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PHYSIOTHERAPY ADJUNCTS. Billie Hurst Part-Time Lecturer QMUC. Content. Oxygen therapy Humidification Non Invasive ventilation - BIPAP/CPAP Bronchoscopy. Oxygen therapy. For over 200 years oxygen therapy has often been used and sometimes misused (Hough 2001). Oxygen Therapy.

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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 (PaO2<8KPA, O2sats<90%)

  • 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 it’s 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 >8Kpa

  • Worn as much as possible >15hours

  • 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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