PTP 673 CardioPulmonary Plan of Care July 16 th, 2013 Emily E.
Houser, PT, DPT, CCS
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Lecture: Introduction to airway physiology Continued
information on airway clearance techniques Apply differential for
choice of intervention Provide literature to support evidence based
practice Lab: Hands on practice of techniques and devices Apply
differential for choice of intervention
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If you cant breathe, you cant function! DPT: We need to look at
all body systems to properly assess and successfully treat a
problem. Linda Crane Memorial Lecture: The Patient Puzzle, Piecing
it all together.
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MS NM: GBS, SCI CP INT: burns, scerolderma IO: Obesity, room
for diaphragm
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Every muscle of respiration is ALSO a muscle of posture
Respiration and Posture = duality of function External and Internal
pressures that affect one will affect the other PRESSURE IS THE
KEY
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Work of breathing is the energy cost of inspiration and
expiration. In normal healthy individuals their work of breathing
is not a limiting factor even with strenuous activity.
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In the presence of respiratory or cardiac compromise work of
breathing can be a major portion of the total energy expenditure
for a person and can also be a primary limiting factor for function
and survival.
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Increased work of inspiration: Posture/kyphosis Connective
tissue diseases Pregnancy Obesity Pleural effusion
Pneumonia/inflammation Neuromuscular disease/SCI/CVA/Guillian Barre
Ventilatory muscle length and strength Excessive pulmonary
secretions
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Increased work of expiration Secretions: cystic fibrosis
Bronchial smooth muscle tone Structural stability of the airways
COPD Inflammation of airways Expiratory muscle weakness
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Pharmacological approaches Physical Approaches Mucociliary
Elevator
Incorporates all these aspects to achieve optimal functioning.
ROLE: To minimize the impact of airway clearance and ventilatory
impairments on a patients functional capacity, ADLs, work, and
leisure. Included with this, are airway clearance techniques.
Used to help facilitate secretion mobilization. Provides:
Compression Vibration Settings Compression: between 1-8, 4 is most
common Vibration: Between 6-16, 12 is most common
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Has actually been around and evolved over the past 20 years.
Good option for patients who have need for daily secretion removal.
Also for use in ICU pts. Can be done independently. Can be done in
conjunction with nebulizer treatments. Is expensive: approx
15K.
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Important that its not too tight or vibrating too fast. Need to
find individual settings which work. Recommend using at least 10
minutes, or until patient feels secretions moving. Typically 20
Encourage coughing several times after each cycle, when there is
something in upper airway to clear.
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Recommend changing positions; not just sitting Recommend doing
aerobic activity while using the vest Such as: Stair stepping
Marching in place
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Most research will show that if properly instructed, can be as
effective as classic techniques. But also is not fool proof. In
terms of PFTs and sputum production as outcomes, it has also been
shown to be less effective. (Kluft, 1996; Oermann, 2001; Phillips
2004) **Key, must fit the individual for their needs.
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Postive End Pressure Regular PEP (low pressure) Thera-PEP
Oscillatory PEP (low pressure) Flutter Acapella
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A. Collateral ventilation facilitates air movement between
adjacent lung segments B. Airway wall splinting, stabilizing, back
pressure (blunting effect) C. Decreases asynchronous ventilation -
for equal filling (not shown) B. A.
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Can use a mouth piece or facemask Can change resistance Gives
an incentive meter this device is similar to incentive spirometer,
just opposite. Tough to get buy in from patient
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Blow air in; pushing steel ball which creates resistance and
vibration for airway. Positional Dependent. Need to hold at correct
angle. Requires strong expiratory force to use.
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Blow air in, pushing on diaphragm which creates vibration for
airway. Can be done in any position and angle. Can adjust the
resistance, and comes in different levels. Can actual deliver
nebulizer treatments through them.
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PEP has significant advantages compared to conventional
postural drainage and percussion. PM, McIlwaine et al. Pediactric
Pul. Suppl 12, 1995. Flutter may not be as effective as PEP in
maintain pulmonary function in CF pt. PM McIlwaine. This may be due
to having to maintain same position. **Something is better than
nothing, need to individually assess best results.
