Chapter 39
Lung Expansion Therapy
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Learning Objectives
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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.
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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Learning Objectives (cont.)
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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.
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Introduction
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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
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Causes & Types of Atelectasis
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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
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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Which of the following is a cause for compression
atelectasis?
A. mucus plugs blocking ventilation to selected
regions of the lung
B. significant shifts in V/Q
C. persistent breathing with small tidal volumes
D. excessive lung volume during normal breathing
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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Factors Associated With Causing
Atelectasis
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Obesity
Neuromuscular disorders
Heavy sedation
Surgery near diaphragm
Bed rest
Poor cough
History of lung disease
Restrictive chest-wall abnormalities
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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Clinical Signs of Atelectasis
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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
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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All of the following are clinical signs of atelectasis,
except?
A.
B.
C.
D.
History of recent major surgery
Tachypnea
Fine, late-inspiratory crackles
decreased density and signs of volume gains
on the chest radiograph
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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Lung Expansion Therapy
● Incentive spirometry
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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
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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Incentive Spirometry
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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Incentive spirometry (cont.)
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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Lung Expansion Therapy (cont.)
● Equipment for incentive spirometry
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Typically simple, portable, & inexpensive
IS devices either flow oriented or volume oriented
Flow-oriented devices more popular because they
are smaller
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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Equipment
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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Flow-Oriented Incentive Spirometer
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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Lung Expansion Therapy (cont.)
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Administration of IS
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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
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Follow-up
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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Lung Expansion Therapy (cont.)
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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All of the following are advantages of incentive
spirometry, except?
A. Potential absence of or improvement in signs of
atelectasis
B. It is only needs to be performed once per day
C. IS devices provide visual cues to the patient
when a desired inspiratory volume of flow is
reached.
D. Has proved to be effective in high-risk patients
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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Lung Expansion Therapy (cont.)
● Intermittent Positive Pressure Breathing
(IPPB)
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Uses positive airway pressure to expand lung
Treatments last 15 to 20 minutes
Exhalation is passive
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IPPB
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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Lung Expansion Therapy (cont.)
● Indications for IPPB
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Patient with atelectasis not responsive to other
modalities such as IS
Patient at high risk for atelectasis who cannot
perform IS
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All of the following clinical situations are
contraindications of IPPB therapy except:
A.
B.
C.
D.
Active, untreated tuberculosis
Nausea
Singultus
Inability to take a deep-breath
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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Lung Expansion Therapy (cont.)
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
23
Lung Expansion Therapy (cont.)
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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Lung Expansion Therapy (cont.)
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Administration of IPPB
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Preliminary planning
• Therapeutic outcomes set
• Evaluate alternatives
• Baseline assessment of patient
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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Lung Expansion Therapy (cont.)
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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Lung Expansion Therapy (cont.)
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Administration of IPPB (cont.)
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Implementation
• Equipment preparation
• Patient orientation
• Patient positioning
• Adjusting parameters


Flow
pressure
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Lung Expansion Therapy (cont.)
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Positive airway pressure therapy (PAP)
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Definition
• PEP
• EPAP
• CPAP
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Positive Airway Pressure Therapy
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Lung Expansion Therapy (cont.)
● Indications
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Treatment of atelectasis
Treatment of cardiogenic pulmonary edema
● Contraindications
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Hemodynamic instability
Patient with hypoventilation
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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Lung Expansion Therapy (cont.)
● Hazards & complications
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Barotrauma
Hypoventilation
Gastric distention
Vomiting & aspiration
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PAP Equipment
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All of the following are complications of lung
expansion therapy, except?
A.
B.
C.
D.
Barotrauma
Increased FRC
Gastric distention
Vomiting and aspiration
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Lung Expansion Therapy (cont.)
● Monitoring & troubleshooting with positive
airway pressure (PAP) therapies
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Most common problem with PAP therapies is
system leaks
Patient must be monitored for hypoventilation &
elevated PCO2
Inspiratory flow must be adequate
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Selecting an Approach
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Chose modality that is safest, simplest, &
most effective
RT should evaluate the following before
choosing a specific modality:
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Level of patient cooperation
 Amount of pulmonary secretions
 Patient’s spontaneous vital capacity
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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Selecting an Approach (cont.)
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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