1. O2 Therapy, Lung Expansion Therapy & Airway Clearance
By Michael S. Allen, RRT
Updated April 8, 2015

2. O2 Therapy, LET & BHT Key Note: Do least invasive therapy first
Do least costly therapy first
If patient condition severe,
then do severe therapy

3. Oxygen (O2) Therapy Why: SpO2 lower than 90% SaO2 lower than 92%
PaO2 lower than 80 mmHg
Patient c/o SOB, dyspnea, or chest pain
Patient Type:
Anyone who meets above criteria regardless of age or diagnosis
Exception:
COPD, Emphysema, or Chronic CO2 retainer
Premature neonate
Devices Used:
Nasal cannula
Simple mask
Air entrainment mask (aka: venti-mask)
High Flow Nasal Cannula
Non-Rebreather (NRB)
Heated Humidified High Flow Nasal Cannula
CPAP

4. No Smoking, Oxygen in Use

5. Oxygen therapy O2 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 deliver
SpO2 is what we measure

6. Oxygen therapy O2 devices
Device: Limitations: FIO2:
Simple Mask 6 Lpm – 10 Lpm 35% – 50 %

7. Oxygen therapy O2 devices
Device: Limitations: FIO2:
“Venti” air-entrainment mask 3 Lpm 24 – 32%
6 Lpm 36 – 44%
8 Lpm 50 – ~70%

8. Oxygen therapy O2 devices
Device: Limitations: FIO2:
High Flow Nasal Cannula 3 Lpm – 12 Lpm questionable FIO2%
(non heated) LPM flow titrated to SpO2

9. Oxygen therapy O2 devices
Device: Limitations: FIO2:
Non-rebreather (NRB) 8 Lpm – 15 Lpm 60% – 95%
“flush” (~16–40 Lpm) 95% – ~100%

10. Oxygen therapy O2 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 …

11. Oxygen therapy O2 devices
Device: Limitations: FIO2:
Heated-Humidified 10 Lpm – 70 Lpm Blender needed for FIO2%
High Flow Nasal Cannula excess rainout

12. Oxygen therapy O2 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.

13. Caution, Lung Expansion in Progress

14. Lung Expansion Therapy aka: Hyperinflation Therapy
Why:
Treat/Prevent Atelectasis
Low lung volumes (as seen from a chest x-ray)
Patient Type:
Asthma, COPD, CHF, Pneumonia
Decreasing SpO2 and/or increased need for O2
Atelectasis (BS = late inspiratory crackles; or as seen on chest x-ray)
Fever
Neuromuscular disorders
Patients on bed-rest or bedridden
Post Surgery (especially upper abdominal or thoracic)
Devices Used:
Deep breathing and cough (DB&C)
Pursed Lip breathing
Body Calisthenics
Incentive Spirometer
TheraPEP
EzPAP
IPPB
CPAP/BiPAP

15. Devices for LET
Deep-breath and Cough “DB&C”

16. Devices for LET
Pursed Lip breathing

17. Devices for LET
Patient position and Body Calisthenics

18. Devices for LET
Incentive Spirometry

19. Devices for LET
TheraPEP

20. Devices for LET
EzPAP
Refer to …

21. Devices for LET
IPPB
Bird Mark 7
IPPB circuit
Bennett PR-2

22. Devices for LET
CPAP/BiPAP

23. BHT … I Need Help

24. Bronchial Hygiene Therapy AKA: Pulmonary Toilet or Airway Clearance Techniques
Why:
Increased mucus in airways
Weak or non-productive (congested) cough
Patient Type:
Asthma, COPD, CHF, Pneumonia
Bronchiectasis, Bronchiolectasis, Bronchiolitis, Bronchitis
Ciliary dyskinetic syndrom
Cystic Fibrosis
Neuromuscular disorders
Immobile, bed-rest or bedridden patients
RSV
Devices Used:
Huff Cough
TheraPEP
Flutter or Acapella
Chest Physiotherapy (CPT):
Percussion (hands or percussion device)
Percussor (pneumatic or electric)
HFCWO (“the Vest”)
Postural drainage
Cough Assist (aka: insufflator-exsufflator)
NT suction
IPV (Intrapulmonary Percussive Ventilation)

25. Devices for BHT
Huff Cough

26. Devices for BHT
TheraPEP

27. Devices for BHT Flutter Acapella Aerobika oscillating PEP (OPEP)
Refer to …
Aerobika oscillating PEP (OPEP)
Refer to …

28. Devices for BHT Chest Physio-Therapy (CPT)
Hand percussion and hand-held device

29. Devices for BHT Chest Physio-Therapy (CPT)
Pneumatic Percussor Electric Percussor

30. Devices for BHT Chest Physio-Therapy (CPT)
High Frequency Chest Wall Oscilation (HFCWO)

31. Devices for BHT
Postural Drainage

32. Devices for BHT
Cough Assist Device

33. Devices for BHT
Nasal-Tracheal Suction (NT sxn)

34. Devices for BHT
IPV (Intrapulmonary Percussive Ventilation)

35. 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