PHYSIOTHERAPY ADJUNCTS

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PHYSIOTHERAPY ADJUNCTS

• Billie Hurst
• Part-Time Lecturer
• QMUC

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Content

• Oxygen therapy
• Humidification
• Non Invasive ventilation - BIPAP/CPAP
• Bronchoscopy

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Oxygen therapy

• For over 200 years oxygen therapy has often been
  used and sometimes misused (Hough 2001)

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Oxygen Therapy

• Should be prescribed
• Acute and chronic respiratory conditions
• Personnel should be trained in its use
• Protocols

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Oxygen therapy - Indications

• Hypoxaemia (PaO2lt8KPA, O2satslt90)
• Acute or chronic respiratory condition
• Pre and post suction
• Routinely post operatively
• Optimise oxygen delivery

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Oxygen therapy - limitations

• Giving oxygen does not guarantee its arrival at
  the mitochondria
• Oxygen does not improve ventilation directly
• (Hough 2001)

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Oxygen therapy complications/cautions

• Respiratory depression if hypoxic drive
• Pulmonary oxygen toxicity
• Tracheobronchitis
• Absorption atelectasis
• Fire
• Variable delivery

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Oxygen Therapy - Monitoring

• Oxygen saturations continuous/intermittent
• Arterial blood gases
• Observation

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Oxygen Therapy - Delivery

• Piped oxygen
• Portable oxygen
• Compressors/concentrators

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Oxygen therapy delivery devices

• Low Flow masks (variable performance)
• High flow masks (fixed flow)/venturi
• Nasal cannulae
• Mask and reservoir bag
• Tracheal mask/t-piece
• Tracheal speaking valves
• Mechanical ventilator

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Oxygen Therapy - low flow masks

• Commonly used
• Variable performance

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Oxygen therapy high flow masks

• Guaranteed percentage of oxygen
• Venturi system
• More expensive
• Up to 60

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Nasal cannulae

• 1l/min 24 oxygen
• 2l/min 28 oxygen
• 3l/min 32 oxygen
• 4l/min 36 oxygen

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Oxygen therapy bag and mask

• High concentrations of oxygen
• Mask and reservoir bag
• 55-90

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Oxygen Therapy tracheostomy

• T-piece
• Mask
• Swedish nose
• Speaking valve

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Long term oxygen therapy

• Chronic hypoxaemia
• Increases survival
• Aim to raise PaO2 to gt8Kpa
• Worn as much as possible gt15hours
• Cylinders/concentrators/liquid

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Oxygen Therapy - Implications

• Assessment
• Limitations to physiotherapy techniques

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Humidification

• Mucocillary escalator
• Adequate hydration is vital
• Bacterial contamination!!!

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Humidification - indications

• URT bypassed
• Thick retained secretions
• High flow oxygen/non-invasive mechanical aids

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Humidification - Cautions

• Hyper-reactive airways - bronchospasm
• Infection
• Burns

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Humidification - Types

• Nebulisers Large/Small/Ultrasonic
• Steam

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Humidification - Humidifiers

• Hot
• - Increases moisture content
• - Increases risk of infection
• Cold
• - Poor moisture content

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Humidification - HME

• Heat moisture exchangers
• Hygroscopic
• Hydrophobic
• Swedish nose
• Tracheostomy bibs

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Non-invasive ventilation

• BiPAP
• CPAP
• IPPB

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Contraindications/Cautions to non- invasive
ventilation

• Undrained pneumothorax,surgical emphysema
• Unstable Cardiovascular system
• Frank haemoptysis
• Facial fractures
• Vomiting
• Raised ICP
• Active TB
• Lung abcess
• Recent GI surgery
• Pneumonectomy/lobectomy with poor stump

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Continuous Positive Airway Pressure

• Constant flow of gas through inspiration and
  expiration
• Invasive/non-invasive
• Endotracheal/tacheostomy/mask
• Improve oxygenation not ventilation

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CPAP - indications

• Type I respiratory failure
• Volume loss
• Sleep apnoea
• Pulmonary oedema
• Flail segment

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CPAP - Problems

• Tolerance
• Discomfort/fit
• Air swallowing
• Difficulty coughing
• Aspiration
• Mild haemodynamic changes
• Note pneumothorax

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Bilevel positive airway pressure

• BiPAP
• Invasive/Non-invasive ventilation
• Endotracheal tube/tracheostomy/mask
• Constant pressure with independent inspiratory
  pressure and expiratory pressure

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BiPAP - Indications

• Respiratory type II failure
• Weaning

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BiPAP - Problems

• Tolerance
• Discomfort/mask fit
• Air swallowing
• Mild haemodynamic changes
• Expectoration

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NIV Implications for treatment

• YES
• Positioning
• Manual techniques
• Thoracic expansion exercises
• ACBT?
• NO
• Mobilisation
• Incentive spirometry

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Bronchoscopy

• Fiberoptic bronchoscope
• Diagnostic
• Therapeutic
• Bronchial lavage

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