This document provides an introduction to respiratory therapy, discussing oxygen therapy, lung expansion therapy, and intubation. It outlines the objectives of oxygen therapy, indications for its use, and types of low-flow oxygen delivery methods. Lung expansion therapy aims to increase lung volume and is demonstrated through incentive spirometry. Intubation establishes an artificial airway and is described through orotracheal intubation, involving assembling equipment, positioning the patient, visualizing the glottis, inserting the tube, and confirming proper placement. Hands-on demonstrations are provided for various respiratory therapy techniques.

1. S A L I S B U R Y U N I V E R S I T Y

2. An Introduction to Respiratory Therapy
Thomas W. Lamey PhD, RRT, AE-C
Fall 2023

3. Today’s Talk

4. Objectives
• Discuss the field of Respiratory Therapy
• Discuss and hands-on demonstration of low-flow oxygen therapy
• Discuss and hands-on demonstration of lung expansion therapy
• Discuss and hands-on demonstration with intubation

5. Oxygen
Therapy
• The overall goal of O2 therapy:
• Maintain adequate tissue oxygenation
• Minimizing cardiopulmonary work
• Clinical objectives for O2 therapy:
• Correct documented or suspected acute
hypoxemia
• Decrease symptoms associated with chronic
hypoxemia
• Decrease the workload hypoxemia imposes on
the cardiopulmonary system

6. Assessing
the Need
for Oxygen
Therapy
Indications
• Documented hypoxemia as evidenced by
• PaO2 less than 60 mm Hg or SaO2 less than 90% in subjects
breathing room air
• PaO2 or SaO2 below desirable range for a specific clinical
situation
• Acute care situations in which hypoxemia is
suspected
• Severe trauma
• Acute myocardial infarction
• Short-term therapy or surgical intervention (e.g.,
postanesthesia recovery)

7. Assessing
the Need
for Oxygen
Therapy
• Precautions and/or possible complications
• PaO2 greater than or equal to 60 mm Hg:
• Ventilator depression may occur rarely in
spontaneously breathing patients with elevated PaCO2
• With FiO2 greater than 0.5:
• Absorption atelectasis, O2 toxicity, or depression of
ciliary or leukocyte function may occur

8. Go with
the Flow
What does it mean to be “low flow”?

9. Nonrebreathing
Mask
• The input flow range for an adult partial
rebreathing mask is a minimum of 10 L/min
to prevent bag collapse on inspiration
• FiO2 range is 0.60 to 0.80
• Prevents rebreathing with one-way valves
• An inspiratory valve sits on top of the bag, and
expiratory valves cover the exhalation ports on
the mask body
• During inspiration, slight negative mask pressure
closes the expiratory valves, preventing air
dilution
• At the same time, the inspiratory valve on top of
the bag opens, providing O2 to the patient
• During exhalation, valve action reverses the
direction of flow

10. Let’s Try
It!

11. Lung
Expansion
Therapy
• Obesity
• Neuromuscular disorders
• Heavy sedation
• Surgery near diaphragm
• Bed rest
• Poor cough
• History of lung disease
• Restrictive chest-wall abnormalities
But Why?

12. Clinical Signs of Atelectasis
• History of recent major surgery
• Tachypnea
• Fine, late-inspiratory crackles
• Bronchial or diminished breath sounds
• Tachycardia
• Increased density and signs of volume loss on chest radiograph
Copyright © 2021 Elsevier, Inc. All Rights Reserved.

13. Lung Expansion Therapy
• All modes of lung expansion therapy increase lung volume by
increasing the transalveolar pressure (PAL) gradient
• PAL gradient can be increased by either:
• Decreasing the surrounding Ppl
• Increasing the Palv
• Baseline assessment
• Early mobilization of the patient
Copyright © 2021 Elsevier, Inc. All Rights Reserved.

14. Incentive
Spirometry
• Has been mainstay of lung expansion
therapy for many years
• IS devices provide visual cues to patient
when desired inspiratory volume of flow is
reached
• Proved to be effective in high-risk patients
• Indications for incentive spirometry
• Presence of pulmonary atelectasis
• Presence of conditions predisposing to
atelectasis
• Upper abdominal surgery
• Thoracic surgery
• Surgery in patients with COPD
• Presence of a restrictive lung defect associated
with quadriplegia or dysfunctional diaphragm
Copyright © 2021 Elsevier, Inc. All Rights Reserved.

15. Incentive Spirometry
• Indications for incentive spirometry
• Presence of pulmonary atelectasis
• Presence of conditions predisposing to atelectasis
• Upper abdominal surgery
• Thoracic surgery
• Surgery in patients with COPD
• Presence of a restrictive lung defect associated with quadriplegia or
dysfunctional diaphragm
Copyright © 2021 Elsevier, Inc. All Rights Reserved.

16. Let’s Try It

17. Intubation
But why?

18. Establishing an Artificial Airway
• Routes
• Pharyngeal airways extend only into pharynx
• Artificial airways placed through mouth and nose into trachea are called
endotracheal tubes
• Intubation: process of placing artificial airway into trachea
• Orotracheal intubation is when tube is passed through mouth on its way into trachea
• Nasotracheal intubation is when endotracheal tube is passed through nose first

19. S A L I S B U R Y U N I V E R S I T Y
Establishing an Artificial Airway
• Procedures
• Orotracheal intubation
• Nasotracheal intubation
• Tracheotomy

20. Pharyngeal Airways
• Nasal pharyngeal airway is most often placed to facilitate frequent
nasotracheal suctioning
• Minimizes damage to nasal mucosa caused by suction catheter
• Oral pharyngeal airway should be restricted to unconscious patient
to avoid gagging and regurgitation
• Maintains patient airway by preventing tongue from obstructing oropharynx
• Can be used as bite block for patients with oral tubes

21. Tracheal Airways
• Two basic types
• Endotracheal tubes are inserted through either mouth or nose, through larynx, and
into trachea
• Tracheostomy tubes are inserted through surgically created opening in neck
directly into trachea
• Specialized endotracheal tubes
• Double-lumen ETT
• Double-lumen airway (Combitube)
• Special ETT adapter
• LMA

22. S A L I S B U R Y U N I V E R S I T Y
Orotracheal Intubation (Part 1 of 2)
• Step 1: Assemble and check equipment
• Step 2: Position patient
• Step 3: Preoxygenate and ventilate patient
• Step 4: Insert laryngoscope
• Step 5: Visualize glottis
• Step 6: Displace epiglottis

23. S A L I S B U R Y U N I V E R S I T Y
Orotracheal Intubation (Part 2 of 2)
• Step 7: Insert tube
• Step 8: Assess tube position
• Tip of tube should be about 3-6 cm above carina
• Step 9: Stabilize tube/confirm placement
• Listen for equal and bilateral breath sounds as patient is being ventilated
• Observe chest wall for adequate and equal chest expansion
• If ET tube in airway, chest CO2 levels begin to rise; seen on capnogram

24. Let’s Try It

25. Intubation
A View

26. Questions?