AIRWAY CLEARNCE TECHNIQUE -THEARPIST VIEW

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PRACTICAL CONSIDERATION IN AIRWAY CLEARANCE-VIEW
OF THERAPIST

• Manivel Arumugam.
• Senior physiotherapist

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Why this topic?

• During mechanical ventilation
• Weaning and extubation planning
• During weaning failure or extubation failure
• Selection of techniques based on patients
  conditions
• How to prescribe ACT in ICU?

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Airway clearance techniques

• Need of airway clearance
• Basics of airway clearance
• Indications of airway clearance
• Techniques
• Current trends in airway clearance.

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Basic physiology of airway clearance
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Indications for airway clearance
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Acute sepsis
Sedatives
Paralysis
Alone/ lack of communication
Ventilation
Economical psychological issues
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Extra thoracic manipulation

• Postural drainage
• Chest percussion
• Vibration and shaking
• High frequency chest wall oscillatory device

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Frequent positioning/ kinesio bed may alleviate
the problems. But economy/ manpower need more
Hardened secretion in dependent zone
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Extra thoracic manipulation
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HFCWO
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Intra thoracic/oral manipulation

• Bagging/ manual hyperinflation
• Intra percussive ventilation
• Cough assist device/ cough insufflators-ex
  sufflator

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• IPV

• COUGH INSUFFLATOR EXSUFFLATOR

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Intra thoracic/ intraoral manipulation
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ACTIVE AIRWAY CLEARANCE DEVICES TECHNIQUES

• PEP THERAPY DEVICES
• ACAPELLA
• FLUTTER
• EZPAP
• CORNET
• QUAKE DEVICE
• TECHNIQUES
• ACTIVE CYCLE OF BREATHING
• AUTOGENIC DRAINAGE
• FORCED EXPIRATORY TECNIQUE

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ACAPELLA

• Acapella combines the benefits of both PEP
  therapy and airway vibrations to mobilize
  pulmonary secretions and can be used in virtually
  any position allowing patients to move freely and
  sit, stand or recline.
• It improves clearance of secretions, is easier to
  tolerate than Chest Physical Therapy (CPT), takes
  less than half the time of conventional CPT
  sessions
• facilitates opening of airways in patients with
  lung diseases with secretory problems  such as
  COPD, asthma and Cystic Fibrosis.
• Color-coded units (green for high-flow, blue for
  low) help customize treatment for each patient
  based on their clinical needs.
• Can adjust the Acapella frequency and flow
  resistance simply by turning an adjustment dial.

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• Allows inhalation and exhalation without removing
  from mouth
• Prolongs expiratory airflow to increase removal
  of secretions
• Allows use with mask or mouthpiece attachment
• Allows use with inline nebulizer when fitted with
  the adapter.
• Accommodates virtually any patients lung capacity

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• Acapella

• FLUTTER

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• cornet

• Quake Bubble PEP

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Active airway clearance devices
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Passive airway clearance devices
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EzPAP-positive airway pressure system

• The EZPAP positive airway pressure system is used
  to expand the lungs by increasing Functional
  Residue Capacity (FRC). Increasing FRC has been
  found to contribute to the prevention and
  reversal of atelectasis.
• EzPAP is the easy option for the prevention and
  treatment of atelectasis and a medical need for
  lung expansion therapy.
• When incentive spirometry alone won't open
  patient's airways, expand your options with
  EzPAP. It makes providing positive airway
  pressure positively easy.
• Simply connect to a flow meter (wall air or O2
  for enhanced FiO2), adjust 5-15 lpm, and instruct
  the patient to breathe normally through the
  mouthpiece or mask. Just a few minutes of
  therapy, as needed - not for hours at a time.

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• Can be used with mask or mouthpiece attachment
• Allows use with inline nebulizer when fitted with
  the adapter Prevents inadvertent occlusion
• Connects to gauge tubing
• Eliminates collecting components
• Eliminates the need to carry a manometer

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EzPAP
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Inspiratory muscle trainer
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Threshold trainer

•  It has an adjustable spring-loaded valve that
  imposes the inspiratory load.
• The inspiratory load can be increased by winding
  the spring more tightly. 
• Advantage of this trainer is that the same load
  is imposed on the inspiratory muscles regardless
  of breathing pattern. 

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Resistive trainer

• It has holes of different diameters. 
• The inspiratory load can be increased by setting
  the dial to holes of lesser diameter. 
• Disadvantage of this trainer is that the subject
  can reduce the inspiratory load by breathing more
  slowly. 
• If this device is used for training, a target
  must be used.  Various targets have been designed
  that set a breathing rate (flow and/or
  inspiratory pressure) for the subject.

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Isocapneic Hypernea Trainer

• It  has a rebreathing bag that can be adjusted to
  ensure that the persons CO2 level is maintained
  within a physiologic range.
• A target is provided for the person to increase
  the level of ventilation to a training
  intensity. 
• This device enables training at low loads but
  much higher inspiratory and expiratory flow such
  that the inspiratory and expiratory muscles
  training at higher speeds of contraction.
• In contrast, the threshold and resistive
  trainers, place high loads while the speed of
  contraction is relatively low

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