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What are the two forms of oscillating PEP?
- flutter and acapella
- - the flutter is mechanical device that applies a variable resistance to expiratory airflow
- - the oscillation is angle dependent adjusted to create the highest frequency for the individual 8-26Hz
- - this causes an oscillation of the air within the airways, intermittent acceleration of expiratory pressure
What is the physiolgical rationale behind oscillating PEP
- - oscillation of the airwaydiameter and airflow:
- - approximates the 'pulmonary resonance' or cilia 'beat' frequency of 8-16Hz, to maximize vibration of the bronchial walls.
- - improves gas-liquid interaction
- - may reduce sputum viscosity by mechanically rupturing the rigid mucus gel, rearranging crosslink and reducing molecular size
- -device held at best angle for oscillations
- - breathe in slightly deeper than normal, brief hold
- - expire through device
- - 5-10 breaths out through flutter then a forced expiration through the flutter
- - continue as appropriate - 15 min?
- similar to flutter but allows a variable resistance and can be used at any angle
Seretions clearance and autogenic drainage
- -developed in germany
- - uses breathing exercises at different lung volumes to enhance expiratory airflow and therefor secretion movement
- - 3 phases unstick, collect, evacuate
- - aims to achieve maximum expiratory flow without airway collapse
What are the indications for autogenic drainage?
- - secretion clearance
- - unstable airways
what are the contrindications for autogenic drainage?
what are the issues to autogenic drainage?
- - not many people know how to perform this technique effectively
- - difficult to learn
- - difficult to teach
- -takes times to learn
- - hard to breathe at low lung volumes
what is hypertonic saline?
- - used to aid secretion clearance
- - usually 9% saline
- - shown to increase clearance in CF, chronic bronchitis
- - main issue- may cause bronchoconstricion
- - mark elkins
What is the main self management for pts with secretions?
- - mostly are effective
- need to consider:
- - specific pathology
- - pt preference
- - ability to perform technique
- - outcomes