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Bronchial Hygiene
Bronchial Hygiene
By Jim Clarke
It consists of a variety of non-invasive techniques designed to improve gas exchange by helping to mobilize and remove secretions
During episodes in which there is an acute secretion clearance problem. Examples; Severe pneumonia with copious secretions Respiratory failure with inability to clear retained secretions Acute lobar atelectasis (documented) Evidence of significant infiltrates and/or consolidation with hypoxemia present
Uncomplicated asthma
Used to prevent complications in the outpatient population and to treat acute problems seen in;
Cystic Fibrosis Bronchiectasis
Sometimes used in Chronic Bronchitis when large volumes of secretions become problematic
Cystic Fibrosis: characterized by increased sputum viscosity (thick mucus), increased mucus volume and impaired clearance
Typically seen in children & young adults only
Bronchiectasis: characterized by muco-stasis, retained secretions, loss of mucociliary escalator & repeated pneumonias
Generally seen only in adults with a history of persistent & repeated lung infections
Patient has a Dx of Bronchiectasis or Cystic Fibrosis? (Read the Hx & PE) They have evidence of copious secretions (>25-30 ml/day) with clearance problems?
Do a cough evaluation Listen to breath sounds Check for evidence of tactile fremitus
Assess oxygenation status by reviewing recent ABGs and/or SpO2 findings Check in chart for evidence of a sputum analysis
Culture & sensitivity findings
Presence of endotracheal or tracheostomy tube History of having to suction patients trachea Poor humidification High FIO2s Drugs: General anesthetics; opiates; narcotics
Process of positioning patients to best utilize gravitational effects in the enhancement of secretion removal
Turn &/or position the patient so that mucus drains out of the effected lung zone(s)
Right Lung
Upper Lobe
Anterior; Posterior; Apical
Middle Lobe
Lateral; Medial
Lower Lobe
Superior; Lateral basal; Anterior basal; Posterior basal
Lower Lobe
Superior; Lateral basal; Anterior basal; Posterior basal
Recent tube feeding or at high risk for aspiration of gastric contents Increased ICP in a recent intracranial injury Uncontrolled hypertension Severely distended abdomen Gross (bright red) hemoptysis
Burns or recent skin grafts to chest Bleeding abnormalities Osteomylitis Subcutaneous emphysema Suspected or active TB Recent insertion of pacemaker
Worsening S.O.B. Pain or injury to chest wall or spine Hypoxemia Nausea & Vomiting Tachycardia; Hypotension; Arrthymias Bronchospasm (not likely but possible in patients with Hx of asthma)
Assessment of Outcome
Have the underlying issues that necessitated the use of PD&P improved?
Less sputum production Improvement of breath sounds Improvement in oxygenation Improvement in CXR
Mostly used in treatment of Cystic Fibrosis & Bronchiectasis Utilizes a expiratory resister designed to create positive pressure during exhalation and lengthen the expiratory phase Aerosol therapy can be done inline & simultaneous with PEP treatments
Patients need to take a breath that is slightly larger than normal Expiratory pressure should be set between 10 - 20 cmH2O in order to create an I:E ratio of 1:3 to 1:4 Have patient perform 10 to 20 breaths and then do 3 coughs Perform PEP for no more than 20 minutes
May prevent or reverse atelectasis May improve aerosol medication delivery Hazards of PEP therapy are similar to IPPB
Flutter Valve
Autogenic Drainage
Composed of 3 breathing phases Phase 1: Patient breathes in normally but exhales each breath close to RV (5-9 cycles) Phase 2: Breathes in slightly above normal Vt but exhales normally (5-9 cycles) Phase 3: Breathes in close to VC but exhales normally (5-9 cycles) All 3 Phases are repeated as necessary
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