Airway Clearance Techniques

Active Cycle of Breathing
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Terms in this set (27)
Active Cycle of Breathing
"Forced expiratory technique"
To assist secretion clearance in pts with asthma.
ACB always couples breathing exercise with the huff cough.
3 phases: breathing control, thoracic expansion exercises, and forced expiratory technique.
Precautions/Contraindications for Active cycle of breathing?
Splinting postoperative incisions to achieve adequate expiratory force.
Bronchospasm or hyperactive airways.
Autogenic Drainage (AD)
Uses controlled breathing to mobilize secretions by varying expiratory airflow without using postural drainage positions or coughing.
Theory is to improve airflow in small airways to facilitate the movement of mucus.
Requires patience to use and can be performed anywhere.
Controlled breathing at 3 lung volumes: Unsticking phase, Collecting phase, and Evacuating phase.
Avg treatment is 30-45 min
Precautions/Contraindications for Autogenic drainage?
Requires motivation and concentration to learn.
Each postural drainage position should be performed for ...?
2-3 minutes
Directed cough or huffing
Directed cough = tries to compensate for the pts physical limitation to elicit a maximum forced exhalation.
Huffing = forced expiratory maneuver performed with the glottis open. Similar to fogging glasses. The potential for airway collapse is less compared to a cough. Can use a quick ADD of arms to self-compress the chest wall.
Precautions/Contraindications for Directed cough or huffing?
Inability to control possible transmission of infection from pts suspected or known to have pathogens transmittable by droplets.
Elevated intracranial pressure or known intracranial aneurysm.
Reduced coronary artery perfusion (Acute MI).
Acute unstable head, neck, or spine injury.
Potential for regurgitation/aspiration.
Acute abdominal pathology, abdominal aortic aneurysm, hiatal hernia, or pregnancy.
Untreated pneumothorax, osteoporosis, and flail chest.
High-frequency airway oscillation
The Acapella and Flutter are handheld devices that combine positive expiratory pressure and high frequency airway vibrations to mobilize mucus secretions in the airways.
Precautions/Contraindications of High-frequency airway oscillation?
Patient tolerance of increased work of breathing (acute asthma, COPD).
Intracranial pressure >20 mmHg.
Hemodynamic instability.
Recent facial, oral, or skull surgery or trauma.
Acute sinusitis, nosebleed, esophageal surgery.
Active hemoptysis, nausea, known or suspected tympanic membrane rupture or other middle ear pathology.
Untreated pneumothorax.
What occurs during a huff compared to a directed cough?
Huff occurs when the glottis remains open. It doesn't produce as much air flow velocity as a cough, but it does reduce the risk of airway collapse.
A cough occurs when the glottis is closed
When using an oral oscillation device, how many active exhalations should be performed through the device followed by how many large exhalations and finally a huff or cough to clear secretions?10-20 active exhalations 2-3 coughs or huffsIntrcranial pressure greater than what is contraindicated for postural drainage?Greater than 20 mm Hg The required positioning may further elevate intracranial pressurePostural drainageConsists of positioning the pts so gravity will help drain bronchial secretions from specific lung segments toward the central airways where they can be removed by cough or mechanical aspiration.PercussionAlso known as cupping or clapping, is the rhythmic clapping or striking of the thorax with a cupped hand or mechanical percussor directly over the lung segment being drained. The rhythmic sequence should last for several minutes and should not be painful.VibrationApplication of fine, tremulous action on the chest wall over the lung segment being drained in the direction the ribs move during exhalation. May be performed manually or with a mechanical vibrator. Vibration should be performed during exhalation.Precautions/Contraindications for all positions?Intracranial pressure > 20 mmHG. Head and neck injury until stabilized. Active hemorrhage with hemodynamic instability. Recent spinal surgery (laminectomy) or acute spinal injury. Active hemoptysis, empyema, bronchopleural fistula. Pulmonary edema associated with congestive heart failure, large pleural effusion, pulmonary embolism. Confused or anxious pts who do not tolerate position changes. Rib fx, with or without flail chest, and surgical would or healing tissue.Precautions/Contraindications for Trendelenburg position?Uncontrolled hypertension, distended abdomen, esophageal surgery. Recent gross hemoptysis related to lung carcinoma treated surgically or with radiation therapy. Uncontrolled airway at risk for aspiration (tube feeding or recent meal).Postural drainage position for apical segments R and L upper lobes?Pt in sitting position, leaning back 30-40 deg. Percussion and vibration performed above the clavicles.Postural drainage position for posterior segment R upper lobe?Pt turned 1/4 from prone on the L side. Bed horizontal with head and shoulders raised on pillow. Percussion and vibration performed around medial border of R scapula.Postural drainage position for posterior segment L upper lobe?Pt turned 1/4 from prone on the R side. Head of bed elevated 45 deg. with head and shoulders raised on pillow. Percussion and vibration performed around medial border of L scapula.Postural drainage position for lingula L upper lobe?Pt turned 1/4 from supine on R side with foot of bed elevated 12 inches. Percussion and vibration over the L chest between axilla and L nipple.Postural drainage position for anterior segments R and L upper lobes?Pt in supine with bed horizontal. Percussion and vibration performed below the clavicles.Postural drainage position for R middle lobe?Pt turned 1/4 from supine on L side. Foot of bed elevated 12 inches. Percussion and vibration performed over R chest between axilla and R nipple.Postural drainage position for superior segments L and R lower lobes?Pt in prone with bed horizontal. Percussion and vibration performed below inferior border of the L and R scapulae.Postural drainage position for anterior basal segments L and R lower lobes?Pt in supine. Foot of bed elevated 18 inches. Percussion and vibration performed over lower ribs on the L and R side.Postural drainage position for posterior basal segments L and R lower lobes?Pt in prone. Foot of bed elevated 18 inches. Percussion and vibration performed over lower ribs on the L and R side of chest.Postural drainage position for lateral basal segment lower lobes?Pt in sidelying. Foot of bed elevated 18 inches. Percussion and vibration performed over the lower ribs. Left lower lobe = pt lying on R side Right lower lobe = pt lying on L side