Hyperinflation therapy 121

Hyperinflation aka

Lung expansion therapy

Purpose of hyperinflation therapy

To prevent or reverse atelectasis

To mobilize secretions

To promote a cough

The types of lung expansion therapy

IS

IPPB

IPV

CPAP

PEP

IS

Incentive spirometer

IPPB

Intermittent positive pressure breathing

IPV

Intrapulmonary percussive ventilation

CPAP

continuous positive airway pressure

PEP

Positive expiratory pressure

Types of PEP

TheraPEP and EZ PAP

Factors associated with atelectasis

Obesity, neuromuscular disorder, heavy sedation, bed rest, poor cough, restrictive chest wall abnormalities

Who needs lung expansive therapy

neuromuscular disease, spinal cord injury, heavy sedation, restrictive lung disease; being bedridden or immobile

Particular risk for post op patients

General anesthesia, rapid shallow breathing due to pain, decrease in surfactant

What does incentive spirometer mimics

Natural sighing

this encourages the patients to take slow deep breaths and monitor patient progress towards their goal

Incentive spirometer

Sustained maximal inhalation

A slow deep inhalation followed by a 5-10second breath hold (FRC to TLC)

Auto peep def

gas trapped in alveoli at end of expiration due to inadequate time for expiration. Bronchoconstriction or mucus plugging, it increases WOB

Incentive spirometer indications

Prevention of treatment of atelectasis for patients who are willing and able to spontaneously take a deep breath

What are the conditions predisposing to atelectasis

Upper abdominal surgery

Thoracic surgery

Surgery in patients with COPD

Goals of incentive spirometer

Absence of or improvement of signs of atelectasis, improved V/S, normalize of BS

Incentive spirometer hazards

Hyperventilation, pulmonary barotrauma, exacerbation of bronchospasm, fatigue, discomfort pain control, hypoxia due to break in mask O2 therapy

Contraindications of IS

Patients unable to deep breathe (VC less than 10ml/kg or IC less than predicted)

Patient cooperation is absent or unable to demonstrate proper use of device

If the patient is unable to use IS, due to obtunded, unconscious, or uncooperative. USE THIS

IPPB OR CPAP

Use CPAP or IPPB when

Patient is uncooperative, obtunded, or unconscious. IS is not possible

Administration of IS

Goal should be obtainable (no pain no gain)

Inhale slowly and deeply

Breath hold for 5-10sec

Hold 30-60sec to avoid hyperventilation

8-10x hour; this mimics normal sigh

HFNC

High flow nasal cannula

What is the purpose of high flow nasal cannula

Designed with larger prongs allowing higher oxygen flow rates

Gas trapped in the alveoli at the end of expiration

Auto PEEP

This increases the work of breathing

Auto PEEP

What breath soundd is associated with Atelectasis

Fine crackles

Predisposing risk of getting atelectasis meaning

at risk of getting atelectasis before

Goals of IS (on the FINAL)

improved inspiratory muscle performance

What makes HFNC different from nasal cannula

HFNC is heated

why do people give mouth to mouth

It gets more air in