1
RSPT 1410
Lung Expansion Therapy
Part 1: General Information
Wilkins: Chapter 39, p. 905-909
2
Lung Expansion Therapy
•  Includes a variety of modalities
–  Incentive Spirometry
–  Intermittent Positive Pressure Breathing (IPPB)
–  Continuous Positive Airway Pressure (CPAP)
–  Positive Expiratory Therapy (PEP)
•  No one therapy is conclusively better
•  RCP and physician should decide on best
choice making most efficient use of resources
3
Lung Expansion Therapy
•  Atelectasis is most common indication
–  __________________ atelectasis: collapse of
distal lung units due to mucus plugging of airways
–  _____________ atelectasis: collapse of distal lung
units due to persistent ventilation with small VTs
•  Patients at risk for atelectasis include those
–  who have had thoracic or abdominal surgery
–  with neuromuscular disorders
–  who are sedated
–  with spinal cord injuries
–  who are bedridden
1
4
Lung Expansion Therapy
•  __________ patients have highest risk due to
–  general anesthesia
–  shallow breathing
–  decreased ciliary activity
–  transient decrease in surfactant production
•  These factors cause a progressive
__________ in FRC during the first 48 hours
following surgery
•  The decrease in FRC is associated with
alveolar collapse, most often in the lung
__________
5
Lung Expansion Therapy
6
Lung Expansion Therapy
. .
•  Since perfusion remains unchanged, a V/Q
mismatch results, causing ______________
•  Pain further restricts ventilation as does the
tendency to “splint” muscles in the incision
area
•  A decreased ability to take ______________
postoperatively also inhibits coughing, leading
to increased secretions in the airway and
possible atelectasis
2
7
Lung Expansion Therapy
•  In the postoperative period, patients with any
disease that increases __________________
and those with a history of ______________
are also at higher risk for atelectasis
8
Lung Expansion Therapy
•  Clinical signs of atelectasis
–  With minimal atelectasis, signs may be _________
–  Increased respiratory rate
–  Fine, late inspiratory ______________ over
affected area
–  Bronchial breath sounds
–  Decreased breath sounds
–  ______________ (if hypoxemia is present)
–  Atelectasis alone does not cause a fever unless
______________ is also present
9
Lung Expansion Therapy
•  Radiographic signs of atelectasis
–  Atelectatic region will show increased __________
–  Evidence of volume loss
•
•
•
•
•
•
•
•
Displacement of interlobar fissures
Crowding of pulmonary vessels
Air ______________
Elevation of diaphragm
______________ of trachea, heart & mediastinum
Pulmonary opacification
Narrowing of space ______________
Compensatory hyperexpansion of surrounding lung
3
10
Lung Expansion Therapy
•  How does it work?
–  All methods of lung expansion therapy
______________ lung volume by increasing the
transpulmonary pressure gradient (PL)
–  PL represents the difference between the alveolar
pressure (Palv) and the pleural pressure (Ppl)
PL = Palv – Ppl
–  If all else is constant, the greater the PL, the more
the alveoli ______________
11
Lung Expansion Therapy
•  PL can be increased by
–  decreasing the surrounding
pleural pressure as with a
______________ (A)
–  increasing the alveolar pressure
as with a inspiration (B)
•  Decreasing pleural pressure
is more physiological and
often more effective, but
requires an ___________,
________________ patient
12
PL = Palv – Ppl
Initial
Final
Maneuver
Palv
Ppl
Palv
Ppl
SI
0
-4
0
-14
PPI
0
-4
13
-1
14
4