respiratory therapypreparation is already best respiratory therapy (e.g. blow one`s nose,...
TRANSCRIPT
Anja Raab
Doktorandin Clinical Trial Unit
June 17th of 2016 1
Respiratory therapy
Anja Raab, MSc
Physiotherapist and Phd-student
SPZ Nottwil
June 17th of 2016
Content
2
Basis for an effective respiratory therapy
Posture
Interaction of 3 essential domes
Positioning
Inhalation
Retention of secretion
Coughing
Abdominal binder
Respiratory muscle training
Impressions of respiratory therapy….
June 17th of 2016
Observe…
3
June 17th of 2016
Basis for an effective respiratory therapy….
4
June 17th of 2016 5
June 17th of 2016
Basis for an effective respiratory therapy
6
Ascend of the diaphragm due to obstipation or swollen abdomen
limited movement of the diaphragm
reduced spirometry
Procedure:
defecation
control parameter of ventilation
physical therapy like colon massage
nutrition therapy
medication
drinking quantity
…..
June 17th of 2016
Posture
7
Head
Trunk
Tone
Stability
June 17th of 2016
Interaction of 3 essential domes
8
Glottis (vocal fold) – diaphragm – pelvic floor
Postural control extends from the vocal folds
on top to the pelvic floor on the bottom. (Massery et al., 2013)
The trunk muscles, including the diaphragm,
function simultaneously as postural and
respiratory muscles.(Hodges et al., 2000; Hamaoui et al., 2014; Hudson et al., 2010)
out of Massery et al., 2013
June 17th of 2016 9
Vocal diaphragm
Thoracic diaphragm
Pelvic diaphragm
T
The Breathing Book by Donna Farhi. Owl books 1996 pages 53-58
June 17th of 2016
Positioning
10
Due to the changing of the positions of the body automatically a relocation of
the secretion occurs
Changing of the position every 2-4hours is recommended
Positions need to be comfortable for the patients (Raab AM, 2014)
June 17th of 2016
Inhalation
11
Secretion mobilisation
Preparation for respiratory therapy
Technique:
2 normal breaths
followed by a deep inspiration
and an end-expiratory break
June 17th of 2016
Retention of secretion
12
Mucociliary clearance
functional destroyed
Ciliated epithelium destroyed by: - smoking
- recurring infections
- absent humectation and warming with ventilator
- high inspiratory oxygen-concentration
within 6-24h contaminants can be transported out of the airways by the cilia
June 17th of 2016
Airstacking
13
by…..
nasal stacking (via glottic closure)
resuscitator bag (till maximal insufflation capacity)
glossopharyngeal breathing
Indication:
atelectasis-prophylaxis
to improve inspiratoy volume (e.g. for coughing)
to maintain thorax-mobility
to maintain vital-capacity
Typically dosage is 3-5 trials of manual insufflation followed by augmented coughing. (Cleary et al., 2013)
June 17th of 2016
Retention of secretion
14
Manual techniques
June 17th of 2016
Retention of secretion
15
Manual techniques
June 17th of 2016
Retention of secretion
16
Manual techniques
June 17th of 2016
Retention of secretion
17
Manual techniques
June 17th of 2016
Acapella® for management of secretion
(Mueller et al., 2013)
18
June 17th of 2016
Coughing
19
to increase intra-abdominal pressure
secretion needs to be proximal
time-point for coughing fatigue!
June 17th of 2016
Assisted coughing with 1 person
20
June 17th of 2016
Assisted coughing with 2 persons
21
June 17th of 2016
Peak Cough Flow
22
< 160 l/min
associated with problems by
extubation/decanulation(Bach and Sapporito, 1996)
<270 l/mincough support necessaryesp. with resp. infections
(Boitano et al., 2006)
>270 l/min
2324.06.2016
Abdominal binder
June 17th of 2016
Abdominal binder
24
June 17th of 2016
Abdominal binder
25
Abdominal muscles: paralyzed or weak?
the diaphragm goes down
the position for the inspiration is not optimal
Abdominal binder improves the mechanic of respiration
•the abdominal binder increases the intra-abdominal pressure
•the diaphragm will be pressed towards cranial direction
•increased tension of the diaphragm
•improved position for the inspiration (Urmey W. et al. 1986, Brown B. 2006)
June 17th of 2016
Abdominal binder
26
improved coughing (peak expiratory flow / peak cough flow)
(Julia et al., 2011)
improved lung function (FVC, VC, FEV1, PImax, PEmax)
(West et al., 2012; Wadswort et al., 2012)
voice (longer sound pressure level) (Wadswort et al., 2012)
Important: Abdominal binder tighten closely!
June 17th of 2016
Respiratory resistance training
27
Training of the respiratory muscles with high intensity and low volume! (Müller et al., 2013; Raab et al., 2016 ready for submission)
Indication:
- reduced inspiratory and expiratory strength
Inspiratory training improves PImax and PEmax
Expiratory training improves PImax and PEmax(Raab et al., 2016 ready for submission)
With inspiratory muscle training
respiratory complications can probably be avoided!(Raab et al., 2016 publication summer 2016)
June 17th of 2016 28
Preparation is already best respiratory therapy (e.g. blow one`s nose, defecation,
inhalation).
By continous positioning a relocation of the secretion occurs.
Airstacking is simple and effective.
Abdominal binder can improve the lungfunction and coughing.
With inspiratory muscle training respiratory complications can probably be avoided.
