Respiratory Therapy Concepts

Pulmonary Complications and Pathophysiology

  • Atelectasis Definition and Risk Factors

    • Definition: Partial or complete collapse of alveoli.

    • Risk Factors:

    • Pain from surgery, shallow breathing, poor ventilation strategies, and failure to mobilize.

  • Atelectasis Types

    • Gas Absorption Atelectasis: often from low nitrogen levels after high oxygen intake.

    • Lobar Atelectasis: obstruction from mucus plugs or foreign bodies leading to collapse in lung lobes.

    • Compression Atelectasis: when transthoracic pressure exceeds transalveolar pressure due to excess weight above the patient's abdomen/chest.

Treatment Strategies for Atelectasis

  • Mucus Clearance and Management

    • Mucus plugs are thick obstructive masses requiring:

    • Suctioning, bronchoscopy, or effective cough strategies.

  • Lung Expansion Strategies

    • Techniques might include incentive spirometry, positive pressure therapy, and pain management for deep breathing.

    • High risk patients require proactive intervention to avoid complications.

Incentive Spirometry and Deep Breathing

  • Incentive Spirometry Education

    • Function: Maintain lung structure and function and reduce pneumonia risk.

    • Usage: Patients should aim for:

    • 10 deep inhalations per hour post-operation.

  • Guidelines for Use

    • Sit up straight, use the device: inhale slowly to raise indicator ball, hold, then exhale.

  • Contraindications

    • Patients with inability to follow instructions or chronic pain inhibiting deep breaths may not benefit effectively.

Positive Pressure Therapy and Barotrauma

  • Intermittent Positive Pressure Breathing (IPPB)

    • Outdated but recognized method; replaced largely by newer devices.

  • Risks of Positive Pressure

    • Can cause barotrauma, decrease venous return, and exacerbate respiratory distress or hypoventilation issues.

Advanced Positive Airway Management

  • CPAP vs BiPAP

    • CPAP: Continuous pressure support; used for oxygenation.

    • BiPAP: Dual pressure (higher during inhalation) for ventilation efficiency.

  • Indications for use based on patient’s respiratory patterns, i.e., hypoventilating patients requiring more support might use BiPAP.

Questions and Clinical Reflection

  • Encourage understanding of physiological relations in breath management and monitoring during patient care.

  • Assess clinical tools and technologies in lung therapy for effectiveness and patient compliance.

    • Differential diagnoses based on respiratory patterns and imaging for pulmonary complications.