Chest Physio

Therapy
ICU management
Respiratory Care is…

A treatment intervention employed

for improving pulmonary hygiene
including positioning, chest
percussion, vibration and manual
hyperinflation to assist in mobilizing
secretions in the lungs from the
peripheral airways into the more
central airways so that they can be
expectorated or suctioned.
Indications

Prophylactic
- Pre-operative high risk surgical patient
- Post-operative patient who is unable to
mobilize secretions
- Neurological patient who is unable to cough
effectively
- Patient receiving mechanical ventilation who has a
tendency to retain secretions
- Patients with pulmonary disease,
who needs to improve bronchial hygiene
 …contd
 Therapeutic
- Atelectasis due to secretions
- Retained secretions
- Abnormal breathing pattern due to primary or
secondary pulmonary dysfunction
- COPD and resultant decreased exercise
tolerance
- Musculoskeletal deformity that makes breathing
pattern and cough ineffective
Assessment

 Neurological system
 Cardiovascular system
 Respiratory system
 Renal system
 Hematological system
 Gastrointestinal system
Neurological system

 Level of consciousness
 Pupils
 Size
 Reactivity
 Equality
 Cerebral perfusion pressure (>70mmHg)

 Intracranial pressure (<10mmHg)

Cardiovascular system

 Heart rate and rhythm

 Arterial BP
 Central Venous pressure
 Pulmonary Artery pressure
Respiratory system

 Auscultation
 Percussion
 Expansion
 Chest X-ray
 Mode of ventilation
 Humidification
 Oxygen therapy
 RR
 Airway pressures
 ABG
 Sputum
Renal system

 Assessment of fluid balance

 Measure of Intravascular volumes
 Urine output
 Serum electrolytes
 ABG
Gastrointestinal system

 Nutritional support
 Routes of administration
 Enteral
 Parentral
 Oral
Assessment

General Observation
 Patient Position
 Respiration - Airway ET/Tracheostomy
Ventillator Mode

 Vital Signs – Temperature, BP, RR, HR ,O2,GCS, ICP

 Tubes - NG Tube, CV line, Peripheral line, Chest tubes,
Catheters
 Drugs
 … contd

Examination

 Auscultations
 Respiratory pattern
 Cyanosis
 Clubbing
 Radiograph
Goals

 Prevent accumulation of secretions

 Improve mobilization and drainage of secretions
 Promote relaxation to improve breathing patterns
 Promote improved respiratory function

 Improve cardio-pulmonary exercise tolerance

 Teach bronchial hygiene programs to patients with

chronic respiratory dysfunction
CONTRAINDICATIONS

 Untreated tension pneumothorax

 Abnormal coagulation profile
 Status epilepticus or status
asthamaticus
 Immediately following intra cranial
surgery
 Head injury with raised ICP
 Osteoporotic bones
 Recent acute myocardial infarction,
unstable vitals
 Immediately after tube feedings
CPT Techniques Used in
ICU
CPT Techniques

 Gravity-assisted Positioning
 Manual techniques
 Manual hyperinflation
 Airway suctioning
 Mobilisation
Positioning
Physiological effects of
Positioning
 Optimizes oxygen transport
 Increases lung volumes
 Reduces the work of breathing
 Minimizes the work of heart
 Enhances mucociliary clearance
(postural drainage)
Postural Drainage isn’t…

 a separate technique. Its just an example

of positioning which has the particular
aim of clearing airway secretions with the
assistance of gravity.
 Patients are positioned with the area to
be drained the upper most, but
modifications should be done in ICU

 Drainage times vary, but ideally each

position requires 10 minutes.
Positioning

 Positioningrestores ventilation to
lung regions more effectively .
 Positioninghas a marked influence
on gas exchange .
 …contd

 Positioning affects compliance

 Positioning affects lung volume

Positioning…

 Which position to choose…

?
Chest Maneuver
Chest Maneuver

 Chest Vibrations

 Chest Percussion
Chest Percussion

 Percussion consists of rhythmic

flexion and extension on the chest
with loose wrist & cupped hand.
 Effect : Dislodges & loosens
secretions from the lung
Chest Vibration

 Vibrations consists of a fine oscillation

of the hands directed inwards against
the chest, performed on exhalation
after deep inhalation.

 Effects: Helpful in moving loosened

mucous plugs towards larger airway
 Manual
Hyperinflation
Manual Hyperinflation

 Was originally defined as inflating the lungs with

oxygen and manual compression.
Indications

 To aid removal of secretions

 To aid reinflation of atelectatic segments
 To assess lung compliance
 To improve lung compliance
Technique

 Slow deep inspiration

 Inspiratory hold (at full inspiration)
 Fast expiratory release
Contraindications

 Undrained Pnuemothorax
 Potential bronchospasm
 Severe bronchospasm
 Gross cardiovascular instability inducing arrhythmias
and hypovolaemia
 Unexplained Haemoptysis
 Advantages of MH

 Reverses atelectasis
 Improves oxygen saturation and
lung compliance
 Improves sputum clearance
Suctioning
Suctioning

 Suctioning is the mechanical aspiration

of pulmonary secretions from a patient
with an artificial airway in place.
 Indications
 Inability to cough effectively
 Sputum plugging
 To assess tube patency
Contraindication

 Frank haemoptysis
 Severe brochospasm
 Undrained pneumothorax
 Compromised cardiovascular system
 The suction catheter used must be less than half the
diameter of endotracheal tube.
 The vacuum pressure should be as low as possible. (60-
150mmHg)
 Suction should never be routine, only when there is an
indication
Hazards of suctioning

 Mucosal trauma
 Cardiac arrhythmias
 Hypoxia
 Raised intracranial pressure
 Nasal and oral suction
 Endotracheal suction
 Tracheostomy suction
Mobilisation
Mobilisation

 Critically Ill
(Frequent Position changes)

 Stable
(Progressive tilting & Ambulation)
Mobilisation

 ICU rehabilitation has been shown to

accelerate recovery
 Early mobilization for unconscious patients
starts right from turning the patient every
two hours.
 Graded exercises can be started as soon as
the patient regains consciousness.
 Activity is required to maintain sensory input, comfort,
joint mobility and healing ability.
 Activity minimizes the weakness caused by loss of up to
half the patients muscle mass.
 Graded ambulation can be started depending on
patients condition