O2 Therapy,
Lung Expansion Therapy
& Airway Clearance
By Michael S. Allen, RRT
Updated April 8, 2015
O2 Therapy, LET & BHT
Key Note:
 Do least invasive therapy first
 Do least costly therapy first
 If patient condition severe,
then do severe therapy
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
No Smoking, Oxygen in Use
OXYGEN THERAPY
O2 DEVICES
Device:
Nasal Cannula
FIO2 is what we deliver
SpO2 is what we measure
Limitations:
Adult = 0.25 Lpm – 6 Lpm
Infant = 1/32, 1/16, 1/8
FIO2:
RA = 20%
1L = 24%
2L = 28%
3L = 32%
4L = 36%
5L = 40%
6L = ~44%?
OXYGEN THERAPY
O2 DEVICES
Device:
Simple Mask
Limitations:
6 Lpm – 10 Lpm
FIO2:
35% – 50 %
OXYGEN THERAPY
O2 DEVICES
Device:
“Venti” air-entrainment mask
Limitations:
3 Lpm
6 Lpm
8 Lpm
FIO2:
24 – 32%
36 – 44%
50 – ~70%
OXYGEN THERAPY
O2 DEVICES
Device:
High Flow Nasal Cannula
(non heated)
Limitations:
3 Lpm – 12 Lpm
FIO2:
questionable FIO2%
LPM flow titrated to SpO2
OXYGEN THERAPY
O2 DEVICES
Device:
Non-rebreather (NRB)
Limitations:
8 Lpm – 15 Lpm
“flush” (~16–40 Lpm)
FIO2:
60% – 95%
95% – ~100%
OXYGEN THERAPY
O2 DEVICES
Device:
Oxymask
Limitations:
FIO2 dictated by flow
* Able to sxn patient, or
provide drink w/o removing mask.
FIO2:
1 LPM 24% - 25%
2 LPM 27% - 32%
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 … www.youtube.com/watch?v=KDsNm72dBRU
OXYGEN THERAPY
O2 DEVICES
Device:
Heated-Humidified
High Flow Nasal Cannula
Limitations:
10 Lpm – 70 Lpm
excess rainout
FIO2:
Blender needed for FIO2%
OXYGEN THERAPY
O2 DEVICES
Device:
CPAP
Limitations:
used in ICU
FIO2:
21% – 100%
Note, a patient’s CPAP is used for OSA, but a CPAP/BiPAP such as seen above is for Oxygen therapy.
Caution, Lung Expansion in Progress
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
Devices for LET
Deep-breath and Cough “DB&C”
Devices for LET
Pursed Lip breathing
Devices for LET
Patient position and Body Calisthenics
Devices for LET
Incentive Spirometry
Devices for LET
TheraPEP
Devices for LET
EzPAP
Refer to … www.youtube.com/watch?v=UA00oG7ou_I
Devices for LET
IPPB
Bird Mark 7
IPPB circuit
Bennett PR-2
Devices for LET
CPAP/BiPAP
BHT … I Need Help
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)
Devices for BHT
Huff Cough
Devices for BHT
TheraPEP
Devices for BHT
Flutter
Acapella
Refer to … www.youtube.com/watch?v=jZCjMQAlGcU
Aerobika oscillating PEP (OPEP)
Refer to … www.youtube.com/watch?v=n7X3QP8HJKA
Devices for BHT
Chest Physio-Therapy (CPT)
Hand percussion and hand-held device
Devices for BHT
Chest Physio-Therapy (CPT)
Pneumatic Percussor
Electric Percussor
Devices for BHT
Chest Physio-Therapy (CPT)
High Frequency Chest Wall Oscilation (HFCWO)
Devices for BHT
Postural Drainage
Devices for BHT
Cough Assist Device
Devices for BHT
Nasal-Tracheal Suction (NT sxn)
Devices for BHT
IPV (Intrapulmonary Percussive Ventilation)
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