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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

PHYSIOTHERAPY ADJUNCTS

Billie Hurst

Part-Time Lecturer

QMUC

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

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

oxygen therapy4
Oxygen Therapy
  • Should be prescribed
  • Acute and chronic respiratory conditions
  • Personnel should be trained in its use
  • Protocols
oxygen therapy indications
Oxygen therapy - Indications
  • Hypoxaemia (PaO2<8KPA, O2sats<90%)
  • Acute or chronic respiratory condition
  • Pre and post suction
  • Routinely post operatively
  • Optimise oxygen delivery
oxygen therapy limitations
Oxygen therapy - limitations
  • Giving oxygen does not guarantee it’s arrival at the mitochondria
  • Oxygen does not improve ventilation directly

(Hough 2001)

oxygen therapy complications cautions
Oxygen therapy – complications/cautions
  • Respiratory depression if hypoxic drive
  • Pulmonary oxygen toxicity
  • Tracheobronchitis
  • Absorption atelectasis
  • Fire
  • Variable delivery
oxygen therapy monitoring
Oxygen Therapy - Monitoring
  • Oxygen saturations continuous/intermittent
  • Arterial blood gases
  • Observation
oxygen therapy delivery
Oxygen Therapy - Delivery
  • Piped oxygen
  • Portable oxygen
  • Compressors/concentrators
oxygen therapy delivery devices
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
oxygen therapy low flow masks
Oxygen Therapy - low flow masks
  • Commonly used
  • Variable performance
oxygen therapy high flow masks
Oxygen therapy – high flow masks
  • Guaranteed percentage of oxygen
  • Venturi system
  • More expensive
  • Up to 60%
nasal cannulae
Nasal cannulae
  • 1l/min 24% oxygen
  • 2l/min 28% oxygen
  • 3l/min 32% oxygen
  • 4l/min 36% oxygen
oxygen therapy bag and mask
Oxygen therapy – bag and mask
  • High concentrations of oxygen
  • Mask and reservoir bag
  • 55-90%
oxygen therapy tracheostomy
Oxygen Therapy tracheostomy
  • T-piece
  • Mask
  • Swedish nose
  • Speaking valve
long term oxygen therapy
Long term oxygen therapy
  • Chronic hypoxaemia
  • Increases survival
  • Aim to raise PaO2 to >8Kpa
  • Worn as much as possible >15hours
  • Cylinders/concentrators/liquid
oxygen therapy implications
Oxygen Therapy - Implications
  • Assessment
  • Limitations to physiotherapy techniques
humidification
Humidification
  • Mucocillary escalator
  • Adequate hydration is vital
  • Bacterial contamination!!!
humidification indications
Humidification - indications
  • URT bypassed
  • Thick retained secretions
  • High flow oxygen/non-invasive mechanical aids
humidification cautions
Humidification - Cautions
  • Hyper-reactive airways - bronchospasm
  • Infection
  • Burns
humidification types
Humidification - Types
  • Nebulisers Large/Small/Ultrasonic
  • Steam
humidification humidifiers
Humidification - Humidifiers

Hot

  • - Increases moisture content
  • - Increases risk of infection

Cold

  • - Poor moisture content
humidification hme
Humidification - HME
  • Heat moisture exchangers
  • Hygroscopic
  • Hydrophobic
  • Swedish nose
  • Tracheostomy bibs
contraindications cautions to non invasive ventilation
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
continuous positive airway pressure
Continuous Positive Airway Pressure
  • Constant flow of gas through inspiration and expiration
  • Invasive/non-invasive
  • Endotracheal/tacheostomy/mask
  • Improve oxygenation not ventilation
cpap indications
CPAP - indications
  • Type I respiratory failure
  • Volume loss
  • Sleep apnoea
  • Pulmonary oedema
  • Flail segment
cpap problems
CPAP - Problems
  • Tolerance
  • Discomfort/fit
  • Air swallowing
  • Difficulty coughing
  • Aspiration
  • Mild haemodynamic changes
  • Note pneumothorax
bilevel positive airway pressure
Bilevel positive airway pressure
  • BiPAP
  • Invasive/Non-invasive ventilation
  • Endotracheal tube/tracheostomy/mask
  • Constant pressure with independent inspiratory pressure and expiratory pressure
bipap indications
BiPAP - Indications
  • Respiratory type II failure
  • Weaning
bipap problems
BiPAP - Problems
  • Tolerance
  • Discomfort/mask fit
  • Air swallowing
  • Mild haemodynamic changes
  • Expectoration
niv implications for treatment
NIV – Implications for treatment

YES

  • Positioning
  • Manual techniques
  • Thoracic expansion exercises
  • ACBT?

NO

  • Mobilisation
  • Incentive spirometry
bronchoscopy
Bronchoscopy
  • Fiberoptic bronchoscope
  • Diagnostic
  • Therapeutic
  • Bronchial lavage