Airway Clearance techniques Pt.1 Flashcards
What are the 2 key components of Airway clearance?
- Mucociliary escalator
- Effective cough
What 3 factors do mucus transport depend on?
- Integrity and function of ciliated epithelium
- Periciliary fluid
- Mucus properties (volume, viscosity, rheology)
What are the 3 phases of cough
- Inspiratory phase: Relies on muscles
- Compression phases: Where both respiratory muscles to contract and the glottis is closed which builds up pressure for the final phase.
- Explosive phase: Where you get a high flow rate.
(some say there’s 5 stages: irritation, inspiration, compression and expulsion)
What can cause Mucoid sputum?
Chronic bronchitis (no infection)
What can cause Mucopurulent mucus?
Bronchiectasis, CF, pneumonia
What can cause Purulent mucus?
Infection, (haemophilus, pseudomonas), pneumococcus
What can cause Frothy mucus?
Pulmonary oedema
What can cause Haemoptysis?
Infection, MI, Ca, TB, trauma
What can cause black sputum?
Smoke inhalation
What are standard treatment goals for patients struggling with airway clearance?
- Reduce airflow obstruction
- Increase mucociliary clearance
- Increase ventilation
- Optimise gas exchange
What are some of the Airway clearance techniques?
list what you can recall
- Active cycle of breathing techniques (ACBT)
- Thoracic expansion exercises
- Breathing control
- The forced expiration technique (FET)
- Gravity assisted positioning (GAP)
- Manual techniques
- Clapping, shaking/vibrations.
- Supporting techniques such as; Flutter, Positive expiratory pressure/Oscillating PEP
- Cough augmentation
- Mechanical insufflation/Exsufflation (MI:E)
- Autogenic drainage
- IPPB & CPAP (see positive pressure lecture)
What are the 2 key physiological explanations that underpin Thoracic expansion exercises (aka deep breathing exercises)?
- Collateral ventilation, alveoli are joined by different connecting channels (Channels of; Martin, Lambert and Pores of Kohn), and there is a reduction in resistance to collateral airflow with increasing lung volumes so by taking in a deeper breath you promote collateral ventilation, and you promote that even more by holding your breath as well, as u allow air to flow between alveoli via the channels. This allows alveoli to expand more.
- Interdependence: The expanding forces between adjacent alveoli influence each other, so if one alveolus that was collapsing the expanding force exerted by its adjacent alveoli would allow it to expand again, and is much more effective at larger lung volumes.
So asking someone to take a deep breath and hold it can promote both of these which help with multiple things mentioned in another card.
What do Thoracic expansion exercise/ deep breathing exercises help with?
They help;
- Loosen and assist removal of secretions
- Aid lung re-expansion
- Mobilise thoracic cage
- May reduce risk of atelectasis and infection.
How would you perform Thoracic expansion exercises with a patient?
- Positioning; ensure they’re comfortable, supported and safe.
- Physio should be positioned at height of bed, observe patient.
- Position of hands; unilateral and bilateral see surface markings.
- Be wary of the number of repetitions, and avoid hyperventilation.
- Tell them to take a deep breath, hold for 3 seconds then ask them to take an extra sniff before expiration. Because of collateral ventilation they’ll be able to draw in an extra sniff of air which helps.
How would you perform the forced expiration technique (FET)?
And who does it best help (what conditions)
- 1 or 2 forced expirations combined with a period of breathing control
- Instruct patient to;
- Have mouth open in a O shape.
- The forced expiration should be from high-mid lung volumes to move proximal secretions. and then high-mid for proximal sections
- Should sound like a forced sigh
- audible crackles if secretions are present.
- Then for breathing control; Gentle breathing using lower chest, unforced expiration.
- CF, bronchiectasis and post-op upper abdominal (UAS) and thoracic surgery.
