Lung expansion therapy includes techniques like incentive spirometry, intermittent positive pressure breathing, and continuous positive airway pressure that aim to increase lung volume through applying positive pressure in the lungs and airways. It is used to treat or prevent pulmonary atelectasis following surgery or respiratory conditions that weaken breathing muscles. Common modalities involve breathing exercises, positioning changes, and devices that provide feedback to encourage deep inspirations sustained for several seconds to optimally expand alveoli. Contraindications include active bleeding, instability, or inability to participate actively.
Application of PEP devices in Cardiorespiratory physiotherapy.
It includes types of PEP devices and their uses in physiotherapy..
It stands for positive expiratory pressure.
It includes spirometry, flutter, rc cornet, acapella, etc.
useful in various cardiorespiratory disorders like COPD, asthma , cystic fibrosis, respiratory failure etc.
Inspiratory Muscle Training or Respiratory Muscle Training or Ventilatory Muscle Training. IMT is the physiotherapy technique, with the help of different breathing exercises.
Intermittent positive pressure breathing (IPPB) is an assisted breathing technique that provides intermittent mechanical ventilation through a mouthpiece or mask. It is used to improve lung expansion and deliver aerosolized medications. While IPPB can help increase inspiration volume and support weak muscles, it is not usually the preferred treatment due to risks of barotrauma and availability of less expensive techniques. The Bird Mark 7 ventilator is commonly used for IPPB, which can benefit patients with atelectasis, secretion retention, or acute exacerbations requiring stronger inspiration. However, the effects of IPPB are short-lived and it is a more labor-intensive method of aerosol delivery than other available options.
Bronchial hygiene techniques are non-invasive methods to clear airways and improve lung function. They include coughing, breathing exercises, postural drainage, active cycle of breathing techniques (ACBT), autogenic drainage, positive expiratory pressure, chest physiotherapy, and suctioning. The document describes the procedures, indications, contraindications, advantages and disadvantages of various airway clearance techniques.
The document discusses the Flutter device, which is used for airway clearance. The Flutter produces oscillatory positive expiratory pressure and can be used as an alternative to remove secretions from the airways. It works by vibrating the airways, intermittently increasing endobronchial pressure, and accelerating expiratory airflow. The Flutter is recommended for use three times per day for conditions like cystic fibrosis, emphysema, and bronchitis. It helps loosen and remove trapped mucus from the lungs.
The document discusses the Acapella device, which uses oscillating positive expiratory pressure (OscPEP) therapy to clear pulmonary secretions. It can be used in various positions and takes less time than conventional chest physical therapy. The Acapella comes in different models and uses a plug-and-magnet system to create airflow oscillations during expiration. Application involves slow inspiratory breaths, breath holds, and forced expirations against resistance while adjusting settings based on clinical needs and feedback. Prescription of cycles depends on sputum volume and symptoms.
Bronchial hygiene therapy involves noninvasive techniques to clear secretions and improve lung function. It includes techniques like positioning, coughing, breathing exercises, and chest manipulation. The goals are to prevent accumulation and promote removal of secretions to improve respiratory status. Indications are excessive sputum production and ineffective cough. Contraindications include conditions that increase risk of aspiration or compromise hemodynamics.
Application of PEP devices in Cardiorespiratory physiotherapy.
It includes types of PEP devices and their uses in physiotherapy..
It stands for positive expiratory pressure.
It includes spirometry, flutter, rc cornet, acapella, etc.
useful in various cardiorespiratory disorders like COPD, asthma , cystic fibrosis, respiratory failure etc.
Inspiratory Muscle Training or Respiratory Muscle Training or Ventilatory Muscle Training. IMT is the physiotherapy technique, with the help of different breathing exercises.
Intermittent positive pressure breathing (IPPB) is an assisted breathing technique that provides intermittent mechanical ventilation through a mouthpiece or mask. It is used to improve lung expansion and deliver aerosolized medications. While IPPB can help increase inspiration volume and support weak muscles, it is not usually the preferred treatment due to risks of barotrauma and availability of less expensive techniques. The Bird Mark 7 ventilator is commonly used for IPPB, which can benefit patients with atelectasis, secretion retention, or acute exacerbations requiring stronger inspiration. However, the effects of IPPB are short-lived and it is a more labor-intensive method of aerosol delivery than other available options.
Bronchial hygiene techniques are non-invasive methods to clear airways and improve lung function. They include coughing, breathing exercises, postural drainage, active cycle of breathing techniques (ACBT), autogenic drainage, positive expiratory pressure, chest physiotherapy, and suctioning. The document describes the procedures, indications, contraindications, advantages and disadvantages of various airway clearance techniques.
The document discusses the Flutter device, which is used for airway clearance. The Flutter produces oscillatory positive expiratory pressure and can be used as an alternative to remove secretions from the airways. It works by vibrating the airways, intermittently increasing endobronchial pressure, and accelerating expiratory airflow. The Flutter is recommended for use three times per day for conditions like cystic fibrosis, emphysema, and bronchitis. It helps loosen and remove trapped mucus from the lungs.
The document discusses the Acapella device, which uses oscillating positive expiratory pressure (OscPEP) therapy to clear pulmonary secretions. It can be used in various positions and takes less time than conventional chest physical therapy. The Acapella comes in different models and uses a plug-and-magnet system to create airflow oscillations during expiration. Application involves slow inspiratory breaths, breath holds, and forced expirations against resistance while adjusting settings based on clinical needs and feedback. Prescription of cycles depends on sputum volume and symptoms.
Bronchial hygiene therapy involves noninvasive techniques to clear secretions and improve lung function. It includes techniques like positioning, coughing, breathing exercises, and chest manipulation. The goals are to prevent accumulation and promote removal of secretions to improve respiratory status. Indications are excessive sputum production and ineffective cough. Contraindications include conditions that increase risk of aspiration or compromise hemodynamics.
This document discusses humidification and nebulization in respiratory therapy. It defines humidification as artificially conditioning gas used for patient respiration. The two main humidification methods are active, using heat/water, and passive, recycling heat/humidity from exhalation. Inadequate humidification can cause various clinical issues. Nebulization delivers drugs to the lungs through an aerosol. Different nebulizer types are described including jet, ultrasonic and mesh varieties. Ideal particle sizes for deposition in different lung regions are noted.
The flutter is a respiratory device that uses positive expiratory pressure and high-frequency oscillations to help clear mucus. It consists of a tube, steel ball, semi-circular cone and mouthpiece. The steel ball vibrates during exhalation, loosening mucus from airways and increasing pressure and airflow to help move mucus out. Therapy involves slow inhalation, breath holding and exhalation through the flutter to mobilize mucus, followed by deep inhalation and forced exhalation to eliminate mucus through coughing. Sessions typically last 5-15 minutes and are done morning and evening.
This document discusses aerosol therapy and nebulizers. It defines aerosols and outlines factors that influence aerosol deposition in the lungs such as particle size, respiratory anatomy, and breathing patterns. It describes different aerosol delivery devices including metered dose inhalers, dry powder inhalers, and nebulizers. The document focuses on nebulizers, outlining their types (jet and ultrasonic), workings, indications, drugs used, and proper technique for administration. Nebulizers are indicated when precise dosing is needed for critically ill, young, elderly or handicapped patients. Proper technique and positioning can optimize drug deposition in the lungs.
Coughing and huffing are techniques used to clear secretions from the lungs. Coughing involves a forceful expiration against a closed glottis, while huffing is expiration with an open glottis. Coughing generates higher pressures but can cause complications like bronchospasm, while huffing creates lower pressures but with less risk. Both techniques work in stages - coughing requires inspiration, glottis closure, building pressure, then opening; huffing is a forced expiration from mid to low lung volumes with an open glottis. Huffing can help clearance with less effort than coughing for some patients.
1. Humidification is important to provide moisture to inspired gas as the upper airway normally humidifies and warms air. Dry gas can damage the respiratory tract.
2. Various types of humidifiers include bubble, passover, and heated humidifiers. Heat and moisture exchangers are passive humidifiers that recycle heat and moisture from expired gas.
3. Factors like temperature, surface area, and contact time impact humidifier performance. Clinical signs of inadequate humidity include thick secretions and increased work of breathing. Humidification is indicated when the upper airway is bypassed.
This document discusses various chest mobilization techniques used in physical therapy to improve chest wall mobility and ventilation. Some key techniques described include rib torsion, lateral stretching, and trunk rotation. Chest mobilization can help increase the length of intercostal muscles and improve biomechanics of chest movement. Specific exercises mentioned involve flexion/extension, lateral flexion, and trunk rotation while sitting. Counterrotation and butterfly techniques are also outlined to reduce neuromuscular tone and increase thoracic mobility. Controlled breathing can also be incorporated into walking exercises.
Neurophysiological facilitation of respiration [npf]Rekha Marbate
NPF involves using selective external stimuli to reflexively assist respiration in unconscious patients. It can be used for those who are unconscious, have neurological deficits, are partially breathing, or on a ventilator. Contraindications include fractures to the rib cage or spine, children, and respiratory failure. Techniques include perioral stimulation to initiate epigastric movement, thoracic vertebral pressure over T2-T4 to increase abdominal excursion and over T9-T11 to increase thoracic movement, anterior stretch lift of the basal area to increase rib movement, intercostal stretching to increase epigastric movement and general respiration, co-contraction of abdominal pressure to increase excursion and stimulate coughing
Humidity therapy adds moisture to air delivered to patients and is used to overcome humidity deficits when the upper airway is bypassed or for humidifying dry medical gases. It helps maintain normal humidity levels in the airways and can assist in managing conditions like thick secretions or hypothermia. Various humidifiers actively add heat or water to air or passively recycle exhaled heat and moisture, with different types suited to invasive or non-invasive ventilation.
Ats guidelines for the six minute walk test by dr kartik soodKartik Sood
The document provides guidelines for administering the six-minute walk test (6MWT) to evaluate functional exercise capacity. It describes the test protocol, including having patients walk as far as possible in 6 minutes while being timed and encouraged standardly. Distances walked, oxygen levels, and exertion ratings are recorded pre-and post-test. The 6MWT is a commonly used submaximal test to assess functional status and treatment outcomes in patients with cardiac and pulmonary conditions.
This document discusses humidification during mechanical ventilation. It begins by outlining the objectives and introducing humidification as a way to artificially condition inspired gas. It then covers the indications for humidification when the upper airway is bypassed and describes how inadequate humidification can cause clinical signs. The document delves into the physiology of normal heat and moisture exchange and how this is disrupted during mechanical ventilation. It describes different types of humidifiers including passive heat and moisture exchangers and active bubble through, passover and nebulizer humidifiers. It outlines principles of humidifier function and discusses indications, contraindications and hazards of humidification. It concludes by assessing the need for different humidifiers and common problems.
This document describes the procedure of pneumonectomy and the role of physiotherapy both before and after the surgery. Pneumonectomy involves complete removal of a lung, usually done to treat lung cancer, infections, or other lung diseases. Physiotherapy before surgery focuses on teaching exercises and breathing techniques to prepare the patient. After surgery, physiotherapy aims to clear secretions, expand the remaining lung, prevent complications, and restore movement and exercise tolerance through a gradual recovery program over 2-3 weeks before discharge.
Relaxation positions for breathelessness patientsSREEJESH R
This document discusses relaxation positions that can help patients with breathing difficulties. It begins by explaining the basic principle that certain positions can optimize the length-tension relationship of the diaphragm and facilitate breathing. It then provides examples of positions for obstructive lung conditions like leaning forward while sitting or standing, and positions for restrictive lung conditions like sitting upright or in high side-lying. Examples are given for each type of position. The document concludes by mentioning forward kneeling as a position that can help breathless children.
Manual ventilation, or ‘bagging’, is the use of a manual resuscitator bag (MRB) for the ventilation of a patient via either a facemask or an endotracheal tube.
The document discusses various airway clearance techniques (ACTs) used to loosen and remove thick mucus from the lungs. It describes techniques like active cycle of breathing, thoracic expansion exercises, forced expiratory techniques, percussion, and positions. ACTs work by mobilizing secretions using breaths, coughing, and vibrations applied to the chest. Proper technique and regular implementation of ACTs can help clear airways and reduce disease symptoms and risks from conditions like cystic fibrosis or chronic lung disease. Contraindications include things like bronchospasm or inability to follow instructions.
This document discusses goals and techniques for chest mobilization. The goals are to maintain or improve mobility of the chest wall, trunk, and shoulders when affected by tightness or other issues. This can improve ventilation. Techniques described include stretching tight muscles while taking deep breaths, and leaning forward during expiration to push internal organs up against the diaphragm. Specific chest mobilization techniques involve movements like bending, lateral flexion, rotation, arm movements, and pulling the knees to the chest while breathing. Contraindications include rib fractures, bone cancer, tuberculosis, osteoporosis, hernias, severe pain, and unstable vital signs.
The goal in patients with primary lung disease is to teach them to relax the neck and chest accessory muscles and use more diaphragmatic breathing to reduce the work of breathing.
Neurophysiological Facilitation of Respiration is a treatment technique used for respiratory care of patients with unconscious or non-alert, and ventilated, and also with a neurological condition
NPF is the use of external proprioceptive and tactile stimuli that produce reflex respiratory movement responses and that increase the rate and depth of breathing
The 6-minute walk test (6MWT) is an easy to perform and practical test that has been used in the assessment of patients with a variety of cardiopulmonary diseases including pulmonary arterial hypertension (PAH). It simply measures the distance that a patient can walk on a flat, hard surface in a period of 6 minutes.
Pulmonary rehabilitation is a comprehensive intervention designed to improve the physical and psychological condition of people with chronic respiratory disease. It includes exercise training, education, and behavior change therapies. Pulmonary rehabilitation aims to promote long-term adherence to health-enhancing behaviors. The summary describes restrictive and obstructive lung diseases, as well as various treatments used in pulmonary rehabilitation including exercise, airway clearance techniques, nutrition management, and psychosocial support.
A mechanical ventilator is a machine that helps a patient breathe (ventilate) when they are having surgery or cannot breathe on their own due to a critical illness. The patient is connected to the ventilator with a hollow tube (artificial airway) that goes in their mouth and down into their main airway or trachea
This document discusses humidification and nebulization in respiratory therapy. It defines humidification as artificially conditioning gas used for patient respiration. The two main humidification methods are active, using heat/water, and passive, recycling heat/humidity from exhalation. Inadequate humidification can cause various clinical issues. Nebulization delivers drugs to the lungs through an aerosol. Different nebulizer types are described including jet, ultrasonic and mesh varieties. Ideal particle sizes for deposition in different lung regions are noted.
The flutter is a respiratory device that uses positive expiratory pressure and high-frequency oscillations to help clear mucus. It consists of a tube, steel ball, semi-circular cone and mouthpiece. The steel ball vibrates during exhalation, loosening mucus from airways and increasing pressure and airflow to help move mucus out. Therapy involves slow inhalation, breath holding and exhalation through the flutter to mobilize mucus, followed by deep inhalation and forced exhalation to eliminate mucus through coughing. Sessions typically last 5-15 minutes and are done morning and evening.
This document discusses aerosol therapy and nebulizers. It defines aerosols and outlines factors that influence aerosol deposition in the lungs such as particle size, respiratory anatomy, and breathing patterns. It describes different aerosol delivery devices including metered dose inhalers, dry powder inhalers, and nebulizers. The document focuses on nebulizers, outlining their types (jet and ultrasonic), workings, indications, drugs used, and proper technique for administration. Nebulizers are indicated when precise dosing is needed for critically ill, young, elderly or handicapped patients. Proper technique and positioning can optimize drug deposition in the lungs.
Coughing and huffing are techniques used to clear secretions from the lungs. Coughing involves a forceful expiration against a closed glottis, while huffing is expiration with an open glottis. Coughing generates higher pressures but can cause complications like bronchospasm, while huffing creates lower pressures but with less risk. Both techniques work in stages - coughing requires inspiration, glottis closure, building pressure, then opening; huffing is a forced expiration from mid to low lung volumes with an open glottis. Huffing can help clearance with less effort than coughing for some patients.
1. Humidification is important to provide moisture to inspired gas as the upper airway normally humidifies and warms air. Dry gas can damage the respiratory tract.
2. Various types of humidifiers include bubble, passover, and heated humidifiers. Heat and moisture exchangers are passive humidifiers that recycle heat and moisture from expired gas.
3. Factors like temperature, surface area, and contact time impact humidifier performance. Clinical signs of inadequate humidity include thick secretions and increased work of breathing. Humidification is indicated when the upper airway is bypassed.
This document discusses various chest mobilization techniques used in physical therapy to improve chest wall mobility and ventilation. Some key techniques described include rib torsion, lateral stretching, and trunk rotation. Chest mobilization can help increase the length of intercostal muscles and improve biomechanics of chest movement. Specific exercises mentioned involve flexion/extension, lateral flexion, and trunk rotation while sitting. Counterrotation and butterfly techniques are also outlined to reduce neuromuscular tone and increase thoracic mobility. Controlled breathing can also be incorporated into walking exercises.
Neurophysiological facilitation of respiration [npf]Rekha Marbate
NPF involves using selective external stimuli to reflexively assist respiration in unconscious patients. It can be used for those who are unconscious, have neurological deficits, are partially breathing, or on a ventilator. Contraindications include fractures to the rib cage or spine, children, and respiratory failure. Techniques include perioral stimulation to initiate epigastric movement, thoracic vertebral pressure over T2-T4 to increase abdominal excursion and over T9-T11 to increase thoracic movement, anterior stretch lift of the basal area to increase rib movement, intercostal stretching to increase epigastric movement and general respiration, co-contraction of abdominal pressure to increase excursion and stimulate coughing
Humidity therapy adds moisture to air delivered to patients and is used to overcome humidity deficits when the upper airway is bypassed or for humidifying dry medical gases. It helps maintain normal humidity levels in the airways and can assist in managing conditions like thick secretions or hypothermia. Various humidifiers actively add heat or water to air or passively recycle exhaled heat and moisture, with different types suited to invasive or non-invasive ventilation.
Ats guidelines for the six minute walk test by dr kartik soodKartik Sood
The document provides guidelines for administering the six-minute walk test (6MWT) to evaluate functional exercise capacity. It describes the test protocol, including having patients walk as far as possible in 6 minutes while being timed and encouraged standardly. Distances walked, oxygen levels, and exertion ratings are recorded pre-and post-test. The 6MWT is a commonly used submaximal test to assess functional status and treatment outcomes in patients with cardiac and pulmonary conditions.
This document discusses humidification during mechanical ventilation. It begins by outlining the objectives and introducing humidification as a way to artificially condition inspired gas. It then covers the indications for humidification when the upper airway is bypassed and describes how inadequate humidification can cause clinical signs. The document delves into the physiology of normal heat and moisture exchange and how this is disrupted during mechanical ventilation. It describes different types of humidifiers including passive heat and moisture exchangers and active bubble through, passover and nebulizer humidifiers. It outlines principles of humidifier function and discusses indications, contraindications and hazards of humidification. It concludes by assessing the need for different humidifiers and common problems.
This document describes the procedure of pneumonectomy and the role of physiotherapy both before and after the surgery. Pneumonectomy involves complete removal of a lung, usually done to treat lung cancer, infections, or other lung diseases. Physiotherapy before surgery focuses on teaching exercises and breathing techniques to prepare the patient. After surgery, physiotherapy aims to clear secretions, expand the remaining lung, prevent complications, and restore movement and exercise tolerance through a gradual recovery program over 2-3 weeks before discharge.
Relaxation positions for breathelessness patientsSREEJESH R
This document discusses relaxation positions that can help patients with breathing difficulties. It begins by explaining the basic principle that certain positions can optimize the length-tension relationship of the diaphragm and facilitate breathing. It then provides examples of positions for obstructive lung conditions like leaning forward while sitting or standing, and positions for restrictive lung conditions like sitting upright or in high side-lying. Examples are given for each type of position. The document concludes by mentioning forward kneeling as a position that can help breathless children.
Manual ventilation, or ‘bagging’, is the use of a manual resuscitator bag (MRB) for the ventilation of a patient via either a facemask or an endotracheal tube.
The document discusses various airway clearance techniques (ACTs) used to loosen and remove thick mucus from the lungs. It describes techniques like active cycle of breathing, thoracic expansion exercises, forced expiratory techniques, percussion, and positions. ACTs work by mobilizing secretions using breaths, coughing, and vibrations applied to the chest. Proper technique and regular implementation of ACTs can help clear airways and reduce disease symptoms and risks from conditions like cystic fibrosis or chronic lung disease. Contraindications include things like bronchospasm or inability to follow instructions.
This document discusses goals and techniques for chest mobilization. The goals are to maintain or improve mobility of the chest wall, trunk, and shoulders when affected by tightness or other issues. This can improve ventilation. Techniques described include stretching tight muscles while taking deep breaths, and leaning forward during expiration to push internal organs up against the diaphragm. Specific chest mobilization techniques involve movements like bending, lateral flexion, rotation, arm movements, and pulling the knees to the chest while breathing. Contraindications include rib fractures, bone cancer, tuberculosis, osteoporosis, hernias, severe pain, and unstable vital signs.
The goal in patients with primary lung disease is to teach them to relax the neck and chest accessory muscles and use more diaphragmatic breathing to reduce the work of breathing.
Neurophysiological Facilitation of Respiration is a treatment technique used for respiratory care of patients with unconscious or non-alert, and ventilated, and also with a neurological condition
NPF is the use of external proprioceptive and tactile stimuli that produce reflex respiratory movement responses and that increase the rate and depth of breathing
The 6-minute walk test (6MWT) is an easy to perform and practical test that has been used in the assessment of patients with a variety of cardiopulmonary diseases including pulmonary arterial hypertension (PAH). It simply measures the distance that a patient can walk on a flat, hard surface in a period of 6 minutes.
Pulmonary rehabilitation is a comprehensive intervention designed to improve the physical and psychological condition of people with chronic respiratory disease. It includes exercise training, education, and behavior change therapies. Pulmonary rehabilitation aims to promote long-term adherence to health-enhancing behaviors. The summary describes restrictive and obstructive lung diseases, as well as various treatments used in pulmonary rehabilitation including exercise, airway clearance techniques, nutrition management, and psychosocial support.
A mechanical ventilator is a machine that helps a patient breathe (ventilate) when they are having surgery or cannot breathe on their own due to a critical illness. The patient is connected to the ventilator with a hollow tube (artificial airway) that goes in their mouth and down into their main airway or trachea
Mechanical ventilation is the use of a ventilator to provide breathing support to patients whose breathing is impaired. There are two main types of ventilation: negative pressure ventilation which uses pressure changes around the chest to drive breathing, and positive pressure ventilation which delivers gas into the lungs through an endotracheal tube.
There are several reasons a patient may require mechanical ventilation including airway obstruction, respiratory failure, or to improve oxygen levels and reduce work of breathing. Key settings on a ventilator include tidal volume, respiratory rate, pressure support, and PEEP. Common modes include assist-control, pressure support, and CPAP. It is important to carefully monitor the patient and ventilator, respond to alarms immediately
This document provides information on various breathing exercises and their goals, indications, contraindications, and techniques. The main goals of breathing exercises are to improve ventilation, cough effectiveness, strength and endurance of respiratory muscles, chest mobility, and breathing patterns. Exercises include diaphragmatic breathing, pursed lip breathing, and localized expansion techniques. The document describes how to perform each exercise and provides guidance on proper technique and positioning.
Breathing exercises and ventilatory training are fundamental interventions for preventing acute and chronic pulmonary disease, with goals of improving ventilation, airway clearance, and preventing postoperative complications. The document outlines various breathing techniques including diaphragmatic breathing, pursed lip breathing, and segmental breathing and provides guidelines for teaching patients and precautions for different conditions.
This document discusses thoracic anesthesia and one lung ventilation. It begins with the aims and goals of thoracic anesthesia, which include minimizing cardiac depression and pulmonary pressures/resistance while ventilating one lung. It then covers topics like the lateral decubitus position, effects of anesthesia/paralysis, techniques for one lung ventilation including double lumen tubes, and the physiological impacts of the lateral position. Hazards of techniques like double lumen tubes are also addressed. The document provides detailed information on evaluating and preparing patients as well as performing thoracic anesthesia.
The document discusses the role of physiotherapy in the pediatric intensive care unit (PICU). The PICU treats extremely sick pediatric patients with conditions like respiratory, neurological, and cardiovascular disorders. Physiotherapy is important for critically ill PICU patients to prevent long-term muscle weakness, facilitate weaning from ventilation, and promote safe discharge. Key physiotherapy techniques discussed include positioning, percussion and vibrations to clear secretions, breathing exercises like active cycle of breathing, and airway suctioning. The goals are both short-term maintenance of muscle function and long-term rehabilitation and reintegration into society.
The document provides information on various modes of mechanical ventilation and strategies for weaning patients off ventilators. It discusses negative pressure ventilation techniques like iron lungs as well as modern positive pressure modes like pressure control ventilation, synchronized intermittent mandatory ventilation (SIMV), and proportional assist ventilation (PAV). The goals of mechanical ventilation are to maintain ventilation and tissue oxygenation while decreasing the work of breathing. Modes are selected based on the level of support needed and to facilitate eventual weaning from the ventilator.
The document discusses weaning patients from mechanical ventilation. It begins by defining weaning as the process of withdrawing ventilator support and transferring breathing work to the patient. It states that patients must recover from their acute illness and be able to breathe spontaneously before weaning. Weaning is gradually started by evaluating clinical status and giving spontaneous breathing trials to assess readiness for extubation. Different ventilator modes used for weaning, like pressure support ventilation, are described. Weaning criteria involving clinical, ventilatory, oxygenation, and pulmonary measurements are provided to determine weaning success. The weaning procedure, including spontaneous breathing trials and parameters like the rapid shallow breathing index to predict weaning outcome, are outlined. Causes of we
This document provides information on prone positioning for patients in the ICU and during occupational therapy. It discusses the physiologic effects of prone positioning on oxygenation, indications for prone positioning, types of proning procedures and techniques, assessing response, complications, and literature on the topic. Prone positioning can improve oxygenation for patients with conditions like ARDS by reducing lung compression and improving ventilation and perfusion. Proper patient positioning and monitoring during proning is important to prevent injuries and complications.
This document summarizes a seminar on discontinuing mechanical ventilation. It discusses weaning parameters like the ratio of respiratory rate to tidal volume. Common weaning methods include spontaneous breathing trials, gradually reducing support on modes like SIMV and PSV. Prerequisites for extubation include ensuring airway protection and patency. Factors that can lead to weaning or extubation failure are also reviewed. The objective is for residents to understand weaning and extubation processes and techniques.
Mechanical ventilation ppt including airway, ventilator, tubings and connections, nursing management, trouble shooting common problems and issues, suctioning etc.
Mechanical ventilation and physiotherapy managementMuskan Rastogi
Mechanical ventilation involves using a machine to breathe for patients who cannot breathe effectively on their own. It works by delivering pressurized air into the lungs via a tube in the airway. Physiotherapists help optimize ventilation, clear secretions, prevent complications, and facilitate weaning patients off the ventilator using techniques like suctioning, drainage positions, percussion, and vibrations. The ventilator settings control aspects of breathing like tidal volume, oxygen levels, and respiratory rate. Modes include mandatory breaths or assisting patients' own breaths. Weaning gradually reduces support as the patient recovers lung function and the ability to breathe independently.
Postural drainage is a technique used to clear secretions from the lungs by placing patients in positions that utilize gravity. It involves tilting or propping patients at angles to drain secretions from the lungs into the central airways. Manual techniques like percussion, vibration, and shaking are used alongside positioning to loosen secretions and enhance their removal. Postural drainage is effective for conditions with increased mucus production and is commonly used for patients who have difficulty coughing up secretions due to illness, surgery, or prolonged bed rest.
The document discusses weaning patients from mechanical ventilation. It defines weaning as the process of withdrawing ventilator support and describes the main steps as assessing patient readiness, using methods like a T-piece trial or pressure support ventilation to gradually reduce support, and monitoring for signs of fatigue or deterioration. Key factors that must be evaluated for readiness include respiratory muscle strength and endurance, ventilatory drive, gas exchange, and hemodynamic status. Nursing plays an important role in explaining the process, monitoring patients, and providing encouragement during weaning trials.
Active cycle of breathing technique.pptxKrishna Gohil
The Active Cycle of Breathing Technique (ACBT) consists of 3 components - breathing control, thoracic expansion exercises, and huffing - to help clear secretions from the lungs. Breathing control involves relaxed tidal breathing to recover from fatigue. Thoracic expansion exercises emphasize slow, deep breathing through the nose to improve ventilation and airflow through collateral channels in the lungs. Performing 5 breaths with breath holds can help mobilize secretions.
1) Mechanical ventilation involves using a machine to move air in and out of the lungs through an artificial airway like an endotracheal tube.
2) There are various modes of mechanical ventilation including volume-cycled, pressure-cycled, and high frequency ventilation. Positive pressure ventilation is the most common type.
3) Potential complications of mechanical ventilation include barotrauma, volutrauma, ventilator-associated pneumonia, hypotension, and impaired cerebral blood flow. Nurses monitor for these complications and manage the ventilator settings.
Mechanical ventilation is a therapeutic method that uses physical devices to assist or replace spontaneous breathing. There are two main types: negative pressure ventilation which applies pressure lower than atmospheric to the chest, and positive pressure ventilation which applies pressure higher than atmospheric to the lungs. Positive pressure ventilation is more commonly used today. It is important to carefully monitor patients on mechanical ventilation to optimize ventilation and prevent lung injury, through monitoring pressures, volumes, oxygen levels and CO2 levels. The goals are to provide adequate gas exchange while applying the lowest possible pressures and volumes to the lungs.
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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Leveraging Generative AI to Drive Nonprofit InnovationTechSoup
In this webinar, participants learned how to utilize Generative AI to streamline operations and elevate member engagement. Amazon Web Service experts provided a customer specific use cases and dived into low/no-code tools that are quick and easy to deploy through Amazon Web Service (AWS.)
A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
Chapter wise All Notes of First year Basic Civil Engineering.pptxDenish Jangid
Chapter wise All Notes of First year Basic Civil Engineering
Syllabus
Chapter-1
Introduction to objective, scope and outcome the subject
Chapter 2
Introduction: Scope and Specialization of Civil Engineering, Role of civil Engineer in Society, Impact of infrastructural development on economy of country.
Chapter 3
Surveying: Object Principles & Types of Surveying; Site Plans, Plans & Maps; Scales & Unit of different Measurements.
Linear Measurements: Instruments used. Linear Measurement by Tape, Ranging out Survey Lines and overcoming Obstructions; Measurements on sloping ground; Tape corrections, conventional symbols. Angular Measurements: Instruments used; Introduction to Compass Surveying, Bearings and Longitude & Latitude of a Line, Introduction to total station.
Levelling: Instrument used Object of levelling, Methods of levelling in brief, and Contour maps.
Chapter 4
Buildings: Selection of site for Buildings, Layout of Building Plan, Types of buildings, Plinth area, carpet area, floor space index, Introduction to building byelaws, concept of sun light & ventilation. Components of Buildings & their functions, Basic concept of R.C.C., Introduction to types of foundation
Chapter 5
Transportation: Introduction to Transportation Engineering; Traffic and Road Safety: Types and Characteristics of Various Modes of Transportation; Various Road Traffic Signs, Causes of Accidents and Road Safety Measures.
Chapter 6
Environmental Engineering: Environmental Pollution, Environmental Acts and Regulations, Functional Concepts of Ecology, Basics of Species, Biodiversity, Ecosystem, Hydrological Cycle; Chemical Cycles: Carbon, Nitrogen & Phosphorus; Energy Flow in Ecosystems.
Water Pollution: Water Quality standards, Introduction to Treatment & Disposal of Waste Water. Reuse and Saving of Water, Rain Water Harvesting. Solid Waste Management: Classification of Solid Waste, Collection, Transportation and Disposal of Solid. Recycling of Solid Waste: Energy Recovery, Sanitary Landfill, On-Site Sanitation. Air & Noise Pollution: Primary and Secondary air pollutants, Harmful effects of Air Pollution, Control of Air Pollution. . Noise Pollution Harmful Effects of noise pollution, control of noise pollution, Global warming & Climate Change, Ozone depletion, Greenhouse effect
Text Books:
1. Palancharmy, Basic Civil Engineering, McGraw Hill publishers.
2. Satheesh Gopi, Basic Civil Engineering, Pearson Publishers.
3. Ketki Rangwala Dalal, Essentials of Civil Engineering, Charotar Publishing House.
4. BCP, Surveying volume 1
How to Manage Your Lost Opportunities in Odoo 17 CRMCeline George
Odoo 17 CRM allows us to track why we lose sales opportunities with "Lost Reasons." This helps analyze our sales process and identify areas for improvement. Here's how to configure lost reasons in Odoo 17 CRM
Reimagining Your Library Space: How to Increase the Vibes in Your Library No ...Diana Rendina
Librarians are leading the way in creating future-ready citizens – now we need to update our spaces to match. In this session, attendees will get inspiration for transforming their library spaces. You’ll learn how to survey students and patrons, create a focus group, and use design thinking to brainstorm ideas for your space. We’ll discuss budget friendly ways to change your space as well as how to find funding. No matter where you’re at, you’ll find ideas for reimagining your space in this session.
This document provides an overview of wound healing, its functions, stages, mechanisms, factors affecting it, and complications.
A wound is a break in the integrity of the skin or tissues, which may be associated with disruption of the structure and function.
Healing is the body’s response to injury in an attempt to restore normal structure and functions.
Healing can occur in two ways: Regeneration and Repair
There are 4 phases of wound healing: hemostasis, inflammation, proliferation, and remodeling. This document also describes the mechanism of wound healing. Factors that affect healing include infection, uncontrolled diabetes, poor nutrition, age, anemia, the presence of foreign bodies, etc.
Complications of wound healing like infection, hyperpigmentation of scar, contractures, and keloid formation.
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
Beyond Degrees - Empowering the Workforce in the Context of Skills-First.pptxEduSkills OECD
Iván Bornacelly, Policy Analyst at the OECD Centre for Skills, OECD, presents at the webinar 'Tackling job market gaps with a skills-first approach' on 12 June 2024
Main Java[All of the Base Concepts}.docxadhitya5119
This is part 1 of my Java Learning Journey. This Contains Custom methods, classes, constructors, packages, multithreading , try- catch block, finally block and more.
2. Lung Expansion Therapy
• Group of medical treatment modalities (I.S,
IPPB, CPAP or EzPAP) designed to prevent or
treat pulmonary atelectasis and associated
problems caused from post-op thoracic or
abdominal surgery, heavy sedation,
neuromuscular diseases, weaken breathing
muscles, chest trauma or chest wall injury.
3/29/2023 PK 2
3. INDICATIONS
• Postoperative patients (highest risk) -Upper
abdominal, thoracic, cardiac surgery
• Acute respiratory failure due to pneumonia Post
traumatic ARF: Pulmonary contusions, Flail chest
• Neuro-compromised patients -Heavily sedated
patients ,Spinal cord injury
• Patients with reduced lung volumes and
ineffective cough resulting from chest wall
deformity, such as Scoliosis
• Respiratory muscle weakness or prolonged
immobility
• Patients unable to take a deep breath
3/29/2023 PK 3
4. • Modalities used to administer lung expansion
therapy to increase the patient's lung volume
by increasing the transpulmonary pressure
gradient (the difference between the alveolar
pressure and the pleural pressure).
• The transpulmonary pressure gradient results
alveoli expand.
3/29/2023 PK 4
5. Contraindications
• Pneumothorax
• ICP >15mmHg
• Active haemophytsis
• Haemodynamic instability
• Recent esophageal surgery & fistula
• Hiccups & air swallowing
• Nausea
3/29/2023 PK 5
6. 3/29/2023 6
MECHANISAM OF LUNG EXPANSION
THERAPY
1)Increasing trans pulmonary pressure
gradient
Trans pulmonary
Pressure
gradient
0
-1
-2
-6
+1
Intrapulmonary
pressure
Intra alveolar
pressure
7. To increase the transpulmonary
pressure gradient:
1.By decreasing the surrounding pleural
pressure (A spontaneous deep inspiration
increases the transpulmonary pressure
gradient by decreasing the pleural pressure.)
2.By increasing the alveolar pressure (Positive
pressure increases the transpulmonary
pressure gradient by raising the pressure
inside the alveoli.)
3/29/2023 PK 7
9. 3/29/2023 9
2)Addition of inspiratory hold to breathing
exercise will improve collateral ventilation of
alveoli
Interbronchial
Channels of
martini
Bronchoalveolar
Channels of
lambert
Interalveolar
Pores of kohn
11. 3/29/2023 11
3)Interdependence-If a group of alveoli have a
tendency to collapse, the adjacent expanded
alveoli produces forces that tend to prevent
collapse
17. 3/29/2023 17
Therapeutic Positioning
• Functional resudal capacity (FRC) decreases from
standing to slumped sitting
• Lung compliance decrease and work of breathing
increases progressively from standing, to sitting
,to supine
• Increase shunt
• Arterial oxygenation is usually higher in side lying
postion than supine
• Supine is unhelpful for lung volume
19. Effect of positioning
• Improve 02 transport in acute/ chronic
cardiopulmonary dysfunction
• Prevent the – ve effect of restricted che wall mobility
• Application of positioning to optimize 02 transport ,
primary by manipulation effects of gravity on
cardiopulmonary
• mobilization and exercise further enhances 02
transport
• Note- therapeutic positioning for PD are based on
anatomy of lung and tracheobronchial tree
3/29/2023 19
20. 3/29/2023 20
• Time should be spent in side lying, well
forward so that the diaphragm is free from
abdominal pressure
• Positioning also affects the V/Q ratio
• Lying with the affected lung uppermost means
that the better ventilation of the dependent
normal lung is matched with better perfusion
21. Incentive spirometry
• Incentive spirometry (IS) enhances lung expansion
through a spontaneous and sustained decrease in
pleural pressure.
• IS designed to mimic natural sighing or yawning by
encouraging the patient to take long, slow, deep
breaths.
• This is accomplished by using a device that provides
patients with visual or other positive feedback when
they inhale at a predetermined flow rate or volume
and sustain the inflation for a minimum of 3 seconds.
3/29/2023 PK 21
24. Intermittent Positive Pressure Breathing
(IPPB)
• Intermittent positive pressure breathing (IPPB)
is a technique used to provide short-term or
intermittent mechanical ventilation for the
purpose of augmenting lung expansion,
delivering aerosol medication, or assisting
ventilation
3/29/2023 PK 24
27. Continuous positive airway pressure
• Continuous Positive Airway Pressure (CPAP) is
a simple approach using a device which
maintains some positive pressure in the
airway at the end of exhalation to keep the
airways continuously open
• Indications for CPAP:
- Mild to moderate RDS
- After extubation
- Alternative to mechanical ventilation
3/29/2023 PK 27
30. Positive Airway Pressure System
(EzPAP)
• Positive Airway Pressure System (EzPAP) is the
easy option for the prevention and treatment
of atelectasis and a medical need for lung
expansion therapy.
3/29/2023 PK 30
31. AMBU BAG / SELF INFLATING BAG
• Instruments used to provide oxygen during
intermittent positive pressure respiration
(IPPR) via an endotracheal tube or a facemask.
• Used in emergencies when somebody is facing
breathing difficulties to provide artificial
ventilation.
3/29/2023 PK 31
33. • It is a compressible, self-inflating, non-rebreathing
silicon bag, which has an inlet through which air and
additional O2 is supplied and an outlet through this can
be transferred to the patient
• The gas enters in the self-expanding bag through one
way valve which restricts the flow back from the inlet.
When the bag is compressed, the air is pushed forward
through the mask in the pharynx or throat which in
turn leads to wind pipe and then in the lungs, hence
assisting in artificial ventilation.
3/29/2023 PK 33
34. • There are other valves which prevent rebreathing of the expired air
and excessive pressure from developing. It basically increases the
FIO 2 of the inspired O2 from 40% to almost 90% (if used with a
reservoir).
Some of these self-inflating bags come with pressure restrictor or
manometer tube connector or pressure gauge connector.
• The manometer connector (or the pressure gauge connector) can
be used to connect manometer tube (or pressure gauge) to monitor
the airway pressure.
• It is strongly recommended to have one of these safety features in
self-inflating bags when they are used in pediatric cases.
3/29/2023 PK 34
35. • various sizes as per the age group: -
- Neonate: - 250ml
- Pediatric: - 500ml
- Adults: - 1600 ml
3/29/2023 PK 35
36. 3/29/2023 36
Technique administered LET
Depends on level of consciousness
• If patient unconscious-PNF respiration
• If patient not alert-IPPB therapy
• If patient having problem with excess
secretions-PEP therapy
• If patient conscious and cooperative-incentive
spirometer
• If problem still not resolved-intermittent CPAP
37. OUTCOME LET
• Prevents or reverses atelectasis
• Aides in the mobilization of secretions
• Reduces air-trapping in asthma and COPD patients
• Optimizes the delivery of bronchodilator therapy
• Decreases work of breathing
• Improves inspiratory muscle strength
• Increases lung volumes
• Recruitment of collapsed alveoli by increasing FRC
• Creates a positive airway pressure gradient that will
prevent premature airway closure and expand
collapsed lung regions.
3/29/2023 PK 37
38. 3/29/2023 38
Summary LET
• Evidence shown that breathing exercises is
always beneficial than any other mechanical aids
• Deep breathing
• Localized breathing exercises
• End-inspiratory hold
• Abdominal breathing
• Sniff
• Stacked inspiration
• Rib springing
39. 3/29/2023 PK 39
Neuro physiological facilitation of
respiration
Externally applied proprioceptive and tactile
stimuli produce reflex respiratory movement
response and that appear to alter the rate and
depth of breathing
40. Rationale
• Shallow respiration leads to inadequate
ventilation
Which leads to atelectasis and retention of
secretions
• Lack of muscle tone leads to instability of
chest wall which leads to deranged
mechanical respiratory dysfunction
3/29/2023 PK 40
41. Perioral pressure
• Stimulus Applying firm
maintined pressure to the
patients on upper lip
• Response 5 second apnea
followed by epi gastric excursion
,deep breathing
mouth closure, swallowing
snout phenomena
• Suggested mechanism
Primitive reflex response related
to sucking breathing and
swallowing
3/29/2023 PK 41
42. Intercostal stretch
• Stimulus applying
pressure to upper border
of rib inorder to stretch
the intercostals muscle in
downward direction
• Response
gradual increase in
respiratory movements in
area under and around
stretch
• Suggested mechanism
intercostals stretch
receptors
3/29/2023 PK 42
43. Manual vertebral pressure (High)
• Stimulus
manual pressure to thoracic
vertebral region of T2 – T5
• Response: Increased epigastric
excursion
Deep breathing
• Suggested mechanism
Dorsal root mediated inter
segmental reflex
3/29/2023 PK 43
44. Manual vertebral pressure(low)
• Stimulus Manual pressure
to thoracic vertebral region
of T 7– T10
• Response Increased
respiratory movements of
apical thorax
• Suggested mechanism
Dorsal root mediated inter
segmental reflex
3/29/2023 PK 44
45. Co contraction of abdomen
Stimulus
• Therapist placing one hand on patients
lower ribs and one pelvis on same side
and pushing with moderate pressure so
that force is applied right angle to the
patient
• Response Increased epigastric
excursion
Increased muscle contraction – rectus
abdominis
Decrease girth in obese
Increase firmness to palpation
Coughing
• Suggested mechanism
Stretch receptors of abdominal muscles
Intercostal to phrenic reflexes
3/29/2023 PK 45
46. Anterior stretch basal lift
• Stimulus Procedure is performed by
placing hands under posterior ribs
of supine patient and lifting gently
upwards
• Response
Increased expansion of posterior
basal area
• Suggested mechanism
Dorsal root mediated inter
segmental reflex stretch receptors
in intercostals and back muscles
3/29/2023 PK 46
47. Maintained moderate manual pressure
• Stimulus
Mild pressure of open hands is maintained
over the area in which expansion is desired
• Response
gradually increased excursion on area of
contact
• Suggested mechanism
Cutaneous afferent
3/29/2023 PK 47
48. Factors that that alter response
• Patients pre existing muscle tone
• Level of consciousness
• Adequacy of ventilation
• Obesity
3/29/2023 PK 48
49. General effects of all the procedure
• Changes in breath sound as determined by
auscultation have been noted with all
procedure
• Some patients appear to become improved
from level of unconscious during respiratory
facilitation
• Response such as fluttering eye lids , head
movements, spontaneous movements ,
opening of eyes
3/29/2023 PK 49
50. Contra indications
• Abdominal co-contractions is avoided in
patients with decerebrate rigidity, young
children
• Inter costal stretch in fractured rib
• In children except peri oral stimulation all
others procedures are contraindicated
3/29/2023 PK 50
51. Incentive Spirometry (IS) or Sustained
Maximal Inspiration (SMI)
• Most widely used form of lung expansion
therapy.
• Mimics a natural sigh by encouraging the
patient to take a deep breath.
• Helps avoid atelectasis and pneumonia.
3/29/2023 PK 51
53. • Incentive spirometry is to facilitate a sustained
slow deep breath involves the patient take a
sustained maximal inspiration (SMI).
• An SMI is a slow, deep inspiration from the
Functional Residual Capacity up to the total
lung capacity followed by ≥5 seconds breath
hold.
3/29/2023 PK 53
54. Types
• Flow oriented – mediflow& triflow
• Volume oriented – cough spirometer& volydyme
Volume calculation by flow spirometer
Flow= volume/time
Volume= flow * time
Eg- rising 1 ball for 1sec
Volume = 600* 1 = 600 ml
Rising 1st ball upon half in the 1st column for 1 sec
Volume = 600/2* 1= 300 ml
Raising 11/2 ball for 2 sec ( 900/1.5 *2= 450
3/29/2023 PK 54
55. Guideline
• Therapist demonstrates prescription of uses
and cleaning advice based on manufacturers
instructions.
• Patient should be in a relaxed position suitable
for deep breathing (e.g. sitting upright in a
chair or side lying if extra volume is required
in one lung due to ventilation perfusion
matching).
3/29/2023 PK 55
56. • Patient creates a tight seal around the
mouthpiece and inhales deeply and slowly.
• The patient watches the flow meter for visual
feedback. If possible the patient sustains the
inhalation to create an end-inspiratory hold.
Ideally, the inhalation is sustained for 4-5
seconds.
• Patient relaxes seal around the mouthpiece and
exhales; normal breathing is resumed with
relaxed shoulder girdle.
3/29/2023 PK 56
57. Indications
• Pre-operative screening of patients at risk of postoperative
complications to obtain a baseline of inspiratory flow and
volume
• Presence of pulmonary atelectasis
• Conditions predisposing to atelectasis such as:
– Abdominal or thoracic surgery[
– Prolonged bed rest
– Surgery in patients with COPD
– Presence thoracic or Abdominal binders
– Lack of pain control
• Restrictive lung disease associated with a dysfunctional
diaphragm or involving respiratory musculature
• Patients with inspiratory capacity less than 2.5 liters
• Patients with neuromuscular disease or spinal cord injury
3/29/2023 PK 57
58. Contraindications
• Patients who cannot use the device appropriately or
require supervision at all times
• Patients uncooperative
• pediatrics with developmental delay
• Hyperventilation
• Hypoxaemia secondary to interruption of oxygen
therapy
• Fatigue
• Patients unable to take deep breathe effectively due to
pain, diaphragmatic dysfunction, or opiate analgesia.
• Patients who are heavily sedated or comatose
• The device is not suitable for people with severe
dyspnoea
3/29/2023 PK 58
59. Precautions
• The technique is inappropriate major lung
collapse or consolidation.
• Hyperventilation
• barotrauma in emphysematous lung
• secondary to uncontrolled pain.
• bronchospasm
3/29/2023 PK 59
60. IPPB
• Therapeutic application, usually via a mask or
mouthpiece of inspiratory positive pressure to
the airway of a spontaneously breathing
patient on an intermittent
• Short-term use is for purposes of assisting
ventilation
3/29/2023 PK 60
61. IPPB
intermittent positive pressure breathing /
ventilation
• Non invasive, Pneumatic devices that involves
the patient triggering the delivery of a positive
inspiratory pressure breath during inspiration
& expiration .
• Once triggered, the IPPB machine will deliver
a positive inspiratory breath to the patient
based on the set peak airway pressure
• intermittent treatments usually last 15 to 20
minutes given several times each day.
3/29/2023 PK 61
63. Physiologic effects of IPPB
• An increase in mean airway pressure
• A decrease in the work of breathing (WOB)
• Manipulation of the inspiratory-expiratory
ratio
• Increase in tidal volume (VT)
• Correct atelectasis
3/29/2023 PK 63
64. Indications
• Removal secretions ( IPPB)
• To improve lung expansion (IPPV)
• To provide short-term ventilatory support
• To aid in the delivery of aerosolized drugs
3/29/2023 PK 64
69. CPAP
• Continuous positive airway pressure
• Non invansive
• Positive pressure is given during both
inspiration & expiration
• Ip=Ep, CPAP is given spontaneously breathing
patients who cannot perform incentive
spirometry
• Cpap given through face mask
• Flow constant inspiration and expirations
3/29/2023 PK 69
71. Effects
• Increased FRC
• Improve gas exchange
• Delay the need of intubation
• Prevention of atectasis
• Re-expansion of collapsed alveoli
3/29/2023 PK 71
75. PEEP
Defined as that positive pressure which is
applied during the end of expiration – which
increases the end expiratory pressure to more
than atmospheric pressure.
Often used to improve patient’s oxygen status
especially in patients with refractory
hypoxemia.
3/29/2023 PK 75
77. Indications of PEEP :
1. Refractory hypoxemia to any cause
2. Intra pulmonary shunts
3. Decreased FRC & lung compliance
3/29/2023 77
PREMKUMAR
78. Refractory hypoxemia:
Hypoxemia which responds poorly to moderate to
high levels of oxygen (FiO2 = 1)
Useful clinical guide is a PaO2 -60mm Hg or less at
FiO2 = > 0.5
3/29/2023 78
PREMKUMAR
79. • Intrapulmonary Shunts & hypoxemia : Caused
by decreased FRC, atelectasis, V/Q mismatch.
• Decreased FRC & lung compliance: PEEP, here
increases FRC and decreases the work of
breathing, hence improves the symptoms.
3/29/2023 PK 79
80. PHYSIOLOGY OF PEEP:
• Positive pressure at the end of expiration ->
reinflates the collapsed alveoli -> maintains
the alveolar inflation even during expiration ->
increases FRC -> improves ventilation.
• Once the recruitment of these alveoli has
occurred, PEEP lowers the alveolar distending
pressure and facilitates the gas diffusion and
oxygenation.
3/29/2023 PK 80
81. Auto PEEP:
• Incomplete expiration prior to the initiation of
the next breath causes progressive air
trapping (hyperinflation).
• This accumulation of air increases alveolar
pressure at the end of expiration
• which is referred to as auto-PEEP or intrinsic
PEEP.
3/29/2023 PK 81
82. • Auto-PEEP develops commonly in high minute
ventilation(hyperventilation), expiratory flow limitation
(obstructed airway) and expiratory resistance (narrow
airway).
• The PEEP value range commonly used ranges from 5-10
cm H2O, though the upper limit has been posted at 20
cm H2O.
• Levels above that is associated with increased
incidence of complications especially barotrauma. PEEP
is increased at the rate of 2-3cm H2O depending on the
clinical condition of the patient.
3/29/2023 PK 82
83. Complications of PEEP
1. Decreases venous return
2. Decreased cardiac output
3. Barotrauma
4. Increased intra cranial pressure
5. Alters renal metabolism and water balance
3/29/2023 PK 83
85. Fixed orifice flow resistor PEP therapy
• Patients exhales through a fixed orifice flow
resistor.
• The patient is taught to exhale actively but not
forcefully through the flow resistor.
• This positive expiratory pressure (5-25 cmH20)
helps to keep the airways open through
exhalation, thus lengthening the expiratory
phase.
3/29/2023 PK 85
87. Mechanism
• Administration of + ve pressure allows air to
enter behind the area of mucus obstruction and
keep the airways open during exhalation
• PEP therapy does not utilize a pressurized gas
source, it is dependant upon the expiratory flow
rate of the patient.
• Can accommodate virtually any patient’s lung
capacity.
• May be used with a mask or mouthpiece with a
nebulizer for bronchodilator therapy.
3/29/2023 PK 87
88. Techniques
• Patient sitting leaning forward with elbow
supported on table
• Exhalation through mouth piece / mask
• Breathing cycle rapid 10-20 times , instruct at
end to do huff
• limitation is patient cooperation and ability to
follow directions
3/29/2023 PK 88
89. FLUTTER
MECHANISM
• Vibration applied to the airways facilitates the
losing secretion
• Increase bronchial pressure and avoid air
trapping , expiratory airflow facilitates upward
movements of mucus
3/29/2023 PK 89
90. Stages of flutter
• Stage1- mucus mobilization & loosening
• Stage 2- mucus elimination by cough or huff
3/29/2023 PK 90
91. Acapella
• Principal of PEP & FLUTTER delivered with
nebuliser
• 2 types * green 15 l/m for > 3 sec
• Blue 15l/m min 3 sec
3/29/2023 PK 91
92. • Patient position – Patient sitting instructed to
breath out 3-4 sec
• perform breath then ask pt to cough /huff
3/29/2023 PK 92
94. Indication PEP, FLUTTER& ACAPELLA
• To reduce air trapping in asthma& copd
• To Aid mobilize retrained secretion
• To Prevent or reverse atlectasis
• To optimize deliver of bronchodilator
Contraindication & hazards - same to IS& IPPB
3/29/2023 PK 94
96. Chest physiotherapy
• CPT is a form of bronchial hygiene which
includes postural drainage ,autogenic
drainage, deep breathing exercises, manual
chest percussion and active cycle breathing
techniques
3/29/2023 PK 96
97. Chest Physiotherapy techniques
• Airway clearance techniques
• Facilitating airway clearance technique with
effective coughing techniques
• Technique to facilitate ventilation pattern
• Mobilization and Exercises
3/29/2023 PK 97
98. Airway Clearance Techniques
Chest Physiotherapy or CPT
• Postural Drainage
• Chest Percussion
• Chest Vibration
• Turning/Positioning
• Deep Breathing Exercises
• Active cycle of breathing technique
• Autogenic drainage
• Positive expiratory pressure
• High frequency chest compression
• Coughing
CPT consists of 2 separate mechanisms
• Mucociliary Clearance
• Cough Clearance
3/29/2023 PK 98
99. Postural Drainage
• PDis a technique in which different positions are
assumed to facilitate the drainage of secretions
from the bronchial airways.
• Gravity helps to move the secretions to the
trachea to be coughed up easily.
• The goal of postural drainage is to help drain
mucus from the affected lobes into the larger
airways of the lungs so it can be coughed up
more readily.
3/29/2023 PK 99
101. …Postural drainage
• All the patients do not require postural
drainage for all the lung segments. So the
procedure must be based on the clinical
findings.
• In postural drainage, the person is tilted or
propped at an angle to help drain secretions
from the lungs.
3/29/2023 PK 101
103. …Postural Drainage
• Postural drainage treatments are scheduled
two or three times daily, depending on the
degree of lung congestion.
• The best times include before breakfast,
before lunch, in the late afternoon, and before
bedtime.
• It is best to avoid hours shortly after meals
because postural drainage at these times can
be tiring and can induce vomiting
3/29/2023 PK 103
104. …Postural Drainage
• Help the patient assume the appropriate
position, based on the lung field that requires
drainage.
3/29/2023 PK 104
105. ….Postural Drainage
• After positioning the client Have the patient
remain in the desired position for 10 to 15
minutes, if tolerated.
• Perform percussion and vibration by keeping
the client in position.
• The sequence for chest physiotherapy is
usually as follows:
Positioning, percussion, vibration, and removal
of secretions by coughing or suction
3/29/2023 PK 105
106. Chest percussion
• Chest percussion involves rhythmically
clapping on the chest wall over the area being
drained to force secretions into larger airways
for expectoration.
• Position the hand so the fingers and thumb
touch and the hands are cupped
3/29/2023 PK 106
107. …..Percussion
• Perform chest percussion by vigorously
striking the chest wall alternately with cupped
hands. begin with non dominant hand
• The procedure should produce a hollow sound
and should not be painful.
• Perform percussion over a single layer of
clothing, not over buttons or zippers.
3/29/2023 PK 107
108. • Percussion is contraindicated - patients with
bleeding disorders, osteoporosis, fractured ribs
and open& unhealed wounds .
• Precautions over the spine, sternum, stomach or
lower back as trauma can occur to the spleen,
liver, or kidneys.
• Typically, each area is percussed for 30 to 60
seconds several times a day.
• If the patient has tenacious secretions, the area
must be percussed for 3-5 minutes several times
per day.
3/29/2023 PK 108
111. Vibration
• Vibration is a gentle, shaking pressure applied
to the chest wall to move secretions into larger
airways.
• The uses rhythmic contractions and relaxations
of arm and shoulder muscles over the patient’s
chest.
• During vibration, place your flat hand firmly
against the chest wall, on the appropriate lung
segment to be drained.
• Vibrate the chest wall as the patient exhales
slowly through the pursed lips.
3/29/2023 PK 111
112. …..Vibration
• After each vibration, encourage the client to
cough and expectorate secretions into the
sputum container.
3/29/2023 PK 112
114. AMBU- Air Mask Bag Unit
• A bag valve mask, abbreviated to BVM and
sometimes known by the proprietary name
Ambu bag or generically as a manual
resuscitator or "self-inflating bag", is a hand-
held device commonly used to provide
positive pressure ventilation to patients who
are not breathing or not breathing adequately
3/29/2023 PK 114
115. • Inflating the lung with oxygen and manual
compression to total volume (Vt) of liter
requiring a peak inspiratory pressure of b/n 20
and 40 cmH20
• Providing a larger Vt than baseline Vt to the
patient and using a Vt which is 50% greater
than that delivered by the ventilator
3/29/2023 PK 115
116. Manual ventilation
Squeezing gas into the patients lungs at tidal
volume
For eg when changing ventilator tubing
Manual hyper ventilation
Delivers rapid breaths
For eg if patient is hypercapnic
3/29/2023 PK 116
117. Indication
• To help clinical assessment of air entry into
lungs
• To improve oxygenation pre and post
suctioning
• To mobilize excess bronchial secreation
• To re-inflate areas of collapsed lungs
• To maintain ventilation when mechanical is
interupted
3/29/2023 PK 117
118. Techniques
• Mapleson circuit-absence of valves to direct
from or to the patient
• When inspiratory gas flow exceeds fresh gas
flow rebreathing occurs
• Self inflating bag-has inbuilt valve that’s
prevent rebreathing
3/29/2023 PK 118
119. Feedback
• Manual hyper inflation may increase the risk
of trauma if high peak airway pressure and
volumes are delivered
• It should be >20 cmH2o to be clinically
effective and < 40 cm H2o to prevent baro-
trauma
3/29/2023 PK 119
120. Effects
• BENEFICIAL EFFECTS
Increase static compliance
Increase removal of secretion
• ADVERSE EFFECTS
Decrease cardiac output – increase intrathoracic
volume causes decrease venous return by
compression great veins
Increase intracranial pressure - increase
intrathoracic volume causes decrease venous
return – cause increases stasis in brain
3/29/2023 PK 120
121. Precaution & CI
• PC- Fall CO, Barotrauma, severe
bronchospasm
• CI- Unstable cvs, pneumothorax, hypoxia
3/29/2023 PK 121
122. Ventilator sign mode vs MH
• A sign mode is perferred in a ventilated
patient instead of AMBU bag
• To get better result 1- PT will do AMBU & 1 –
PT will do chest physio & suctioning
• To expand the lung –slow inspiration hold
• To remove secretion – faster expiratory flow
with short inspiratory time
3/29/2023 PK 122
123. Documentation
• Following chest physiotherapy , the should
auscultation the client’s lungs, compare the
findings to the baseline data, and document
the amount, color, and character of
expectorated secretions.
3/29/2023 PK 123
124. ACBT
• ACBT are a specific set of breathing exercises
designed to remove excess bronchial
secretions
• Combinations of breathing control, thoracic
expansion control and FET
3/29/2023 PK 124
125. Active cycle of breathing technique
3/29/2023 PK 125
Breathing control
Thoracic expansion
FET
128. Breathing control
• relaxed breathing between manoeuvre efforts
• Shoulders relaxed, gentle breathing with lower chest
• Abdomen should move slightly
3/29/2023 PK 128
129. Thoracic expansion
*Deep breaths in. use a three-second breath-hold to
get more air behind the mucus.
• This may be done with chest clapping or vibrating,
followed by breathing control
* Typically limited to 3-4 deep breaths
• Larger lung volume increases airflow through
peripheral airways and collateral ventilation
channels, which increases the gas volume available
to mobilize secretions during expiration.
• Avoid fatigue and hyperventilation.
3/29/2023 PK 129
130. FET
• Combination of manoeuvres described as a
‘milking action’
• Directed Cough
• Forced Huff Exhalation
3/29/2023 PK 130
131. Directed Cough
• Standard procedure
• Deep breath
• Hold, using abdominal muscles to force air against a
closed glottis
• Cough with single exertion
• Several relaxed breaths before next effort
3/29/2023 PK 131
132. • 3-5 slow, deep breaths, inhaling through nose, exhaling
through pursed lips, using diaphragmatic breathing.
• Deep breath and hold for 1-3 seconds
• Exhale from mid-to-low lung volume.
• Normal breath in squeeze it out by contracting the
abdominal and chest wall muscles with the mouth
open while whispering the word ‘huff’ during
exhalation. Repeat several times.
• When secretions enter larger airways, exhale from
high-to-mid lung volume to clear secretions
• Repeat process 2-3 times.
• Take relaxed breaths before next efforts
3/29/2023 PK 132
133. ACBT – A High volumes of mucus production
Breathing
Control
Thoracic
Expansion
Exercises
Breathing
Control
Huff
pk 133
Fink, J.B. (2007). Forced Expiratory Technique, Directed Cough and Autogenic Drainage. Respiratory Care, 52(9), p. 1216, Fig. 6.
135. ACBT – C
airway collapse & mucus plugging
Breathing
Control
Thoracic
Expansion
Exercises
Breathing
Control
Thoracic
Expansion
Exercises
Breathing
Control
Huff
Breathing
Control
pk 135
Fink, J.B. (2007). Forced Expiratory Technique, Directed Cough and Autogenic Drainage. Respiratory Care, 52(9), p. 1216, Fig 6.
Repeat
Forced
Expiratory
Technqiue
136. Equipment
• Patient or care givers hands to percuss or
shake vibrate the chest wall during thoracic
expansion used.
- Mechanical percussors or vibrations may be
required
- If PD positions are used equipment for
positioning will be required
- To teach huffing maneuver
Peak flow meter mouth piece may be used –
game of huffing at the cotton balls
• ‘Chicken breath’
3/29/2023 PK 136
137. Advantages
1.Patient can actively participate in secretion
moblisation
2. Independently managing airway clearance
3. Technique may be adapted for patients with
gastro oesophagial reflex, bronchospasm and
acute exacerbation of pulmonary disease
4. Decrease in oxygen saturation caused by
chest percussion can be avoided by ACBT
5. Cost of ACBT is minimal.
3/29/2023 PK 137
138. Disadvantages
• young children and extremely ill adults a care
giver will be necessary to assist the patient
this technique
• care must be taken to adapt technique in
patient with hyperactive airways
3/29/2023 PK 138
140. Autogenic Drainage
• It’s an airway clearance technique characterized
by breathing control, where the person adjusts
the rate, depth, and location of respiration to
clear chest secretions independently.
• Aim of breathing is to achieve highest possible
expiratory flow simultaneously in different
generations of the bronchi, keeping bronchial
resistance low, and avoiding bronchospasm and
dynamic airway collapse.
3/29/2023 PK 140
141. • Important to note, this technique requires a
great deal of patient cooperation, and is
recommended for patients >8yrs old who have
a good sense of their own breathing, and can
actively participate in the process. Very
difficult clearance technique to master, but
well worth the time and effort to learn.
3/29/2023 PK 141
142. Preparation & Position
• Clear upper airways, ie, nose & throat –
huffing or coughing
• Take prescribed nebulizers or inhalers
• Find comfortable, unrestricted position
pk 142
143. Inspiration
• Performed slowly, through the nose
• Held for 2-4 seconds
• Up to twice the size of normal tidal breath
pk 143
144. Expiration
• Active, silent sigh
• At least as long as inspiration, but exhaling a
little longer helps to achieve low lung volume
stage
• Urge to cough should be suppressed until
secretions are high enough to expectorate
successfully
• Utilize controlled cough or huff for
expectoration
pk 144
145. The process
• ‘unstick’ – low volume breathing
• ‘collect’ – breathe based on frequency
vibrations
• ‘evacuate’ – only when secretions have made
their way to upper/central airways or mouth
pk 145
Agostini, P. & Knowles, N. (2007) Autogenic drainage: the technique, physiological basis and evidence. Physiotherapy, 93, p. 159.
150. Contraindications
• Intracranial pressure (ICP) > 20 mm Hg
• Head and neck injury until stabilized
• Active hemorrhage with hemodynamic instability
• Recent spinal surgery (e.g .• laminectomy) or acute spinal
injury
• Active hemoptysis Empyema
• Bronchopleural fistula
• Large pleural effusions
• Pulmonary embolism
• Aged, confused, or anxious patients
• Rib fracture. with or without flail chest
• Surgical wound or healing tissue
3/29/2023 PK 150
151. Trendelenburg Position is Contraindicated
• Patients in whom increased ICP is to be
avoided
• Uncontrolled hypertension
• Distended abdomen
• Esophageal surgery
• Recent gross hemoptysis related to recent
lung carcinoma
• Uncontrolled airway at risk for aspiration
3/29/2023 PK 151
152. • Subcutaneous emphysema
• Recent epidural spinal infusion or spinal anesthesia
• Recent skin grafts, or flaps, on the thorax
• Burns.
• open wounds. and skin infections of the thorax Recently
placed pacemaker
• Suspected pulmonary tuberculosis
• Lung contusion
• Bronchospasm
• Osteomyelitis of the ribs
• Osteoporosis
• Coagulopathy Complaint of chest-wall pain
3/29/2023 PK 152
153. Treatment prescription.
• Motivation
• Patient’s goals
• Physician/caregiver’s goals
• Effectiveness ( of considered technique
• Patient’s age
• Ease (of learning and of teaching)
• Skill of therapist/teachers
• Fatigue or work required
• Need for assistants or equipment
• Limitations of technique based on disease type and
severity
• Costs (direct and indirect)
• Desirability of combing methods
3/29/2023 PK 153
154. Facilitating airway clearance with
effective coughing technique
• What is cough….???
• Stages of cough
• Techniques of teaching effective coughing
self assisted coughing
manual coughing
3/29/2023 PK 154
160. Technique to facilitate ventilation
pattern
• Body positioning
• Breathing technique
• Mobilizing the thorax
• Facilitating the accessory muscles of
respiration
3/29/2023 PK 160
161. Body positioning
• Standing upright position
• Erect sitting (self supported or with assist) with feet moving
(e.g., active, active assisted or passive cycling motion)
• Erect silting (self-supported or with assist) with feet
dependent
• Lean forward sitting with arms supported and feet
dependent
• 24S degree sitting with legs dependent
• Erect long sitting (legs non dependent)
• < 4S degrees sitting (legs non dependenl)
• Prone and semi prone/side lying
• Supine
3/29/2023 PK 161
162. Breathing exercise
• BE also called as ventilatory training.
• Levenson classified breathing exercise into 3
categories:
1. BE includes to increase lung volume& capacities
( FRC), redistribute ventilation& gas exchange
Outcomes
• Improve ventilation& gas exchange
• Decrease work of breathing
• Maintain or improve chestwall mobility
• Prevent pulmonary compromise
3/29/2023 PK 162
163. 2nd category BE includes improve strength,
endurance& efficiency of ventilatory muscle
3rd category of BE includes to decrease the work
of breathing and facilitation of relaxation
3/29/2023 PK 163
172. Mobilization and exercises
• Mobilization is defined as the therapeutic and
prescriptive application of low-intensity exercise in the
management of cardiopulmonary dysfunction usually
in acutely ill patients.
• Primarily, the goal of mobilization is to exploit the
acute effects of exercise to optimize oxygen transport.
• Even a relatively low intensity mobilization stimulus
can impose considerable metabolic demand on the
patient with cardiopulmonary compromise.
3/29/2023 PK 172
173. • In addition, mobilization is performed in the
upright position, that is the physiologic
position, whenever possible,
• to optimize the effects of being upright on
central and peripheral hemodynamics and
fluid shifts.
• Thus mobilization is prescribed to elicit both a
gravitational stimulus and an exercise stimulus
3/29/2023 PK 173
174. exercise
• What are the exercises given-Exercise is the
term used to describe the therapeutic and
prescriptive application of exercise in the
management of subacute and chronic
cardiopulmonary and cardiovascular
dysfunction. Primarily, the goal of exercise is
to exploit the cumulative effects of and
adaptation to long-term exercise and thereby
optimize the function of all steps in the
oxygen transport pathway.
3/29/2023 PK 174
175. Treatment prescription for
mobilization and exercises
• It depends on the patient’s condition
• Whether the patient is in patient or in out
patient department
• Also it depends on the functionality of the
patient at the present stage
• It is decided on the basis of the exercise
testing protocol
• Also on the basis of METs
3/29/2023 PK 175
177. • Step 1
Identify all the factors underlying the pathology
causing deficits in oxygen supply.
• Step 2
Determine whether mobilization and exercise are
indicated and if so, which form of either will
specifically address the oxygen transport deficits
identified in Step I.
3/29/2023 PK 177
178. 3/29/2023 PK 178
Step 3
Match the appropriate mobilization or exercise
stimulus to patient's oxygen transport capacity.
Step 4
Set the intensity within therapeutic and safe
limits of the patient's oxygen transport
capacity.
Step 5
Combine the various body positions especially
in the erect position with the following
maneuvers:
179. • Step 6
Set the duration of the mobilization sessions based on the
patient's responses (i.e., changes in measures and
indices of oxygen transport) rather than time.
• Step 7
Repeat the mobilization session as often as possible
based on its beneficial effects and on is being safely
tolerated by the patient.
• Step 8
Increase the intensity of the mobilization stimulus.
duration of the session, or both comml!l1surate with
the patient's capacity to maintain optimal oxygen
transport when confronted with an increased
mobilization stressor, and in the absence of distress;
monitored variables to remain within predetermined
threshold range.
3/29/2023 PK 179
180. Heiarchy of treatment for oxygen
supply treatment
• PREMISE: Position of optimal physiological function is
being upright and moving. Mobilization and Exercise
• Body Positioning
• Breathing Control Maneuvers
• Coughing Maneuvers
• To minimize the work of breathing. of the heart. and
oxygen demand overall
• ROM Exercises (Cardiopulmonary indications)
• Postural Drainage Positioning
• Manual Technique
• Suctioning
3/29/2023 PK 180
181. Parameters for treatment prescription
in the management of
cardiopulmonary patients
• Define parameters of treatment based on history,
laboratory investigations, tests, and assessment
• Treatment type
• Intensity (if applicable)
• Duration
• Frequency
• Instruct patient in "between treatment" treatment,
and if applicable the nurse. a family member. or both
• Reassessment every treatment
• Modify as necessary within each treatment
• Progress between treatments as indicated
3/29/2023 PK 181
182. • Define treatment outcomes
• Determine when treatment is to be discontinued
• Request for additional supportive information. tests,
and investigations as indicated
• Predict time course for optimal effects and course of
treatment to determine treatment efficacy; modify as
necessary
• In conjunction with other interventions (e.g., medical,
surgical, nursing, respiratory therapy (weaning oxygen
supplementation.
• sympathomimetic drugs, ADLs, balance with sleep and
rest periods. peak of nutrition and feeds. Peak energy
times. peak of drug potency and effects (e.g., pain,
reduced sedation. reduced neuromuscular blockade)
3/29/2023 PK 182
183. references
• Principles and practice of cardiopulmomary
physical therapy 3rd edition Donna Frownfelter
• Tidy’s physiotherapy
• Physiotherapy for respiratory and cardiac
problems 3rd edition by Jenifer A Pryor
3/29/2023 PK 183
May benefit patients with high volumes of mucus production, but without much airway hyperreactivity, atelectasis, or plugged airways – cycle of breathing control, thoracic expansion exercises, breathing control, FET, and then repeating back to breathing control, thoracic expansion exercises, and on and so on.
Bronchospastic patients – longer period of breathing control.
For people with airway plugging, atelectasis, and some reactive airway disease, additional breathing control and thoracic expansion exercises may provide greater benefit.
Chevaillier suggested a ‘breath-stimulating’ position – ie where the client/patient is comfortable, and their breathing is not restricted.
‘unstick’ – instruct pt to breathe out as far as possible, and then to breathe the functional tidal volume in and out
‘collect’ – pt needs to change volumes at which they breathe – essentially collecting the secretions based on frequencies they hear when breathing – secretions in the peripheral airways vibrate at a high frequency, as opposed to more central secretions which have a reduced frequency. This requires some coaching, and intentional focus on pt’s part. Also requires substantial feedback to the patient – they need to learn how to control volume and flow ranges in their breath so they become attuned to auditory frequency changes (or turbulence) and can modulate their breathing accordingly.
Autogenic drainage is a learned art of finding the correct balance of forces. It requires intentional time and attention, but once learned, equips a person to manage their condition much more independently.