Transcript Bronchial Hygiene - Respiratory Therapy Files

Bronchial Hygiene
What is bronchial hygiene?
• Any device/procedure utilized to maintain lung
sterility by loosening/removing retained secretions,
Bronchodilating, and hyper inflating the lung
• Techniques include:
• Suctioning patients
• Giving bronchodilating and mucus thinning
medications
• Giving chest physiotherapy
• Giving devices to increase lung volume
• Maintaining airways
• Warm Humidity
Why is Bronchial Hygiene
important?
• The lungs are a sterile environment
• Anything unnatural can lead to
inflammatory cell release/congestion
• We must clear the lung of this
congestion to allow for proper gas
exchange/breathing
• Atelectasis and/or Pneumonia can
occur
Mucus Plugging can lead to…
Atelectasis/Collapsed Lung
Suctioning
• RT’s often suction patients airways either through their nose
to their lungs, mouth or through a artificial airway
Suctioning
• Suctioning is the application of negative pressure (below
atmopheric) to the airways through a collecting tube
• Performed on patients without the ability to cough or who have
weak coughs
Effective Cough
• Components
• Abdominal contraction
• Glottic closure/ability to take a deep breath
• Coughing is a reflex, however it can also be
voluntarily controlled
• Increased urge to cough: viral vs bacterial (acute
bronchitis); chronic cough (chronic bronchitis from
smoking or lung ailment)
Phases of a Cough
• Irritation of airway (particulate/dust…)
• Inspiration of adequate volume
• Compression
• Glottic closure
• Contraction of abdominal muscles
• Increase in intrathoracic pressure
Phases of a Cough
• Expulsion
• Opening of glottis
• Explosive expulsion of air and matter (flow up to 500 mph)
Ineffective Cough
• You must have every patient demonstrate the
effectiveness of a cough before/after every
treatment.
• If a patient is unable to cough:
• Give expectorants/ensure patient is hydrated
• Give mucoactives/bronchial hygiene
• Suction patient?
• May lead to mucus accumulation
• Leads to mucus plugs and atelectasis
• Leads to lung infection and pneumonia
Ineffective Cough
Causes
• The very old and young
• Patients who are physically weak
• Patients with neuromuscular diseases
• Patients who are medicated/sedated
• Patients with strokes
Bronchodilators
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Used to relax constricted bronchial smooth muscle
Allows better gas flow out of the lung thus helps with cough
Common medications include:
Albuterol
Xopenex
Given as a MDI or a Nebulizer
Mucus thinning medications
Chest Physiotherapy
Chest Physiotherapy
Vest Therapy
Lung Inflation
• Increasing lung inflation allows for a bigger and better cough
• Devices include:
• Incentive Spirometer
• Intermittent Positive Pressure Breathing
• Positive Expiratory Pressure
Airway Management
• Some patient’s require artificial airways, in part to help
facilitate suctioning. Artificial airways include:
• Endotracheal intubation
• Trachestomy
Warm Humidity
• Adding humidity to inspired air helps to add moisture to the
mucosal lining of the airway, allowing mucus to become more
fluidic and mobile
Others
• Ensuring the patient is properly hydrated
• Ensuring the patient is taking deep breaths, coach patient to
perform pursed lip breathing and diaphragmatic breathing
• Nasal breathing, nasal sprays