1. Bronchial Hygiene Therapy
RET 2275
Respiratory Therapy Theory 2

2. Bronchial Hygiene
Bronchial hygiene therapy involves noninvasive airway clearance techniques to help mobilize secretions and improve gas exchange
Reading Assignment
Egan’s Fundamentals of Respiratory Care
NINTH EDITION (pgs )

3. Bronchial Hygiene Normal clearance
Normal airway clearance requires a(an)
Patent airway
Functional mucocilary escalator
Effective cough
An effective cough can effectively move mucus from the lower airways to the upper airway.

4. Bronchial Hygiene
Normal clearance

5. Bronchial Hygiene Abnormal clearance
Abnormalities in airway patency, mucuciliary function, strength of breathing muscles, or cough reflex can lead to mucus retention.
Mucus plugging can lead to atelectasis, pneumonia, and hypoxemia.

6. Bronchial Hygiene

7. Bronchial Hygiene Diseases associated with abnormal clearance
Internal or external compression of an airway lumen (e.g., asthma, lung cancer)
Cystic fibrosis
Bronchiectasis
Neuromuscular diseases can cause a weak cough.

8. Bronchial Hygiene General Goals and Indications
Bronchial hygiene therapy for acute conditions
Acutely ill patient with copious secretions
Patient in acute respiratory failure with clinical signs of retained secretions
Patient with acute lobar atelectasis
Patient with hypoxemia due to lung infiltrates

9. Bronchial Hygiene General Goals and Indications (cont.)
Bronchial hygiene therapy to prevent retention of secretions
May be useful in acutely ill patients when combined with patient mobilization
Cystic fibrosis patients benefit from chest physical therapy combined with exercise to maintain lung function.

10. Bronchial Hygiene Determining Need for Bronchial Hygiene Therapy
Bedside findings such as
Loose, ineffective cough
Labored breathing pattern
Coarse inspiratory and expiratory crackles
Tachypnea/tachycardia
Fever
The chest radiograph demonstrating atelectasis and infiltrates

11. Bronchial Hygiene Bronchial Hygiene Methods Postural drainage therapy
Coughing and related expulsion techniques
Positive airway pressure (PAP)
High-frequency compression/oscillation
Mobilization and exercise

12. Bronchial Hygiene Postural drainage therapy
Involves the use of gravity and mechanical energy to mobilize secretions
Includes turning, postural drainage, and percussion and vibration

13. Bronchial Hygiene Postural drainage therapy Indications
Inability or reluctance of patient to change position
Poor oxygenation associated with position (e.g., unilateral lung disease)
Potential for or presence of atelectasis
Evidence or suggestion of difficulty with secretion clearance
Difficulty clearing secretions, with expectorated sputum production >25 – 30 ml/day (adult)

14. Bronchial Hygiene Postural drainage therapy Indications (cont.)
Evidence or suggestion or retained secretions in the presence of an artificial airway
Diagnosis of diseases such a cystic fibrosis, bronchiectasis, or cavitating lung disease
External Manipulation of the Thorax
Sputum volume or consistency suggesting a need for additional manipulation (e.g., percussion and/or vibration to assist movement of secretions by gravity in a patient receiving postural drainage

15. Bronchial Hygiene Postural drainage Turning
Primarily done to promote lung expansion, improve oxygenation, and prevent retention of mucus
Proning has been used in patients with acute lung injury to improve lung function.

16. Bronchial Hygiene Postural drainage Turning and “Plumbing Problems”
Ventilator disconnection
Accidental extubation
Accidental aspiration of ventilator circuit condensate
Disconnection of vascular lines or urinary catheters – ouch!

17. Bronchial Hygiene Postural drainage (cont.)
The process placing the patient in various positions to drain specific segmental bronchi
Positions are typically held for 3 to 15 minutes.
Most effective in patient with excessive mucus secretion

18. Patient positions for Postural Drainage

19. Bronchial Hygiene Postural Drainage Monitoring
Subjective response to pain
Pulse, arrhythmia, and ECG if available
Breathing pattern and rate
Sputum production
Mental function
Skin color
Breath sounds
Blood pressure
SpO2
ICP

20. Bronchial Hygiene Postural drainage Outcome assessment
Change in sputum production
Change in breath sounds
Change in dyspnea level
Change in vital signs
Change in chest radiograph/ABG results
Change in ventilator variables

21. Bronchial Hygiene Postural drainage Documentation and follow-up
The chart entry should include
The positions used
Time in positions
Patient tolerance
Indicators of effectiveness
Any untoward effects observed

22. Bronchial Hygiene Postural drainage Percussion and vibration
The application of mechanical energy to the chest wall by use of the hands or various electrical or pneumatic devices
Designed to aid in movement of mucus toward the central airways

23. Bronchial Hygiene Postural drainage Vibration
Place one hand on the patient’s chest over the involved area and place the other hand on top of the first
Ask the patient to take a deep breath
Exert slight to moderate pressure on the chest wall and initiate a rapid vibratory motion of the hands throughout expiration

24. Bronchial Hygiene Postural Drainage Absolute Contraindications
Head and neck injury until stabilized
Active hemorrhage with hemodynamic instability
Relative Contraindications
Active hemoptysis
Pulmonary embolism
Recent spinal surgery
Aged, confused, or anxious patients who do not tolerate position changes
Refer to AARC Clinical Practice Guidelines for complete list

25. Bronchial Hygiene Postural Drainage
Trendelenburg position is contraindicated for:
Recent gross hemoptysis
ICP >20 mm Hg
Uncontrolled hypertension
Distended abdomen
Patient in whom increased ICP is to be avoided (neurosurgery, aneurysms, eye surgery)
Uncontrolled airway at risk for aspiration (tube feeding or recent meal)
Esophageal surgery
Refer to AARC Clinical Practice Guidelines for complete list

26. Bronchial Hygiene Postural Drainage Complications/Hazards Hypoxemia
Increase ICP
Acute hypotension during procedure
Pulmonary hemorrhage
Pain or injury to muscles, ribs, or spine
Vomiting and aspiration
Bronchospasm
Arrhythmias