Advanced Respiratory Therapy Study Notes

Vital Sign Ranges for Different Age Groups

  • Infants: 100 - 120 bpm (Heart Rate)

  • Pediatrics: 120 - 150 bpm (Heart Rate)

  • Adults: 120 - 150 bpm (Heart Rate)

Nebulizers and Treatments

  • Nebulizers

    • Aerogen and AeroNeb

    • Power Source:

      • Aerogen: Runs on electricity (no gas required)

      • AeroNeb: Also runs on electricity

    • Acorn Nebulizer

    • Requirement for oxygen tubing

    • Used less frequently; mainly in emergency settings

    • Not considered cost effective for general treatments

  • Small Volume Nebulizers:

    • Advantages include lower flow requirements by patients during treatment

    • Ideal for patients in distress (e.g., asthma attacks, COPD exacerbations)

    • Coordination required by patients when using Metered Dose Inhalers (MDI) or Dry Powder Inhalers (DPI)

Types of Inhalers

  • MDIs: Provide rescue options

  • Respimat Nebulizers: Provide rescue options

  • Dry Powder Inhalers (DPIs): For maintenance only; do not provide rescue options

Inhaler Priming

  • Time required before re-priming: 48 hours

Lung Physiology and Expansion Techniques

  • Importance of Lung Expansion

    • Involves recruitment of collapsed alveoli (atelectasis)

    • Mechanism: Use of PEEP (Positive End-Expiratory Pressure) in ventilation

    • PEEP Levels: 0 (collapsed lung) to 20 (high pressure, needs to be controlled to prevent barotrauma)

    • Functional Residual Capacity (FRC): Importance in keeping alveoli open

    • FRC is the volume of air remaining in the lungs after expiration.

Incentive Spirometry

  • Purpose: Prevents atelectasis rather than treating it

  • Guidelines:

    • Deep inhalation required (slow and steady inhalation)

    • Recommendation: Use every hour (e.g., five to ten breaths per commercial during TV shows)

  • Safety: No risk of causing harm or pus due to no exerting back pressure; however, specific care needed for patients with fragile lung tissue (e.g., blebs)

Airway Clearance Techniques

  • Cough Assist for Patients:

    • Different types of coughs explained (splinted cough, huff cough)

    • Splinted Cough:

      • Use of a pillow to ease pain during coughing

    • Huff Cough: Technique for moving secretions from the lungs

  • Postural Drainage and Percussion:

    • Improves secretion clearance from lungs (e.g., Trendelenburg position for lower lung regions)

    • Chest physical therapy (CPT) is an older method, now replaced by devices in most cases

  • Chest PT Devices: Used for clearing secretions, e.g., vest therapy (high-frequency chest wall oscillation)

Advanced Aerosol Devices

MetaNeb System

  • Combination of therapies (e.g., CPAP = Continuous Positive Airway Pressure and oscillation for secretion clearance)

  • Key settings:

    • CPAP levels: Baseline resistance for lung expansion (recommended 5-20 cmH2O)

    • Adjustments for patient comfort and treatment effectiveness

  • Therapeutic Requirement: Treatments should last typically 10-20 breaths/cycles for effectiveness; patient cooperation is essential

Application Settings and Considerations

  • Application of PEEP in various lung therapies for patient care

  • Considerations for patients:

    • Patients with pneumothorax or high intracranial pressure cannot receive positive pressure therapy due to risks of worsening their condition

    • Understanding of how to address complications such as rib fractures or coughing challenges in patients

  • Patient Education: Emphasis on correct use of devices and importance of following guidelines to ensure effectiveness

Quiz Preparation

  • Material from both the current class and previous classes will be covered in the upcoming quiz; review all devices and methods discussed as well as their intended functions and implications in clinical settings.