Improving ventilation & reducing the work of breathing in infants and children Robyn Smith...
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![Page 1: Improving ventilation & reducing the work of breathing in infants and children Robyn Smith Department of Physiotherapy University of Free State 2011.](https://reader035.fdocuments.in/reader035/viewer/2022062716/56649dd35503460f94acaee0/html5/thumbnails/1.jpg)
Improving ventilation & reducing the work of breathing in infants
and children
Robyn Smith Department of Physiotherapy
University of Free State2011
![Page 2: Improving ventilation & reducing the work of breathing in infants and children Robyn Smith Department of Physiotherapy University of Free State 2011.](https://reader035.fdocuments.in/reader035/viewer/2022062716/56649dd35503460f94acaee0/html5/thumbnails/2.jpg)
Aims of Chest Physiotherapy
Other aims of chest physiotherapy apart from mobilising and clearing secretions are:◦improve ventilation and ◦decrease the work of breathing (WOB)
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Ventilation
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Challenges in children
Maintaining adequate lung volumes and ensuring adequate ventilation remains a challenge in children whose immature airways have a tendency to closure/collapse
Physiotherapy aims to:◦Re-expand atelectatic segments◦ prevent secondary lung complications due to
atelectasis
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Physiotherapy techniques to improve ventilation and lung volume
PositioningPlay and exerciseBreathing exercisesACBTIncentive spirometryPostural drainage and manual techniques
In this section only positioning and breathing exercises will be discussed. Please refer to the presentation regarding mobilisation of secretions for information regarding the other techniques
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Differentiating between shortness of breath and
dyspnoea
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Shortness of breath Dyspnoea
Associated rapid RR or tachypnoea largely
Common in children with acute respiratory disease
Sense of breathlessness cannot get enough breath
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Shortness of breath and dyspnoea
Teach relaxation positions and breathing control in older children
Position in relaxation position Relax shoulder girdle Encourage diaphragmatic breathing
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Positioning
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Positioning
Positioning is one of the most important ways one can optimise respiratory functioning
Small children breathe more comfortably in a slightly head up position
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Position in semi-fowlers or head up position:
◦Not slumped as this compresses the diaphragm◦Knees in slight flexion to decrease the load on
the diaphragm
Can even use sitting up on parents lap
Can use cuddly toys to aid positioning
Positioning
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Breathing exercises
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Breathing exercises
It is possible to encourage children to breathe deeply from about 2 years
Can make use of games and activities in younger children e.g. Blowing bubbles, pinwheels or even incentive spirometry (flutter) or bubble PEP
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Blowing activities children
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Neurophysiological stimulation of respiration
Makes use of tactile and proprioceptive stimulation
A stimulus (intercostal stretch) is given at the end of expiration
This facilitates improved chest expansion and therefore ventilation
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Localised breathing exercises
Used to improve thoracic expansion in older children
Physiotherapists hands at the level of the 8th rib
Child is instructed to expand the lower ribs against her hands
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Improving the ventilation/ perfusion ration
Physiological characteristics of the immature respiratory system influence the inability of ventilated areas of the lung to match the perfused areas in a child.
In young children ventilation is preferably distributed to the uppermost lung areas and the dependant areas are poorly ventilated.
This happens due to the airway closing pressure in young child being before the FRC is reached and the highly compliant chest wall.
The dependant lung areas have better perfusion.
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Improving the ventilation/ perfusion ration
Principles to improve gaseous exchange in a child are the opposite to those in an adult (up until 10 years of age)
e.g. Child with right sided pathology should be placed on the right side to optimise ventilation and reduce mismatching
Children may desaturate and their respiratory function deteriorate significantly when placing child with the affected lung uppermost
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References
Hardy, L. 2007. Cardiorespiratory physiotherapy for the acutely ill, non-ventilated child. In Physiotherapy for Children. Poutney, T (Ed). Butterworth Heinemann Elsevier pp 285-290
Anderson, JM & Innocenti, DM. 1992. Techniques used in physiotherapy. In Cash’s Textbook of chest, vascular disorders for Physiotherapists. Downie PA (ed). 4th ed. Pp 325-354
Ammani Prasad, S & Main, E. 2008. Respiratory disease in childhood. In Physiotherapy for respiratory and cardiac problems .Adults and children. Pryor, JA & Ammani Prasad, S (eds).4 ed. Churchill Livingstone Elsevier pp 337-343
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References
Pryor, JA & Ammani Prasad, S. 2008. Physiotherapy techniques. In Physiotherapy for respiratory and cardiac problems .Adults and children. Pryor, JA & Ammani Prasad, S (eds).4 ed. Churchill Livingstone Elsevier pp136-176
Hough , A. 2001. 2001. Physiotherapy to clear secretions. In Physiotherapy in Respiratory care. An evidence based approach to respiratory and cardiac management. 3rd edition. Nelson Thornes. London pp184- 210