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Email : [email protected] Fanpage : Catatan Nury Nury’s keynotes Weblogs : http://nury-nus.blogspot.com http://rehab-med.blogspot.com http://rehab-med- research.blogspot.com http://tanpa-pita-suara.blogspot.com http://laryngectomees.blogspot.com Dr. dr. Nury Nusdwinuringtyas, SpKFR- K, M.Epid

Dr. dr. Nury Nusdwinuringtyas, SpKFR- K, M

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PowerPoint PresentationMucus Clearance
The 7th Jakarta International Chest and Critical Care Internal Medicine
• Mucus secretion and clearance are important for pulmonary defense.
• Mucus secretion volume is between 10 and 100 mL/day in health.
• Pulmonary disorders such as CF, COPD, bronchiectasis alter the production of mucus and mucociliary clearance disorders airway obstruction.
• ACT used to aid in mucus mobilization and expectoration.
Oxygen delivery DO2 = arterial oxygen
content x cardiac output
PaO2 x 0.003
Oxyhaemoglobin + dissolved oxygen
PvO2 x 0.003
Oxygen delivery DO2
Pathophysiological basis
1. Inreased production 2. Colonization of mucus, e.g viral,
bacterial and fungal organism 3. systemic dehydration
Abnormalities in Cilial structure or function
Impaired MCC 1. Age 2. Sleep 3. Enviromental pollutants 4. Drugs 5. High Flow gases 6. Hypoxaemia and Hypercapnia 7. Social Factors
Abnormal Cough Reflex 1. Decreased 2. Increased
Ineffective cough due to inability to generate sufficient expiratory flow
Abnormal Cough 1. Post nasal drip 2. GERD
Airway clearance in the normal lung
1. Mucociliary clearance (MCC)
The first phase helps you relax your airways.
The second phase helps you to get air behind mucus and clears mucus.
The third phase helps force the mucus out of your lungs.
Autogenic Drainage
Is a breathing technique aims to maximize airflow within the airways, to improve ventilation and the clearance of mucus.
Chest Clapping
Postural Drainage
Huff Coughing:
• Huff coughing, or huffing, is an alternative to deep coughing if you have trouble clearing your mucus.
• Take a breath that is slightly deeper than normal.
• Use your stomach muscles to make a series of three rapid exhalations with the airway open, making a "ha, ha, ha" sound.
Contraindications Forced Breathing
• Inability to control possible transmission of infection from patients suspected or known to have pathogens transmittable by droplet nuclei (eg: M tuberculosis)
• Presence of an elevated intracranial pressure or intracranial aneurysm
• Presence of reduced coronary artery perfusion, such as in acute myocardial infarction
• Acute unstable head, neck, or spine injury
• Effective peak cough flow in healthy subjects > 360 - 400 L/min
• Peak cough flow (PCF) for mucus expectoration > 160 - 200 L/min.
• PCF > 250 - 270 L/min has been shown to be sufficient to prevent pneumonia in patients with NMDs
Mellies U, Goebel C. Optimum Insufflation Capacity and Peak Cough Flow in Neuromuscular Disorders. Ann Am Thorac Soc. 2014
Evaluation of Peak
Healthy Adults
Cardoso et al. Evaluation of peak cough flow in Brazillian healthy adults. International Archives of Medicine. 2012
Peak Cough Flow in Indonesian Healty Adults
Affecting Factor of Peak Cough Flow
• Peak Cough Flow values in Indonesian healthy adults about 310 – 645 L/min
• Sex, height and age affect peak cough flow values in Indonesian healthy adults.
6-Minute Walk Test
1. Walk as FAR (not as FAST) as possible; running is prohibited
2. Walk around the marking cones for 6 minutes
3. Exhaustion or discomfort may cause the patient to stop but stopwatch will keep running
4. Every minute passed will be notified by the examiner
5. Examiner will monitor vital signs and O2 saturation
6. Upon completion, BORG Scale is re-assessed
7. Calculate total walking distance, rounded to the nearest meter
Take home message
• Comprehensive evaluation should be done before and after intervention for optimal results