Deep breathing exercises can
– Help a patient to inspire deeply enough to facilitate a more effective cough
– Reopen closed small airways that will then Facilitate MCC & Allow gas to move through airways and “get behind’ secretions
Gravity Assisted Drainage (GAD)
- Utilises gravity to assist movement/drainage of secretions from peripheral airways towards the larger central airways for clearance
Indications for GAD:
– Excessive volume of secretions (> 30 ml/day)
Precautions & Contraindications
to Head Down Tilt (HDT)
- Gastro-oesophageal reflux
- Cardiac failure
- Severe hypertension
- Cerebral oedema
- Aortic and cerebral aneurysms
- Severe haemoptysis
Percussion
- Application of a rhythmic pressure to the chest wall, usually with cupped hands
- Applied:
– Throughout inspiration and expiration (> 30 sec )
– To a specific area of the chest wall or generally
how does percussion work
– Imparts mechanical energy to the airway
– This is proposed to
* increase EFR
* “loosen” secretions
* change rheology (less sticky)
Vibration
The application of a fine oscillatory movement combined with compression of the chest
how does vibration work
– Imparts mechanical energy to the airways which has been shown to ↑ EFR & make change rheology (less sticky)
Shaking
Application of a coarse oscillatory and compressive force to the chest wall during expiration
how does shaking work
– Imparts mechanical energy to the airways which has been shown to ↑ EFR & make change rheology (less sticky)
Precautions & Contraindications to
Percussion/Vibration/Shaking
- Severe haemoptysis or risk of further haemoptysis during or after technique
- Bone diseases associated with brittle or fragile bones
- Worsening bronchospasm (for vibration) with SOB
- Very low platelets / coagulopathy (risk of bruising)
- Stiff/rigid chest wall
- Severe hypoxaemia
Newer Airway Clearance (AC)
techniques
- Mechanisms to move air BEHIND obstructions → ventilate airways distal to the obstruction
- ↑ / modulate EFR (expiratory flow bias) → moves secretions UP the airways
- Add vibrations / oscillation
ACBT is a cycle involving 3 components:
- Slow deep breathing (thoracic expansion exercises + inspiratory hold) [get air behind secretions]
- Breathing control
- FET (huffs + breathing control) [expiratory airflow bias]
Forced Expiration Technique (FET)
- Huff/s (1-2)
– From specified lung volume (ie, high to mid, mid to low) - Breathing control
– Relaxed breathing
– Aims to reduce bronchospasm and desaturation
– Breathing
Autogenic Drainage
Moves secretions from peripheral to central airways through breathing at different lung volumes in stages
Airway Clearance Devices
- Positive expiratory pressure (PEP)
- Oscillating PEP
how do Airway Clearance Devices work
– move air BEHIND obstructions → ventilate airways distal to the obstruction
– Keep airways open (stabilise floppy airways)
– ↑ / modulate EFR → moves secretions UP the airways towards the central airways
– Oscillations also change sputum rheology
Low pressure PEP
– 10-20 cmH2O
– Use of a pressure manometer
High pressure PEP
– 40-100 cmH2O Not commonly used in Australia
– High PEP can also be achieved by performing a forced expiratory manoeuvre into the device after a maximal inspiration
PEP Devices: Mechanism
o Temporarily increases FRC (prevents expiration to patient’s
usual FRC)
o Alveolar recruitment occurs via collateral channel
ventilation
o Allows air to move behind secretions
* Minimises /prevents excessive airway compression
Oscillating PEP (OPEP)
Combine PEP with (automatically controlled) expiratory oscillation/vibration
OPEP flutter
– Pipe shaped device with steel ball inside it
– Positional dependent
OPEP acapella
– Counterweighted plug & magnet
– Not positional dependent
OPEP aerobika
– Higher PEP and oscillation amplitude
– Not positional dependent
