AIRWAY CLEARANCE TECHNIQUES

1. Postural drainage
2. Breathing techniques
3. Inhalation therapy
4. Exercise
5. Oxygen therapy
6. Non-invesive ventilation

Pulmonary physiology
Interdependence
Pendelluft
Equal pressure point
Hysteresis
Collateral ventilation
Altered rheology
Two-phase gase liquid flow interactions

Conventional chest physiotherapy

1. Gravity-assisted drainage
2. Manual techniques
3. Coughing

Sputum expectoration

Short term airway clearance therapy

Quality of life in long term

Positive expirtory pressure (PEP)

Oscillating PEP (OPEP)

Patient satisfavtion, motvation and perceived efficiency to adherence

Respiratory failure secondary to sputum retention

Breathing conrol (BC)

Avoidance of high pressures associated with valsalva manoeuvres

Work of breathing

Barrel-shapped chest and forward protracted shoulders increase work of breathing

Musculoskeletal pain

Contraindications or adverse events related to ACT

Theoretical rationales for secretion clearance interventions

3 main physiological mechanisms

1. Increase in expiratory flow (explained by two-phase liquid flow by theory of fluid mechanics)
2. Oscillation of airflow
3. Increasing lung volumes

Mist flow

Annual flow

Cough

Supramaximal transient expiratory flow rates

Huff

Airway clearance strategies for babies and children

Modified postural drainage and percussion (mPD&P)

Infant PEP

Assisted autogenic drainage (AAD)

Bubble PEP

Physical activity like floor play, playing on gym ball, trampolining, swimming

Traditional and manual airway clearance techniques

Postural drainage and modified postural drainage

Manual techniques

Percussion (fast and slow)

Vibration

Shaking

Chest compression with cough

Clinical application and evidence for manual techniques

Contraindications and precautions for manual techniques

Suction
Independently performed airway clearance techniques

Breathing techniques

Active cycle of breathing techniques

Breathing control

Thoracic expansioin exercises

Forced expiration techniques

Clinical application and evidence for ACBT

Autogenic drainage and assisted autogenic drainage

Clinical application and evidence for autogenic drainage

Device-dependent techniques

Positive expiratory pressure and infant PEP therapy

Key points when using PEP therapy

Clinical precautions for PEP therapy

Key points when using high pressure PEP (HIPEP) therapy

Clinical application and evidence for HiPEP

Inspiratory resistance-positive expiratory pressure (IR-PEP)

Ossilating PEP therapy including bubble PEP

Key points when using flutter

Clinical application and evidence for flutter

RC-Cornet

Key points when using RC-Cornet

Evidence for RC-Cornet

Acapella

Evidence for clinical application for acapella

Bubble PEP or bottle PEP

Shaker classic or shaker deluxe

Quake

Lunge flute
Machine-dependent techniques

Non-invasive ventilation for airway clearance

Mechanical insufflation / exsufflation and assisted cough

Intrapulmonary percussive ventilation (IPV)

High-frequency chest wall oscillation

Exercise and pulmonary rehabilitation for airwaay clearance

Adujunctive techniques

Management of streess incontinence

Techniques for improving lung volumes

Intermittent positive pressure breathing (IIPB)

Preparation of apparatus

Treatment of patient

Contraindications for IPPB

Non-invasive ventilation

introduction

what is non-invasive ventilation?

Indications for non-invasive ventilation

Chronic respiratory failure

Assessing ‘at-risk’ patients

Common conditions where nocturnal hypercapnic respiratory failure is likely to occur

Acute respiratory failure

Assessing need for non-invasive ventilation

Indications and contraindications to non-invasive ventilation in acute setting

Chronic obstructive pulmonary disease

Cardiogenic pulmonary oedema

Weaning and post extubation respiratory failure

Immunocompromised patients

Evidence for other indications

Practical issues in application of non-invasive ventilation

Interfaces

Initiating and monitoring therapy

Steps in initiating non-invasive ventilation (NIV) therapy for home ventilatory support

Physiotherapy in management of non-invasive ventilation

Humidification

Oxygen therapy

Adverse effects of non-invasive ventilation

Airway clearance and non-invasive ventilation

Non-invasive ventilation as an adjunct to exercise

Incentive spirometry

Manual and ventilator hyperinflation

Manual hyperinflation procedure

Precautions and contraindications for lung hyperinflatioin

Manual hyperinflation technique (MHI)

Ventilator hyperinflation technique (VHI)

Glossopharyngeal breathing

Uses of glossopharyngeal breathing

Three stages for each gulp in glossopharyngeal breathing

Stages with nasal glossopharyngeal breathing

Techniques for improving gas exchange

Positioning and mobilization

Factors contributing to cardiopulmonary dysfunction (factors that compromise or threaten

oxygen transport)

To improve oxygen transport in acute cardiopulmonary dysfunction

Acute effect of upright positioning and mobilization on oxygen transport

Positioning

Mobilization

Physiological and scientific rationale

Chronic effects of mobilization / exercise on oxygen transport

Planning an exercise programme

Progressioin

Oxygen therapy

Introduction

Reference ranges for arterial blood in young healthy adults

Oxygen therapy in acute setting

General principles

Delivery systems

Commanly used systems and interfaces for delivery of oxygen therapy in acute
setting
Variable performance systems

Nasal cannula

Reservoir cannulae

Nasal catheter

Transtracheal catheter

Simple oxygen mask

Reservoir masks

Partial rebreathing mask

Non-rebreathing mask

Fixed performance systems

Air entrainment (‘venturi’) mask

Air entrainment nebulizer

Heated humedifier systems

Interface devices for fixed performance systems

Enclosure systems

Domiciliary oxygen therapy

Domiciliary oxygen therapy delivary and prescription guidelines

Delivary systems and devices

Oxygen concentrators

Compressed gas cylinders

Liquid oxygen systems

Conservation devices

Domiciliary oxygen therapy prescription

Continuous oxygen therapy (COT)

Short-term oxygen therapy (STOT)

 Intermittent oxygen therapy

Domiciliary ambulatory oxygen

Ambulatory oxygen in conjunction with COT

Training oxygen

Short burst oxygen therapy

Other uses of intermittent oxygen therapy

Hazards of oxygen therapy

Physiological hazards

Inhalation therapy

Medications in mucoactive class, arranged by subclass with detailed mechanisms of actioin

Hypertonic saline

Mechanism of action

Evidence about efficacy

Interaction with physiotherapy

Mannitol

Mechanism of action

Evidence about efficacy

Interaction with physiotherapy

Dornase alpha

Mechanisms of action

Evidence about efficacy

Interaction with physiotherapy

Bronchodilators

Structuring an airway clearance sessioin

Order of interventions

Combining interventions

Techniques for improving dyspnoea

Difference between shortness of breath and dyspnoea

Mechanism underpinning dyspnoea

Assessment of dyspnoea

Management strategies for dyspnoea

Summary of systematic review findings for recommendations concerning management of

dyspnoea

Inspiratory muscle training

Breathing control

Positions for breathing control

Techniques for improving dysfunctional breathing

Manual therapy techniques for musculoskeletal dysfunction

Subjective assessment

Physical assessment: posture

Physical assessment: range of motion

Physiotherapy management

Postural correction and motor control training

Mobilization techniques

Muscle-lengthening techniques

Assessment of muscle length

 Taping

Muscle retraining (strength and endurance)

Assessment of holding capacity of lengthened muscles

Neural tissue techniques

Neurophysiological facilitation of respiration

Neural control

Respiratory muscles

Diaphragm

Intercostal muscles

Accessary muscles of inspiratioin

Abdominal muscles

Neurophysiological facilitatory stimuli (table for all techniques list)

Intercostal stretch

vertebral pressure

anterior stretch basal lift

maintained manual pressure

perioral pressure

co-contraction of abdomen

clinical application