Principles + application for Mx of increased work of breathing

Principles of Mx of increased work of breathing

Principles

Pain relief

Positioning

Breathing exercises

Demand ventilation

Facilitation techniques

Incentive spirometry

Positive expiratory pressure devices

Non-invasive ventilation

Manual + ventilator hyperinflation

Aim + method of pain relief

Aim	Methods
Optimise inspiratory volume	Support/ positioning  Modalities: TENS  Timing Ax + Rx w/ pain meds

Aim of positioning

Increase FRC

Types of positioning

High sitting

Sitting out of bed***/ standing

Lateral/ side lying

Prone lying

Application of high sitting

Application

*Hip joint at bed crease  → Patients w/ obesity: sitting < 60’ → before Ax + Rx

Application + benefits of sitting out of bed/ standing/ walking erect

Application	Principle
Forward lean standing: good for SOB  → good for paralytic ileus  → tilt table used?  → recovery positions	Greatest FRC

Application + benefit of side lying

Application	Principle
Unilateral lung disease	Good lung down + bad lung up  → more perfusion to good lung ( dependent lung ) → ventilation follows → better gas exchange → bad lung up: gravity can help drain the secretions

Application + benefit of prone lying

Application	Principle
Can be contraindicated against/ poorly tolerated	Stabilisation of anterior chest → increase compliance of posterior chest ( location of lung ) → max ventilation

Demand ventilation principles

Increase muscle activity  → increase minute ventilation ( RR x TV )  → increase cardiac output  → increase O2 extraction at tissue

Demand ventilation methods

Upper limb + lower limb movements 

*Care → low intensity activity can impact patients w/ acute cardiorespiratory disease 

→ Walking → gold standard

Facilitation techniques principles

Stretch reflex  → stronger contraction of intercostals → larger inspiration  → for patients who are drowsy/ hard to cooperate in therapy

Methods of facilitation techniques

1. Stretch facilitation

→ Stretch reflex/ PNF 

→ Timing: end of expiration  

→ location: intercostal muscles 

2. Neurophysiological facilitation

• Perioral stimulation → primitive reflex

Principles of incentive spirometry + methods

Slow laminar flow  Visual cue to provide feedback on inspiration

1. Flow device → triflow/ Cliniflow

2. Volume device

Pathology + signs + management of increased work of breathing

Pathology	Signs	Management
Respiratory failure  COPD  Anxiety  Exertion	↑ accessory muscle use  ↑RR  ↓ Energy available for other organs	Positioning  Breathing control

Positioning + Breathing control choices

	Methods
Positioning	Supported positions Forward lean sitting/ standing  Relaxed sitting/ standing  Recruitment of axiohumeral muscles  → principle: reverse origin -insertion action  → fixate the insertion point → action reversed to help expand the thorax
Breathing control	Principle:  Gentle tidal breathing  Emphasise lower chest X upper chest → minimise effort  Inspire through nose  2-3 breaths