What are the different modalities of lung expansion therapy?
Lung expansion therapy encompasses a variety of respiratory care modalities designed to prevent or correct atelectasis. The most common modalities include deep breathing/directed cough, incentive spirometry (IS), continuous positive airway pressure (CPAP), positive expiratory pressure (PEP),...
When should positive airway pressure be applied during lung expansion therapies?
Positive pressure lung expansion therapies may apply pressure during inspiration only (as in IPPB), during expiration only (as in PEP and expiratory positive airway pressure [EPAP]), or during both inspiration and expiration (CPAP).
What is lung expansion therapy for atelectasis?
Lung Expansion Therapy. Lung expansion therapy encompasses a variety of respiratory care modalities designed to prevent or correct atelectasis. The most common modalities include deep breathing/directed cough, incentive spirometry (IS), continuous positive airway pressure (CPAP), positive expiratory pressure (PEP),...
What is the most efficient use of resources in lung expansion?
The most efficient use of resources is a primary concern with any plan to apply lung expansion therapy. If all of the following therapies were to be compared, the common factor they share is that they all are designed to increase functional residual capacity (FRC).
In which of the following patients is incentive spirometry contraindicated?
6.4 Incentive spirometry is contraindicated in patients unable to deep breathe effectively due to pain, diaphragmatic dysfunction, or opiate analgesia.
Which of the following patient categories are at high risk for developing atelectasis?
[3] Obese and/or pregnant patients are more likely to develop atelectasis due to cephalad displacement of the diaphragm (see the section on epidemiology).
Is pneumothorax contraindicated for incentive spirometry?
Other contraindications for spirometry include coughing up blood (hemoptysis) without a known cause, active tuberculosis, and a history of syncope associated with forced exhalation. Individuals with a history or increased risk of pneumothorax should also avoid spirometry testing.
Which of the following are potential indications for incentive spirometry?
The indications are:Pre-operative screening of patients at risk of postoperative complications to obtain a baseline of their inspiratory flow and volume.Presence of pulmonary atelectasis.Conditions predisposing to atelectasis such as: Abdominal or thoracic surgery. Prolonged bed rest. Surgery in patients with COPD.
What's the best treatment for atelectasis?
TreatmentPerforming deep-breathing exercises (incentive spirometry) and using a device to assist with deep coughing may help remove secretions and increase lung volume.Positioning your body so that your head is lower than your chest (postural drainage). ... Tapping on your chest over the collapsed area to loosen mucus.
What treatment is used for atelectasis?
Atelectasis treatments include: Bronchoscopy to clear blockages like mucus. Medicine that you breathe in through an inhaler. Physiotherapy such as tapping on your chest to break up mucus, lying on one side or with your head lower than your chest to drain mucus, and exercises to help you breathe better.
Who should not do spirometry?
Relative contraindications(9,10) to performing spirometry are 5.1 hemoptysis of unknown origin (forced expiratory maneuver may aggravate the underlying condition); 5.2 pneumothorax; 5.3 unstable cardiovascular status (forced expiratory maneuver may worsen angina or cause changes in blood pressure) or recent myocardial ...
What are the indications and contraindications for spirometry lung function test )?
ContraindicationsHemodynamic instability.Recent myocardial infarction or acute coronary syndrome.Respiratory infection, a recent pneumothorax or a pulmonary embolism.A growing or large (>6 cm) aneurysm of the thoracic, abdominal aorta.Hemoptysis of acute onset.Intracranial hypertension.Retinal detachment.
Who needs to use spirometer?
It can help you to build your lung capacity after surgery or when you have a progressive condition, such as lung disease. Using this device helps you take active steps in your recovery and healing. One 2019 study found that the use of incentive spirometry after lung surgery can prevent complications such as pneumonia.
When do you not use an incentive spirometer?
If you have an active respiratory infection (such as pneumonia, bronchitis, or COVID-19) do not use the device when other people are around.
How does incentive spirometry improve lung function?
Using an incentive spirometer can improve overall lung function, which in turn increases the amount of oxygen that is breathed into the lungs, ultimately increasing the oxygen that ends up in the body. This device is also able to help patients clear mucus from their lungs.
Why do you use an incentive spirometer after surgery?
Using your incentive spirometer after surgery will help you keep your lungs clear. The incentive spirometer will also help keep your lungs active when you are recovering from surgery, as if you were at home performing your daily activities.
What is lung expansion therapy?
Lung expansion therapy encompasses a variety of respiratory care modalities designed to prevent or correct atelectasis. The most common modalities include deep breathing/directed cough, incentive spirometry (IS), continuous positive airway pressure (CPAP), positive expiratory pressure (PEP), and intermittent positive airway pressure breathing (IPPB). The common purpose that all of these techniques share is to guide the patient into improving pulmonary function by maximizing alveolar recruitment and optimizing airway clearance.
How does lung expansion therapy increase lung volume?
All modes of lung expansion therapy increase lung volume by increasing the transpulmonary pressure (P#N#l#N#) gradient. As detailed elsewhere in this text, P L gradient represents the difference between the alveolar pressure (Palv) and the pleural pressure (Ppl):
What causes atelectasis in the chest?
Compression atelectasis results when the forces within the chest wall and lung—specifically, the pleural pressure—are exceeded by the transmural pressure, which is what distends and maintains the alveoli in an open state. 2- 4 Compression atelectasis is primarily caused by persistent use of small tidal volumes by the patient. This situation is common when general anesthesia is given, with the use of sedatives and bed rest, and when deep breathing is painful, as when broken ribs are present or surgery has been performed on the upper abdominal region. Weakening or impairment of the diaphragm can also contribute to compression atelectasis. Compression atelectasis results when the patient does not periodically take a deep breath and expand the lungs fully. It is a common cause of atelectasis in hospitalized patients. It may occur in combination with gas absorption atelectasis in a patient with excessive airway secretions who breathes with small tidal volumes for a prolonged period.
What is atelectasis in bedridden patients?
Although atelectasis can occur from a large variety of problems, this chapter focuses on the two primary types associated with postoperative or bedridden patients who are breathing spontaneously without mechanical assistance : (1) gas absorption atelectasis and (2) compression atelectasis. Gas absorption atelectasis can occur either when there is a complete interruption of ventilation to a section of the lung or when there is a significant shift in ventilation/perfusion ( ). Gas distal to the obstruction is absorbed by the passing blood in the pulmonary capillaries, which causes partial collapse of the nonventilated alveoli. When ventilation is compromised to a larger airway or bronchus, lobar atelectasis can develop.
How to tell if you have atelectasis?
The physical signs of atelectasis may be absent or very subtle if the patient has minimal atelectasis. When the atelectasis involves a more significant portion of the lungs, the patient’s respiratory rate increases proportionally. Fine, late-inspiratory crackles may be heard over the affected lung region. These crackles are produced by the sudden opening of distal airways with deep breathing. Bronchial-type breath sounds may be present as the lung becomes more consolidated with atelectasis. Diminished breath sounds are common when excessive secretions block the airways and prevent transmission of breath sounds. Tachycardia may be present if atelectasis leads to significant hypoxemia. Patients with preexisting lung disease often present with significant abnormalities in respiratory and heart rates, even when atelectasis is not severe.
How does lung expansion work?
IS enhances lung expansion via a spontaneous and sustained decrease in Ppl. Positive airway pressure techniques increase Palv in an effort to expand the lung. Positive pressure lung expansion therapies may apply pressure during inspiration only (as in IPPB), during expiration only (as in PEP and expiratory positive airway pressure [EPAP]), or during both inspiration and expiration (CPAP). Although all of these approaches are used in lung expansion therapy, the methods that decrease Ppl (e.g., IS) have more of a physiologic effect than the methods that increase Palv and often are most effective. However, they require an alert, cooperative patient who is capable of taking a deep breath.
What is sustained maximal inspiration?
An SMI is a slow, deep inhalation from the functional residual capacity (FRC) up to (ideally) the total lung capacity, followed by a 5- to 10-second breath hold. An SMI is functionally equivalent to performing an inspiratory capacity (IC) maneuver, followed by a breath hold. Figure 39-2 compares the alveolar and Ppl changes occurring during a normal spontaneous breath and an SMI during IS.
Which modality should be used for gas absorbtion atelectasis?
C. IPPB should be the single treatment modality for gas absorbtion atelectasis.
Is gastric distention a harmless effect of IPPB?
B. Gastric distention is a relatively harmless effect of IPPB.
What are indirect signs of pulmonary opacification?
displacement of the interlobar fissures, crowding of the pulmonary vessels, and air bronchograms. Indirect signs include elevation of the diaphragm, shift of the trachea, heart, or mediastinum, pulmonary opacification, narrowing of the space between the ribs, and compensatory hyperexpansion of the surrounding lung.
Can nose clips be used to eliminate airway leaks?
To eliminate airway leaks in the alert patient, an initial trial of nose clips may be needed until the technique is understood and the treatment can be performed without them .
How many times more likely are metabolic syndrome patients to have lung impairment?
Those with metabolic syndrome were about 1.4 times more likely to have lung function impairment.
How big is the waistline of a woman?
Or, the extra fat could increase inflammation in the body, somehow harming the lungs. Abdominal obesity is defined most often as a waistline greater than 35 inches for women, and 40 inches for men. More than half of American adults today have bellies this size or larger.
Does obesity affect lung function?
Previously, experts believed only severe obesity contributed to decreases in lung function. Researchers aren't sure what the relationship is between big bellies and bad breathing. The effect could be mechanical: a large belly might restrict the diaphragm and make it harder for lungs to expand.
Can you put a spare tire on your lungs?
From the WebMD Archives. March 6, 2009 -- Inflating that "spare tire" around your waist may put the squeeze on your lungs, a new French study shows. Scientists have long suspected abdominal obesity to pose its own health risks, aside from those of being overweight.
Does metabolic syndrome affect lung function?
The current study shows that metabolic syndrome is also associated with impaired lung function. Further, abdominal obesity -- compared to the other factors -- is most tightly linked to the lung function impairment.
What is the pressure of endotracheal tube cuff?
A patient's endotracheal tube cuff pressure is measured at 35 mm Hg. The most appropriate immediate action to take is:
Should oral intubation be attempted first?
An oral intubation should be attempted first.
Does IPPB therapy help with atelectasis?
A patient who is receiving IPPB therapy for atelectasis now exhibits improved breath sounds and an increased ability to clear secretions. Chest radiography reveals improvement, but not total resolution, of atelectasis. The IPPB therapy is discontinued. What is the most appropriate action at this time?
What is the anatomy of the lung?
Anatomy of the Lungs. Your airway is structured like an upside down tree. When you breathe in, the air flows into the trunk-like trachea which then divides into two large branch-like bronchi. Within each lung, these bronchi further divide into progressively smaller branches.
How to prevent pneumonia?
Doing these exercises will help prevent lung problems such as pneumonia. Breathing exercises include deep breathing and coughing. Learn and practice these exercises before surgery; practice everyday for at least a week before your surgery.
How does anesthesia affect lungs?
The anesthesia medications used during surgery can affect how well our lungs work immediately after surgery. Also, inactivity after surgery (secondary to pain, drowsiness) limits amount of oxygen taken in by our lungs since we don’t breath as deeply as we do when we are active, even just doing our daily activities.
How to get air back into the sacs?
In order to get air back into these sacs and open them up, you need to take deep breaths and hold them. Deep breathing exercises have other benefits too. They can help you to relax and assist with post-operative pain control.
What is the green line on the chest?
The green line is your diaphragm. Notice how the chest cavity expands when the diaphragm contracts (flattens). This occurs when you breathe in. After surgery, breathing exercises are an important part of the recovery. Doing these exercises will help prevent lung problems such as pneumonia.
Why do I have shallow breathing?
As a result of this, these sacs can flatten. Additionally, following surgery, inactivity, pain, and the side effects of pain medications, can further contribute to this slowed, shallow breathing.
What is the incentive spirometer?
Many times, after surgery, you will be given an incentive spirometer (image right) to help you to do deep breathing exercises after surgery. The hospital staff will teach you how to use it.