bronchial hygiene therapy ret 2275 respiratory therapy theory 2
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Bronchial Hygiene Therapy
RET 2275
Respiratory Therapy Theory 2
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Bronchial Hygiene
Bronchial hygiene therapy involves noninvasive airway clearance techniques to help mobilize secretions and improve gas exchange
Reading AssignmentEgan’s Fundamentals of Respiratory Care
NINTH EDITION (pgs. 921-932)
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Bronchial Hygiene
Normal clearance Normal airway clearance requires a(an)
Patent airway Functional mucocilary escalator Effective cough
An effective cough can effectively move mucus from the lower airways to the upper airway.
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Bronchial Hygiene
Normal clearance
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Bronchial Hygiene
Abnormal clearance Abnormalities in airway patency, mucuciliary function,
strength of breathing muscles, or cough reflex can lead to mucus retention.
Mucus plugging can lead to atelectasis, pneumonia, and hypoxemia.
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Bronchial Hygiene
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Bronchial Hygiene
Diseases associated with abnormal clearance Internal or external compression of an airway lumen
(e.g., asthma, lung cancer)
Cystic fibrosis
Bronchiectasis
Neuromuscular diseases can cause a weak cough.
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Bronchial Hygiene
General Goals and Indications Bronchial hygiene therapy for acute conditions
1. Acutely ill patient with copious secretions
2. Patient in acute respiratory failure with clinical signs of retained secretions
3. Patient with acute lobar atelectasis
4. Patient with hypoxemia due to lung infiltrates
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Bronchial Hygiene
General Goals and Indications (cont.) Bronchial hygiene therapy to prevent retention of
secretions May be useful in acutely ill patients when combined with
patient mobilization
Cystic fibrosis patients benefit from chest physical therapy combined with exercise to maintain lung function.
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Bronchial Hygiene
Determining Need for Bronchial Hygiene Therapy Bedside findings such as
Loose, ineffective cough Labored breathing pattern Coarse inspiratory and expiratory crackles Tachypnea/tachycardia Fever
The chest radiograph demonstrating atelectasis and infiltrates
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Bronchial Hygiene
Bronchial Hygiene Methods1. Postural drainage therapy
2. Coughing and related expulsion techniques
3. Positive airway pressure (PAP)
4. High-frequency compression/oscillation
5. Mobilization and exercise
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Bronchial Hygiene
Postural drainage therapy Involves the use of gravity
and mechanical energy to mobilize secretions
Includes turning, postural drainage, and percussion and vibration
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Bronchial Hygiene
Postural drainage therapy Indications
Inability or reluctance of patient to change position Poor oxygenation associated with position (e.g.,
unilateral lung disease) Potential for or presence of atelectasis Evidence or suggestion of difficulty with secretion
clearance Difficulty clearing secretions, with expectorated
sputum production >25 – 30 ml/day (adult)
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Bronchial Hygiene
Postural drainage therapy Indications (cont.)
Evidence or suggestion or retained secretions in the presence of an artificial airway
Diagnosis of diseases such a cystic fibrosis, bronchiectasis, or cavitating lung disease
External Manipulation of the Thorax Sputum volume or consistency suggesting a need for
additional manipulation (e.g., percussion and/or vibration to assist movement of secretions by gravity in a patient receiving postural drainage
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Bronchial Hygiene
Postural drainage Turning
Primarily done to promote lung expansion, improve oxygenation, and prevent retention of mucus
Proning has been used in patients with acute lung injury to improve lung function.
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Bronchial Hygiene
Postural drainage Turning and “Plumbing Problems”
Ventilator disconnection Accidental extubation Accidental aspiration of ventilator
circuit condensate Disconnection of vascular lines or
urinary catheters – ouch!
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Bronchial Hygiene
Postural drainage (cont.) The process placing the
patient in various positions to drain specific segmental bronchi
Positions are typically held for 3 to 15 minutes.
Most effective in patient with excessive mucus secretion
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Patient positions for Postural Drainage
Postural Drainage
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Bronchial Hygiene
Postural Drainage Monitoring
Subjective response to pain Pulse, arrhythmia, and ECG if available Breathing pattern and rate Sputum production Mental function Skin color Breath sounds Blood pressure SpO2 ICP
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Bronchial Hygiene
Postural drainage Outcome assessment
Change in sputum production Change in breath sounds Change in dyspnea level Change in vital signs Change in chest radiograph/ABG results Change in ventilator variables
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Bronchial Hygiene
Postural drainage Documentation and follow-up
The chart entry should include The positions used Time in positions Patient tolerance Indicators of effectiveness Any untoward effects observed
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Bronchial Hygiene
Postural drainage Percussion and vibration
The application of mechanical energy to the chest wall by use of the hands or various electrical or pneumatic devices
Designed to aid in movement of mucus toward the central airways
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Bronchial Hygiene
Postural drainage Vibration
Place one hand on the patient’s chest over the involved area and place the other hand on top of the first
Ask the patient to take a deep breath
Exert slight to moderate pressure on the chest wall and initiate a rapid vibratory motion of the hands throughout expiration
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Bronchial Hygiene
Postural Drainage Absolute Contraindications
Head and neck injury until stabilized Active hemorrhage with hemodynamic instability
Relative Contraindications Active hemoptysis Pulmonary embolism Recent spinal surgery Aged, confused, or anxious patients who do not tolerate position
changes
Refer to AARC Clinical Practice Guidelines for complete list
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Bronchial Hygiene
Postural Drainage Trendelenburg position is contraindicated for:
Recent gross hemoptysis ICP >20 mm Hg Uncontrolled hypertension Distended abdomen Patient in whom increased ICP is to be avoided (neurosurgery,
aneurysms, eye surgery) Uncontrolled airway at risk for aspiration (tube feeding or recent
meal) Esophageal surgery
Refer to AARC Clinical Practice Guidelines for complete list
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Bronchial Hygiene
Postural Drainage Complications/Hazards
Hypoxemia Increase ICP Acute hypotension during procedure Pulmonary hemorrhage Pain or injury to muscles, ribs, or spine Vomiting and aspiration Bronchospasm Arrhythmias