibratory PEP adds flow oscillations during expiration

What are the major benefits of exercise for airway clearance?

Increased tidal ventilation, increased HR, increased cardiac output, and improved physical condition