8976 Study Guide - Midterm Guide: Pediatrics, Chest Tube, Bronchiectasis
2 Jul 2018
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Treatment How does it work? Indicated for? Precautions and Indications
Mobilization (Postural or Activity)
-every day of immobilization (where
the patient remains in bed) increases
the patients chance of developing
post-operative pulmonary
complications (PPC) by a factor of 3
(Haines, 2013)
-Upright posture = increased lung
volumes
-increased TV + increased respiratory
rate means more airflow and more
chance to open collapsed airways
and shear out sputum
-increased lymphatic flow, BP, HR
surfactant
Most CT patients as first choice
treatments that have to mobilize
and have a condition that is
amenable to physiotherapy
(atelectasis or sputum clearance
issues)
-Precaution: pain, decreased cognition,
possibility of internal bleeding,
critically ill, continuous UWSD required
(can still mob at bedside), no WB, very
low BP (relative to normal)
-remember UWSD precautions
(clamps, height of UWSD, and
reconnect when finished)
-Contraindicated: current
pneumothorax (air in pleural space),
pleural effusion (fluid in pleural space),
APO (fluid in lungs)
PEP
-blow 6 seconds, 6 reps
-anywhere from twice daily to 3-5x
per hour as pain permits
-bubble PEP group had significantly
less atelectasis than control group
(Westerdahl et al, 2005)
-reinflates collapsed alveoli via
collateral ventilation (via Pores of
Kohn and Canals of Lambert)
-allows inflation of airways distal to
sputum blockage and thus
encourages expulsion of sputum
-operates through concept of
positive expiratory pressure
-atelectasis
-mucus clearance problems
(these two conditions likely to
occur post-operatively, with CF, or
extended bed rest)
-pneumothorax (undrained)
-pneumonectomy (removal of lung,
lobectomy is removal of part of lung –
lobe)
-haemoptysis (coughing up blood)
-extensive blistering/cysts in airway
-decreased cognitive capacity or
pediatrics
-high O2 therapy required (cant
remove mask or breathing device for
PEP)
Active Cycle Breathing Technique
(ACBT)
-30 seconds of normal breathing
followed by 5 deep inspirations with
breath held for 3 seconds
-repeat above twice
-may huff or cough
-No benefit over mobilization
(Mckay & Ellis, 2005)
-slow deep inspirations from FRC to
TLC increases filling time and
encourages ventilation to dependent
regions of the lung
-holding breath at maximal
inspiration creates collateral
ventilation and sustained alveolar
stretch which increases surfactant
production, LV, FRC, compliance
-instances where sputum
clearance and extended bed rest
are an issue and patient is unable
to mobilize
-pneumothorax without a chest drain
-recent insertion of a central line
-cardiovascular instability (decreased
BP, arrhythmia)
-Pain, SOB, dizziness, hyperventilation
Percs & Vibes with Postural Drainage
-congested side upward
-tappa tappa tappa over towel
-can shake or vibe on expiration
-pt may huff or cough periodically
-PD uses gravity and physical
vibrations to displace and expel
sputum plugs
-increased region lung volume
-improve V/Q matching
-alveoli of congested lobe are
stretched open to promote drainage
-instances when active
mobilization and PEP are
insufficient to clear sputum
-instances of large sputum
production (CF or bronchiectasis)
-extremely fatigued, weak patients
who are unable to do active
techniques
-Osteoporosis, high BP, wounds,
asthmatics, # ribs, severe plueritic
pain, decreased platelet levels,
breathlessness with laying, severe
dyspnea, APO, severe obesity, ICD,
arrhythmias, oesophogeal surgery,
after eating or GORD, hernia, head
injury, cerebral or aortic anuerysm
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Document Summary
Every day of immobilization (where the patient remains in bed) increases the patients chance of developing post-operative pulmonary complications (ppc) by a factor of 3 (haines, 2013) Increased tv + increased respiratory rate means more airflow and more chance to open collapsed airways and shear out sputum. Most ct patients as first choice treatments that have to mobilize and have a condition that is amenable to physiotherapy (atelectasis or sputum clearance issues) Anywhere from twice daily to 3-5x per hour as pain permits. Bubble pep group had significantly less atelectasis than control group (westerdahl et al, 2005) Reinflates collapsed alveoli via collateral ventilation (via pores of. Allows inflation of airways distal to sputum blockage and thus encourages expulsion of sputum. Mucus clearance problems (these two conditions likely to occur post-operatively, with cf, or extended bed rest)
