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PHYSIOTHERAPY ADJUNCTS

PHYSIOTHERAPY ADJUNCTS

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PHYSIOTHERAPY ADJUNCTS

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  1. PHYSIOTHERAPY ADJUNCTS Billie Hurst Part-Time Lecturer QMUC

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

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

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

  5. Oxygen therapy - Indications • Hypoxaemia (PaO2<8KPA, O2sats<90%) • Acute or chronic respiratory condition • Pre and post suction • Routinely post operatively • Optimise oxygen delivery

  6. Oxygen therapy - limitations • Giving oxygen does not guarantee it’s arrival at the mitochondria • Oxygen does not improve ventilation directly (Hough 2001)

  7. Oxygen therapy – complications/cautions • Respiratory depression if hypoxic drive • Pulmonary oxygen toxicity • Tracheobronchitis • Absorption atelectasis • Fire • Variable delivery

  8. Oxygen Therapy - Monitoring • Oxygen saturations continuous/intermittent • Arterial blood gases • Observation

  9. Oxygen Therapy - Delivery • Piped oxygen • Portable oxygen • Compressors/concentrators

  10. 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

  11. Oxygen Therapy - low flow masks • Commonly used • Variable performance

  12. Oxygen therapy – high flow masks • Guaranteed percentage of oxygen • Venturi system • More expensive • Up to 60%

  13. Nasal cannulae • 1l/min 24% oxygen • 2l/min 28% oxygen • 3l/min 32% oxygen • 4l/min 36% oxygen

  14. Oxygen therapy – bag and mask • High concentrations of oxygen • Mask and reservoir bag • 55-90%

  15. Oxygen Therapy tracheostomy • T-piece • Mask • Swedish nose • Speaking valve

  16. Long term oxygen therapy • Chronic hypoxaemia • Increases survival • Aim to raise PaO2 to >8Kpa • Worn as much as possible >15hours • Cylinders/concentrators/liquid

  17. Oxygen Therapy - Implications • Assessment • Limitations to physiotherapy techniques

  18. Humidification • Mucocillary escalator • Adequate hydration is vital • Bacterial contamination!!!

  19. Humidification - indications • URT bypassed • Thick retained secretions • High flow oxygen/non-invasive mechanical aids

  20. Humidification - Cautions • Hyper-reactive airways - bronchospasm • Infection • Burns

  21. Humidification - Types • Nebulisers Large/Small/Ultrasonic • Steam

  22. Humidification - Humidifiers Hot • - Increases moisture content • - Increases risk of infection Cold • - Poor moisture content

  23. Humidification - HME • Heat moisture exchangers • Hygroscopic • Hydrophobic • Swedish nose • Tracheostomy bibs

  24. Non-invasive ventilation • BiPAP • CPAP • IPPB

  25. 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

  26. Continuous Positive Airway Pressure • Constant flow of gas through inspiration and expiration • Invasive/non-invasive • Endotracheal/tacheostomy/mask • Improve oxygenation not ventilation

  27. CPAP - indications • Type I respiratory failure • Volume loss • Sleep apnoea • Pulmonary oedema • Flail segment

  28. CPAP - Problems • Tolerance • Discomfort/fit • Air swallowing • Difficulty coughing • Aspiration • Mild haemodynamic changes • Note pneumothorax

  29. Bilevel positive airway pressure • BiPAP • Invasive/Non-invasive ventilation • Endotracheal tube/tracheostomy/mask • Constant pressure with independent inspiratory pressure and expiratory pressure

  30. BiPAP - Indications • Respiratory type II failure • Weaning

  31. BiPAP - Problems • Tolerance • Discomfort/mask fit • Air swallowing • Mild haemodynamic changes • Expectoration

  32. NIV – Implications for treatment YES • Positioning • Manual techniques • Thoracic expansion exercises • ACBT? NO • Mobilisation • Incentive spirometry

  33. Bronchoscopy • Fiberoptic bronchoscope • Diagnostic • Therapeutic • Bronchial lavage