1. Chapter 39 Lung Expansion Therapy

2. Learning Objectives Describe the various causes of atelectasis.
State who needs lung expansion therapy.
Identify the clinical findings seen in atelectasis.
Describe how lung expansion therapy works.

3. Learning Objectives (cont.)
List the indications, hazards, and complications associated with the various modes of lung expansion therapy.
Describe the primary responsibilities of the respiratory therapist in planning, implementing, and evaluating lung expansion therapy.

4. Introduction
Pulmonary complications are common after surgery involving upper abdomen or thorax
Such complications include atelectasis, pneumonia, & acute respiratory failure
Lung expansion therapy is utilized to prevent or correct respiratory complications in postoperative period

5. Causes & Types of Atelectasis
Gas absorption atelectasis can occur when mucus plugs block ventilation to selected regions of lung or if there is significant shift in V/Q; gas distal to obstruction is absorbed by passing blood
Compression atelectasis is caused by persistent breathing with small tidal volumes and/or certain types of restrictive chest-wall disorders

6. Which of the following is a cause for compression atelectasis?
mucus plugs blocking ventilation to selected regions of the lung
significant shifts in V/Q
persistent breathing with small tidal volumes
excessive lung volume during normal breathing
Answer: C

7. Factors Associated With Causing Atelectasis
Obesity
Neuromuscular disorders
Heavy sedation
Surgery near diaphragm
Bed rest
Poor cough
History of lung disease
Restrictive chest-wall abnormalities

8. Clinical Signs of Atelectasis
History of recent major surgery
Tachypnea
Fine, late-inspiratory crackles
Bronchial or diminished breath sounds
Tachycardia
Increased density & signs of volume loss on chest radiograph

9. All of the following are clinical signs of atelectasis, except?
History of recent major surgery
Tachypnea
Fine, late-inspiratory crackles
decreased density and signs of volume gains on the chest radiograph
Answer: D

10. Lung Expansion Therapy
Incentive spirometry
Has been mainstay of lung expansion therapy for many years
IS devices provide visual cues to patient when desired inspiratory volume of flow is reached
Proved to be effective in high-risk patients

11. Incentive Spirometry

12. Incentive spirometry (cont.)

13. Lung Expansion Therapy (cont.)
Equipment for incentive spirometry
Typically simple, portable, & inexpensive
IS devices either flow oriented or volume oriented
Flow-oriented devices more popular because they are smaller

14. Equipment

15. Flow-Oriented Incentive Spirometer

16. Lung Expansion Therapy (cont.)
Administration of IS
Need for IS is determined by careful patient assessment (high-risk patient)
Effective patient teaching
Demonstrate then observe patient
Patient should sustain his/her maximal inspiratory effort for 5 to 10 seconds
Follow-up

17. Lung Expansion Therapy (cont.)

18. All of the following are advantages of incentive spirometry, except?
Potential absence of or improvement in signs of atelectasis
It is only needs to be performed once per day
IS devices provide visual cues to the patient when a desired inspiratory volume of flow is reached.
Has proved to be effective in high-risk patients
Answer: B

19. Lung Expansion Therapy (cont.)
Intermittent Positive Pressure Breathing (IPPB)
Uses positive airway pressure to expand lung
Treatments last 15 to 20 minutes
Exhalation is passive

20. IPPB

21. Lung Expansion Therapy (cont.)
Indications for IPPB
Patient with atelectasis not responsive to other modalities such as IS
Patient at high risk for atelectasis who cannot perform IS

22. Active, untreated tuberculosis Nausea Singultus
All of the following clinical situations are contraindications of IPPB therapy except:
Active, untreated tuberculosis
Nausea
Singultus
Inability to take a deep-breath
Answer: D

23. Lung Expansion Therapy (cont.)

24. Lung Expansion Therapy (cont.)

25. Lung Expansion Therapy (cont.)
Administration of IPPB
Preliminary planning
Therapeutic outcomes set
Evaluate alternatives
Baseline assessment of patient

26. Lung Expansion Therapy (cont.)

27. Lung Expansion Therapy (cont.)
Administration of IPPB (cont.)
Implementation
Equipment preparation
Patient orientation
Patient positioning
Adjusting parameters
Flow
pressure

28. Lung Expansion Therapy (cont.)
Positive airway pressure therapy (PAP)
Definition
PEP
EPAP
CPAP

29. Positive Airway Pressure Therapy

30. Lung Expansion Therapy (cont.)
Indications
Treatment of atelectasis
Treatment of cardiogenic pulmonary edema
Contraindications
Hemodynamic instability
Patient with hypoventilation

31. Lung Expansion Therapy (cont.)
Hazards & complications
Barotrauma
Hypoventilation
Gastric distention
Vomiting & aspiration

32. PAP Equipment

33. Vomiting and aspiration
All of the following are complications of lung expansion therapy, except?
Barotrauma
Increased FRC
Gastric distention
Vomiting and aspiration
Answer: B

34. Lung Expansion Therapy (cont.)
Monitoring & troubleshooting with positive airway pressure (PAP) therapies
Most common problem with PAP therapies is system leaks
Patient must be monitored for hypoventilation & elevated PCO2
Inspiratory flow must be adequate

35. Selecting an Approach
Chose modality that is safest, simplest, & most effective
RT should evaluate the following before choosing a specific modality:
Level of patient cooperation
Amount of pulmonary secretions
Patient’s spontaneous vital capacity

36. Selecting an Approach (cont.)