airway clearance feb 2011

8/4/2019 Airway Clearance Feb 2011

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Esther O¶Flaherty,

Physiotherapy

Feb 2011



yAnatomy

y Physiology

y Physiotherapy

y Positioning

y Percussion

yClearance



Aims of

Cleara

nce

yRemove secretions

yIncrease gas exchange

yDecrease Work of Breathing (WOB)

yPatient self management



Anatomyy 3 lobes right and 2 lobes left.

y Right main bronchus more vertical

yCilia from the 23r d division upwar ds

y Diaphragm 55 % inspiration

y Humidification in upper airways



Physiologyy Gas exchange lower airways

y Goblet cells mucous

yCilia propelling 2 layer sputum

yCrowd surfing

http://www.youtube.com/watch?v=NSXbb5KZl_I



Physiotherapy

y Gravity assisted positioning

y Percussion

yVibrations

� Peak cough flow

yMucous clearance

yCough



Positioning

y Position accor ding to auscultation and areas of atelectasis or sputum consolidation.

y The inclusion of head down tilt improves PEFR in ventilated patients. Ber ney and Denehy 2004



PositioningyCOPD Diaphragm is in a poor position.

y Elongated, Type I (fast twitch)

y Poor length tension relationship.

y Needs to contract to ventilate.

y Load the anterior aspect of the diaphragm.

y Position the patient with legs flexed

y Increased dome of the diaphragm.



Peak Cough Flow (PCF)y Peak Cough Flow (PCF)

y 160 L/min sufficient to expel debris from airway.Bach et al 1996

y Normal 700 l/min Decreases by 10% cold.

y COPD diaphragm drops down, thoracic cage opened up.

y Increased Resp rate««.

y Decreased peak expiratory flow rate (PEFR)

y ««««««....this decreases ventilation!!



PercussionyUnequal air flow velocity produce unequal shear

forces in opposing directions, and enhances liquid

layer movement in the greater flow direction.Kim et al 1987

y Percussion increases shear forces on the liquid

layer within the bronchial tree.

y Enhancement of the gas liquid interaction assist in

movement of secretions towar ds the larger central

airways. Wong & Paratz 2003



Vibrationsy Fine tremorous action applied to the chest wall

y Enhances Peak Expiratory Flow rate (PEFR).

yChest wall Vibs 58.2 L/min McCarren et al,2006

yChest wall

Vibs 80L/mi

n Shann

on

et al, 2006

yPEFR significantly increased with VibsShannon et al, 2010



Clearancey ³Forced expirtory techniques (FETs) are the probably the most effective part of chest physiotherapy´ Van der Schanns 1997

yACBT

yBreathing control, deep breathing, Huff (FET)

y !!!!! NB!!!!! FET with an Open Glottis

y Not to end expiration or with wheeze

yAirways at closi

ng volume



Self ManagementyBreathing exercisesyPositions of ease,

rest upper limbs for

support.

y Control of breathing

y Pursed lip breathingThe patient may

have already adopted

this method of breathing.



Clearance TechniquesTeach breathing control with a slow inspiration, and

slightly faster expiration



Incentive spirometer

y Provide some positiveexpiratory pressure(PEP)

y Oscillating with PEP

y Prevents airway collapse

y Increase airway clearance(Newhouse µ98, Volsko 2003)



Conclusion

yAssessment, locate secretions

yPosition appropriatelyyAim for Crowd surfing

yManual techniques increase

Peak expiratory flow rate

yAssist in Chest Clearance



Key messageyAchieved Aims

yRemoved secretions

yDecreased WOB

y Increase gas exchange

y Patient self management

yHopefully yes!

yMeasurements either y Exercise tolerance

y MR C dyspnoea scale

y or borg with exercise



Thank you&

Questions



2 phase gas liquid flow Insp/Exp

airway clearance feb 2011

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