2nd semester "Pulmonary rehabilitation"
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. What would you like to do?
What does EZPAP do?
what is its purpose?
Combines patient negative pressure breathing and all of its benefits, with a positive expiratory pressure.
purpose: to expand the lung by increasing functional residual capacity (FRC), which contributes to prevention and reversal of atelectasis.
What is the "Coanda Effect" involved with EZPAP?
EZPAP uses a fluidic process (called Coanda) so that flow is augmented on inspiration. This augmentation provides for a larger flow and volume with less effort than an unsupported inspiration.
Is PEP provided with EZPAP? if so, when is it provided? (inspiration/expiration?)
PEP is provided during EXPIRATION.
1.) What should you do if you need to apply more pressure?
2.) What is the recommended liter flow?
3.) Why is it recommended that the ports be positioned on the side?
1. Turn up the flow to apply more pressure
2. 5-15 LPM
3. To inhibit moisture from entering the tubing
1.) when using EZPAP if you want to enhance FiO2 what should you do?
2.) how should you instruct the patient to breath?
3.) can it be used with aerosol medication (e.g nebulizer) ? if so, how?
1. Connect it to a flow meter, use wall air OR O2 for enhanced FiO2.
2. instruct patient to breathe diaphragmatically through the mouthpiece or mask
3. yes, use a 22-mm connection between EzPAP and patient.
What is "Mechanical Insufflator-Exsufflator"
"CoughAssist" - a portable electric device that helps pediatric or adult patients w/ respiratory insufficiency (those who cannot cough for themselves) clear retained bronchopulmonary secretions.
What are the indications for "Mechanical Insufflator-Exsufflator" (CoughAssist)
For any patient that cant cough or clear secretions effectively due to reduced peak cough expiratory flow (less than 3 liters per second)
Patients that cannot cough or clear secretions resulting from high spinal cord injuries, neuromuscular deficits or sever fatigue associated with intrinsic lung disease, would be great candidates for what device?
"Mechanical Insufflator-Exsufflator" (CoughAssist)
aka : coughlator
What are contraindications for using the "Mechanical Insufflator-Exsufflator" (CoughAssist) ?
Any patient w/ a history of bullous emphysema (saggy sack of weak alveoli that are all opened up. using this device can pop their lung), known susceptibility to pneumothorax or pnuemo-mediastinum, or known to have had any recent barotrauma, should be carefully considered before use.
How does the "Mechanical Insufflator-Exsufflator" (CoughAssist) work? (is it invasive? how much positive pressure does it apply? what does the rapid shift in pressure do? what are the two models of the CoughAssist?
CoughAssist is a noninvasive device that uses a blower and valve to alternatively apply positive pressure (30-40 cm), and then an abrupt negative pressure (-30--50 cm) to a patients airway.
The rapid shift in pressure (which occurs over 0.2 second) produces a high expiratory flow rate from the lungs, stimulating a natural cough.
There are 2 models of the CoughAssist - automatic and manual.
1.) what does a session of coughing with the CoughAssit normal involve? (what does it need to cycle? and for how many times?)
2.) why should you let the patient rest for a minuet in between the session?
3.) how many times is the pattern repeated?
4.) how long does a cough session take for secretion removal?
1. a session of coughing w/ the machine involves cycling the unit positive then negative, in a quick session about 5-6 times
2. to prevent hyperventilation
3. pattern is repeated 4-5 times
4. cough session takes about 10-15 min for secretion removal
1.) What should you start the pressure at? and what should you build it up to? what do u want to achieve by building pressure up?
2.) Are the + & - pressures set at the same level?
3.) What is the timing for the positive-negative?
1. start pressures low, about 10-20 cm as tolerated, then build up to 40-45 cm to get deep insufflation
2. they are set at about the same, though some ppl like the insp. pressure to be slightly less
3. timing for the + to - is about 1-2 seconds
How is treatment delivered with the CoughAssist? what parts are involved? do patients need to use it continuously?
Treatment is delivered via a breathing circuit incorporating a flexible tube, a bacterial filter and either a facemask, a mouthpiece or endotracheal tube
No they don't need to use it continuously, just for resp. tract infections
What are the instructions for the Flutter Valve? (2 stages)
Stage 1 : inhale slightly deeper & hold breath for 2-3 seconds
place flutter in mouth (keep cheeks stiff & adjust tilt of flutter)
exhale w/ enough pressure to cause flutter (not forced)
do this 5-10 times
stage 2: Deepest breath in & forced full exhalation X 2 huff cough
How does the Flutter Valve work to loosen mucus?
when does the slight increase in pressure happen and what does it help with?
movement of the steel ball during exhalation produces vibrations to loosen mucus.
slight increase in pressure during exhalation that aids in keeping the airways open and move mucus
Does the Flutter Valve have PEP? if so, what amount of pressure are they exerting when they use this device?
Yes Flutter does have PEP. They are exerting 10-20 cm H2O when they use this device.
1.) What 2 things does the Flutter device combine that helps to mobilize the secretions in the airway?
2.) What are the parts of the Flutter valve? (3)
1. Combines techniques of pep with high frequency oscillation of the airway
2. Consists of a pipe shaped device with a steel ball in a bowl, loosely covered by a perforated cap
1. What does the weight of the steel ball in the Flutter device serve as? and what does it stabilize?
2. How does the shape of the bowl allow? how many Hz does this device produce?
3. what is the final step after stage 1 & 2?
1. weight of ball serves as the PEP device (10 cm H2O). It stabilizes the airway
2. shape of the bowl allows the ball to vibrate on exhalation generating oscillations of about 15 Hz shearing mucus from the airway
3. after performing for about 5-10 breaths, and deep breath w/ forceful exhalation two times the patient should perform the "Huff Cough"
What is the rational for the use of a mucus clearance therapy in COPD patients? (4) & what can all of these things lead to?
1. Hypersecretion of mucus
2. Changes in mucus viscoelasticity
3. Surface adhesion
4. Impaired cilia
(leads to entrapped mucus)
What can retained airway secretions cause ? (2)
Retained airway secretions can form mucus plugs and bronchial casts that cannot be expelled by coughing.
What are 4 airway plugging causes?
1. Impaired ventilation
2. Lower ventilation-to-perfusion- ratios
3. Increased airway resistance to airflow
4. Air trapping resulting in hyperinflation of the chest & inspiratory loading of the respiratory muscles, leading to fatigue
What is the main muscle for inspiration? where is it located at?
the diaphragm, located at C3-C5
Because the diaphragm is located at C3-C5:
1. People with injusries at C2 and above usually need _____.
2. C3-C5 can ____ _____ _____.
3. C6 are able to take _____ ____.
4. Expiration on the other hand is a problem with a ll injury levels down to ____. The expiratory muscles are the _____-between the _____- and the _____.
1. C2 & above injuries - Need ventilator
2. C3-C5 injuries - can take small breaths
3. C6 injuries - are able to take deep breaths
4. Expiration : problem w/all injuries down to T12. Expiration muscles are the intercostals -between the ribs- and the abdominals
what is the saying about C3-5?
" C3 -5 keeps the diaphragm alive "
What is a shunt?
perfusion w/o ventilation
- vent 8 6 0
- ----- --- decreases to --> --- --- = SHUNT
- perf 10 10 10
What is dead space?
ventilation w/o perfusion
(= increased CO2)
- vent 8 8 8
- ---- -- decreases to -->-- -- = Dead space
- perf 10 6 0
What is the location of inspiration and expiration?
Above C3 (neck muscles) & C3-C5(diaphragm)
T1-T12 (intercostal muscles) & T7-T12 (abdominal muscles)
What are the 4 reasons to perform breathing exercises?
1. To improve the strength of the diaphragm
2. To get more air into the lungs
3. To help bring up deep-seated mucous
4. To keep the lungs and chest wall mobile
Name 4 different types of breathing exercises
1. Pursed-lip breathing
2. Diaphragmatic breathing
3. Segmental breathing
4. Progressive ambulation
What would you like to do?
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