4901018.ppt

Lung expansion therapy in atlectasis

1. Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
Chapter 39
Lung Expansion Therapy

2. Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 2
Learning Objectives
Describe the various causes of atelectasis.
State who needs lung expansion therapy.
Identify the clinical findings seen in
atelectasis.
Describe how lung expansion therapy works.

3. Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 3
Learning Objectives (cont.)
List the indications, hazards, and
complications associated with the various
modes of lung expansion therapy.
Describe the primary responsibilities of the
respiratory therapist in planning,
implementing, and evaluating lung expansion
therapy.

4. Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 4
Introduction
Pulmonary complications are common after
surgery involving upper abdomen or thorax
Such complications include atelectasis,
pneumonia, & acute respiratory failure
Lung expansion therapy is utilized to prevent
or correct respiratory complications in
postoperative period

5. Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 5
Causes & Types of Atelectasis
Gas absorption atelectasis can occur when
mucus plugs block ventilation to selected
regions of lung or if there is significant shift in
V/Q; gas distal to obstruction is absorbed by
passing blood
Compression atelectasis is caused by
persistent breathing with small tidal volumes
and/or certain types of restrictive chest-wall
disorders

6. Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 6
Which of the following is a cause for compression
atelectasis?
A.mucus plugs blocking ventilation to selected
regions of the lung
B.significant shifts in V/Q
C.persistent breathing with small tidal volumes
D.excessive lung volume during normal breathing

7. Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
Factors Associated With Causing
Atelectasis
Obesity
Neuromuscular disorders
Heavy sedation
Surgery near diaphragm
Bed rest
Poor cough
History of lung disease
Restrictive chest-wall abnormalities
7

8. Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 8
Clinical Signs of Atelectasis
History of recent major surgery
Tachypnea
Fine, late-inspiratory crackles
Bronchial or diminished breath sounds
Tachycardia
Increased density & signs of volume loss on
chest radiograph

9. Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 9
All of the following are clinical signs of atelectasis,
except?
A.History of recent major surgery
B.Tachypnea
C.Fine, late-inspiratory crackles
D.decreased density and signs of volume gains
on the chest radiograph

10. Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 10
Lung Expansion Therapy
●Incentive spirometry
Has been mainstay of lung expansion therapy for
many years
IS devices provide visual cues to patient when
desired inspiratory volume of flow is reached
Proved to be effective in high-risk patients

11. Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
Incentive Spirometry
11

12. Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
Incentive spirometry (cont.)
12

13. Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 13
Lung Expansion Therapy (cont.)
●Equipment for incentive spirometry
Typically simple, portable, & inexpensive
IS devices either flow oriented or volume oriented
Flow-oriented devices more popular because they
are smaller

14. Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
Equipment
14

15. Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
Flow-Oriented Incentive Spirometer
15

16. Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 16
Lung Expansion Therapy (cont.)
Administration of IS
Need for IS is determined by careful patient
assessment (high-risk patient)
Effective patient teaching
•Demonstrate then observe patient
•Patient should sustain his/her maximal inspiratory effort
for 5 to 10 seconds
Follow-up

17. Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
Lung Expansion Therapy (cont.)
17

18. Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 18
All of the following are advantages of incentive
spirometry, except?
A.Potential absence of or improvement in signs of
atelectasis
B.It is only needs to be performed once per day
C.IS devices provide visual cues to the patient
when a desired inspiratory volume of flow is
reached.
D.Has proved to be effective in high-risk patients

19. Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 19
Lung Expansion Therapy (cont.)
●Intermittent Positive Pressure Breathing
(IPPB)
Uses positive airway pressure to expand lung
Treatments last 15 to 20 minutes
Exhalation is passive

20. Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
IPPB
20

21. Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 21
Lung Expansion Therapy (cont.)
●Indications for IPPB
Patient with atelectasis not responsive to other
modalities such as IS
Patient at high risk for atelectasis who cannot
perform IS

22. Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 22
All of the following clinical situations are
contraindications of IPPB therapy except:
A.Active, untreated tuberculosis
B.Nausea
C.Singultus
D.Inability to take a deep-breath

23. Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
Lung Expansion Therapy (cont.)
23

24. Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
Lung Expansion Therapy (cont.)
24

25. Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 25
Lung Expansion Therapy (cont.)
Administration of IPPB
Preliminary planning
•Therapeutic outcomes set
•Evaluate alternatives
•Baseline assessment of patient

26. Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
Lung Expansion Therapy (cont.)
26

27. Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 27
Lung Expansion Therapy (cont.)
Administration of IPPB (cont.)
Implementation
•Equipment preparation
•Patient orientation
•Patient positioning
•Adjusting parameters
Flow
pressure

28. Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 28
Lung Expansion Therapy (cont.)
Positive airway pressure therapy (PAP)
Definition
•PEP
•EPAP
•CPAP

29. Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
Positive Airway Pressure Therapy
29

30. Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 30
Lung Expansion Therapy (cont.)
●Indications
Treatment of atelectasis
Treatment of cardiogenic pulmonary edema
●Contraindications
Hemodynamic instability
Patient with hypoventilation

31. Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 31
Lung Expansion Therapy (cont.)
●Hazards & complications
Barotrauma
Hypoventilation
Gastric distention
Vomiting & aspiration

32. Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
PAP Equipment
32

33. Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 33
All of the following are complications of lung
expansion therapy, except?
A.Barotrauma
B.Increased FRC
C.Gastric distention
D.Vomiting and aspiration

34. Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 34
Lung Expansion Therapy (cont.)
●Monitoring & troubleshooting with positive
airway pressure (PAP) therapies
Most common problem with PAP therapies is
system leaks
Patient must be monitored for hypoventilation &
elevated PCO
2
Inspiratory flow must be adequate

35. Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 35
Selecting an Approach
Chose modality that is safest, simplest, &
most effective
RT should evaluate the following before
choosing a specific modality:
Level of patient cooperation
Amount of pulmonary secretions
Patient’s spontaneous vital capacity

36. Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
Selecting an Approach (cont.)
36