Lung Expansion Therapy
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What is resorption atelectasis, how does it occur?
- Occurs when mucus plugs block ventilation to selected regions of the lung
- Gas distal to the obstruction is absorbed by the passing blood
What is passive atelectasis caused?
Caused by persistent breathing with small tidal volumes
Can both types of atelectasis' happen at the same time?
What is it called when a large mucus plug blocks ventilation of a single lobe?
What are some factors associated with causing atelectasis?
- Neuromuscular disorders
- Heavy sedation
- Surgery near the diaphragm
- Bed rest
- Poor cough
- History of lung disease such as COPD
What are some clinical signs of atelectasis?
- History of recent majory surgery
- Fine, late inspiratory crackles
- Bronchial or diminished breath sounds
- Increased density and signs of volume loss on the chest radiograph
The closer the incision to the __________, the greater the risk of ______________ atelectasis.
What are the 3 types of Lung expansion therapies?
- Incentive Spirometry (IS)
- Intermittent Positive Pressure Breathing (IPPB)
- Positive Airway Pressure Therapy
How does the incentive spirometry device work?
Mimics natural sighing by encouraging PTs to take slow, deep breaths
The incentive spirometry uses _______ ____ to the PT when an inspiratory volume of flow is reached
What are some indications for Incentive Spirometry?
- Presence of pulmonary atelectasis
- Presence of conditions predisposing to atelectasis
- -Upper abdominal surgery
- -Thoracic surgery
- -Surgery in PTs with COPD
- Presence of restrictive lung defect associated with quadriplegia and/or dysfunctional diaphragm
Why is Incentive Spirometry one of the main mainstay devices used? What are the 2 types of IS devices?
- Simple, portable and inexpensive
- Flow oriented - more popular because they are smaller
- Volume oriented
What is a basic maneuver for PTs using an IS device?
- SMI - sustained maximal inspiration
- Slow deep inhalation from FRC followed by a 5-10 second breath hold
What is an effective way for PT teaching maneuvers? How many maneuvers should be done in an hour?
- Demonstrate it by doing it yourself then observe how the PT does it
- PT should sustain maximal inspiratory effort for 5-10 seconds
- Aim for 5-10 maneuvers an hour
What are AARC guidelines for indications of Incentive Spirometry?
- To improve atelectasis
- To prevent atelectasis (post-op, COPD, other pulmonary complications)
- Mobilize secretions
What are some contraindications for Incentive Spirometry?
- PT unable to coordinate
- PT cant be instructed
- PT is unable to breath deeply (VC < 10ml/kg)
- Prescence of open tracheal stoma requires modification
.What are some hazards and complications with Incentive Spirometry?
- Hyperventilation/Respiratory alkalosis is #1
- Ineffective unless performed correctly
- Discomfort secondary to pain
How does Intermittent Positive Pressure Breathing work? How long do treatments last? (IPPB)
- Uses positive airway pressure to expand the lung
- Treatments last 15-20 mins
What is the absolute contraindication for IPPB machines?
What range must PTs be in to be treated with an IPPB machine? mL/kg, %?
- <10mL/kg = VC vital capacity
- <33% = IC inspiratory capacity
What are some contraindications for Intermittent Positive Pressure Breathing (IPPB)?
- Tension pneumothorax
- ICP > 15mmHg
- Hemodynamic instability
- Active hemoptysis
- Tracheoesophageal fistula
- Recent esophageal surgery
- Active, untreated tuberculosis
- Radiographic evidence of blebs
- Recent facial, oral or skull surgery
- Singultus (hiccups)
- Air swallowing
What are some hazards and complications of Intermittent Positive Pressure Breathing (IPPB)?
- Increased airway resistance
- Pulmonary barotrauma
- Nosocomial infection
- Respiratory alkalosis
- Hyperoxia (with O2 as source gas)
- Impaired venous return
- Gastric distension
- Air trapping, auto-PEEP, overdistension
- Psychological dependence
What are the 3 things you should do for Intermittent Positive Pressure Breathing preliminary planning?
- Therapeutic outcomes
- Evaulate alternatives
- Baseline assessment
What are some potential outcomes of Intermittent Positive Pressure Breathing>
- Improved VC
- Increased FEV, or peak flow
- Enhanced cough and secretion clearance
- Improved chest radiograph
- Improved breath sounds
- Improved oxygenation
- Favorable PT subjective response
What is the best position for a PT getting Intermittent Positive Pressure Breathing? Another effective position?
- Supine is also acceptable
What is a positive pressure ventilator?
Bird Mark 7 - pushes air into lungs
How is the Bird Mark 7 powered? What source?
Pneumatically powered - runs on a gas source, does not require electricity
How many circuits does a Bird Mark 7 have?
Single circuit - the same gas supply goes to the PT that powers machine
What does pressure cycled or cycling mean? When does the machine end inspiration?
- Cyciling is what ends inspiration
- When pressure is reached, machine ends inspiration
At what sensitvity setting is good for a PT taking in a breath? Where is the sensitivty settings located?
- 1-2 below ambient
- Left side of the machine
At what pressure is good to set for a PT and where is the pressure settings located?
- Initially set 10-15 cmH2O
- Located on the right side of the machine
An increase in ________ means increases in _________.
Where is the flow rate located on the Bird Mark 7? What is it initially set at?
- Located on the front of the machine
- Initially set to 15LPM (low to moderate)
What is the max flow rate on a Bird Mark 7?
The _______ the flow, the ________ the breath is delivered resulting in a short 'I' time and a long 'E' time
What are the 3 different PAP machines? definitions? which one is the most effective?
- PEP= Positive Expiratory Pressure
- EPAP= Expiratory Postive Airway Pressure
- CPAP= Continuous Positive Airway Pressure
- They are all just as effective
What are the 2 indications for CPAP?
- Treatment of atelectasis
- Treatment of cardiogenic pulmonary edema
What are 2 contraindications of CPAP?
- Hemodynamic instability #1
What are 3 hazards and complications with CPAP?
- Gastric Distention
What is the most common problem with CPAP machines?
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