O2 Therapy, Lung Expansion Therapy

& Airway Clearance

By Michael S. Allen, RRTUpdated April 8, 2015

O2 Therapy, LET & BHT

Key Note: Do least invasive therapy first Do least costly therapy first If patient condition severe, then do severe therapy

OXYGEN (O2) THERAPY

Why:SpO2 lower than 90%SaO2 lower than 92% PaO2 lower than 80 mmHgPatient c/o SOB, dyspnea, or chest pain

Patient Type:Anyone who meets above criteria regardless of age or diagnosisException: COPD, Emphysema, or Chronic CO2 retainer Premature neonate

Devices Used:Nasal cannulaSimple maskAir entrainment mask (aka: venti-mask)High Flow Nasal CannulaNon-Rebreather (NRB)Heated Humidified High Flow Nasal CannulaCPAP

No Smoking, Oxygen in Use

OXYGEN THERAPYO2 DEVICES

Device: Limitations: FIO2:Nasal Cannula Adult = 0.25 Lpm – 6 Lpm RA = 20%

Infant = 1/32, 1/16, 1/8 1L = 24%2L = 28%3L = 32%4L = 36%5L = 40%6L = ~44%?

FIO2 is what we deliverSpO2 is what we measure

OXYGEN THERAPYO2 DEVICES

Device: Limitations: FIO2:Simple Mask 6 Lpm – 10 Lpm 35% – 50 %

OXYGEN THERAPYO2 DEVICES

Device: Limitations: FIO2:“Venti” air-entrainment mask 3 Lpm 24 – 32%

6 Lpm 36 – 44%8 Lpm 50 – ~70%

OXYGEN THERAPYO2 DEVICES

Device: Limitations: FIO2:High Flow Nasal Cannula 3 Lpm – 12 Lpm questionable FIO2%(non heated) LPM flow titrated to SpO2

OXYGEN THERAPYO2 DEVICES

Device: Limitations: FIO2:Non-rebreather (NRB) 8 Lpm – 15 Lpm 60% – 95%

“flush” (~16–40 Lpm) 95% – ~100%

OXYGEN THERAPYO2 DEVICES

Device: Limitations: FIO2:Oxymask FIO2 dictated by flow 1 LPM 24% - 25%

* Able to sxn patient, or 2 LPM 27% - 32% provide drink w/o removing mask. 4 LPM 34% - 40%

6 LPM 42% - 48%8 LPM 49% - 55%10 LPM 53% - 58%12-15 LPM 59% - 65%

It is suggested that this Oxymask can replace the NC, Simple mask, and NRB.However, assess for patient comfort and need.

Refer to … www.youtube.com/watch?v=KDsNm72dBRU

OXYGEN THERAPYO2 DEVICES

Device: Limitations: FIO2:Heated-Humidified 10 Lpm – 70 Lpm Blender needed for FIO2%High Flow Nasal Cannula excess rainout

OXYGEN THERAPYO2 DEVICES

Device: Limitations: FIO2:CPAP used in ICU 21% – 100%

Note, a patient’s CPAP is used for OSA, but a CPAP/BiPAP such as seen above is for Oxygen therapy.

Caution, Lung Expansion in Progress

LUNG EXPANSION THERAPYAKA: HYPERINFLATION THERAPY

Why:Treat/Prevent AtelectasisLow lung volumes (as seen from a chest x-ray)

Patient Type:Asthma, COPD, CHF, PneumoniaDecreasing SpO2 and/or increased need for O2

Atelectasis (BS = late inspiratory crackles; or as seen on chest x-ray)FeverNeuromuscular disordersPatients on bed-rest or bedriddenPost Surgery (especially upper abdominal or thoracic)

Devices Used:Deep breathing and cough (DB&C)Pursed Lip breathingBody CalisthenicsIncentive SpirometerTheraPEPEzPAPIPPBCPAP/BiPAP

Devices for LET

Deep-breath and Cough “DB&C”

Devices for LET

Pursed Lip breathing

Devices for LET

Patient position and Body Calisthenics

Devices for LET

Incentive Spirometry

Devices for LET

TheraPEP

Devices for LET

EzPAP

Refer to … www.youtube.com/watch?v=UA00oG7ou_I

Devices for LET

IPPB

Bird Mark 7

Bennett PR-2

IPPB circuit

Devices for LET

CPAP/BiPAP

BHT … I Need Help

BRONCHIAL HYGIENE THERAPYAKA: PULMONARY TOILET OR AIRWAY CLEARANCE TECHNIQUES

Why:Increased mucus in airwaysWeak or non-productive (congested) cough

Patient Type:Asthma, COPD, CHF, PneumoniaBronchiectasis, Bronchiolectasis, Bronchiolitis, BronchitisCiliary dyskinetic syndromCystic FibrosisNeuromuscular disordersImmobile, bed-rest or bedridden patientsRSV

Devices Used:Huff CoughTheraPEPFlutter or AcapellaChest Physiotherapy (CPT):

Percussion (hands or percussion device)Percussor (pneumatic or electric)HFCWO (“the Vest”)

Postural drainageCough Assist (aka: insufflator-exsufflator)NT suctionIPV (Intrapulmonary Percussive Ventilation)

Devices for BHT

Huff Cough

Devices for BHT

TheraPEP

Devices for BHTFlutter Acapella

Aerobika oscillating PEP (OPEP)Refer to … www.youtube.com/watch?v=n7X3QP8HJKA

Refer to … www.youtube.com/watch?v=jZCjMQAlGcU

Devices for BHT

Chest Physio-Therapy (CPT) Hand percussion and hand-held device

Devices for BHT

Chest Physio-Therapy (CPT)

Pneumatic Percussor Electric Percussor

Devices for BHT

Chest Physio-Therapy (CPT)

High Frequency Chest Wall Oscilation (HFCWO)

Devices for BHT

Postural Drainage

Devices for BHT

Cough Assist Device

Devices for BHT

Nasal-Tracheal Suction (NT sxn)

Devices for BHT

IPV (Intrapulmonary Percussive Ventilation)

Medicine Delivery for BHT

Percussive Nebulizer

VORTRAN PercussiveNEB®• New improved modulator operates more consistently• Intrapulmonary percussive aerosol nebulizer• Mucus clearance (i.e. cystic fibrosis, COPD and post-op atelectasis)• High aerosol output• Automatic PEP• Single patient, multiple use• Pressure dial adjustable between SOFT to HARD setting• Home or hospital use• High flow compressor available for home use