Physical Therapy Management of Acute Respiratory …10+-+Pulmonary+Ede… · Pulmonary edema:...
Transcript of Physical Therapy Management of Acute Respiratory …10+-+Pulmonary+Ede… · Pulmonary edema:...
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Physical Therapy Management of Acute
Respiratory Distress Syndrome (ARDS) in an
Acute Care Setting
Chase Eifert, Amber Denomme, Ross
Fenimore, and Emma Richards
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Objectives
• Define Pulmonary Edema
• Define ARDS
– Goals for treatment
– Interventions
• Current research for interventions of ARDS
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What is Pulmonary Edema?
• Classifications
– Cardiogenic
– Non-cardiogenic
• Pathophysiology
– ↓ Lung compliance
– ↓ Lung volume
– ↑ Work of breathing
– ↑ Pressure in lung tissue
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What is Pulmonary Edema cont.
• Diagnostic Tests– Chest x-rays
– ↑ BNP levels (only in cardiogenic)
– Pulmonary function test changes• ↓ Lung volumes
• ↑ RR
• No change in FEV1
• Normal flow rate
– Arterial blood gasses• ↑ pH (respiratory alkalosis)
• ↓ PaO2
• ↓ PaCO2
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What is Pulmonary Edema cont.
• Clinical Manifestations
– Breath sounds• Wet Rales
• Wheezing
– Cardiovascular• Dysfunction
• Arrhythmias
– Symptoms• Respiratory distress
• SOB
• Cyanotic
• Labored breathing
• Pallor
• Diaphoresis
• Cough
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ARDS
• Non-cardiogenetic form of pulmonary edema
• Characterized by bilateral pulmonary infiltrate
and hypoxemia
• No cardiogenic problems
• Usually results from injury to the lungs
• Diagnosis defined by PaO2 to the fraction of
oxygen in the inspired air is less than 200mmHg
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PT Goals for the treatment of ARDS in the Acute
Care Setting
• Improve Oxygenation
• Decrease incidence of ventilator induced
pneumonia
• Initiate gradual mobilization
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• Mobilization
• Continuous Rotational
Therapy
• Posture
• Limb Exercise
• NMES
• Respiratory Muscle
Training
• Management of Airway
Secretion
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Mobilization
• Immobility contributes to patient decline in function
• Patient outcomes associated with early mobilization
• Holistic improvements with:– Overall Function
– Muscular Strength
– Cognition
– Respiratory Function
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Continuous Rotational Therapy
• Continually turning
patient on
longitudinal axis 60
degree
• Lack of sufficient
evidence
https://images.dlf.org.uk/mee/products/full/0042431.jpg
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Posture
• Improvements in V/Q
mismatch & residual
volume
• Prone ventilation
improved survival of
hypoxemic patients
• Techniques not widely
used
http://accessphysiotherapy.mhmedical.com/data/
books/detu2/detu2_c019f004.jpg
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Limb Exercise
• PROM, AAROM, &
AROM
– ↑ ROM, prevent
contracture, ↑ strength,
& prevent DVT
• Effects of limb exercise
of mechanical
ventilation weaning time
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NMES
• Low-intensity NMES
applied to LE
• Outcomes improved
without respiratory stress
• Patients suffering from
COPD, SCI, or CHF may
see greater benefits
http://www.kneeguru.co.uk/assets/images/
Community_Hub/kokmeyer/IMG_1871.png
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Respiratory Muscle Training
• Inspiratory muscle training safe with ventilated patients
• Outcomes dependent on case-by-case basis
• More research required before universal application to patients with ARDS
https://i.pinimg.com/originals/fd/59/79/fd597974caa0ec8a387ccd36ce2c65c5.jpg
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Management of Airway Secretion
• The relationship between mechanical ventilation and airway secretion
• Humidification
• Manual hyperinflation
• Percussion & vibration
• Intrapulmonary percussive ventilation
• Cough assist http://downloads.lww.com/wolterskluwer_vitalstream_c
om/sample-
content/9780781788786_Craven/samples/mod09/img/1
0a_2.jpg
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Objectives
• Define Pulmonary Edema
• Define ARDS
– Goals for treatment
– Interventions
• Current research for interventions of ARDS
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References
1. Ambrosino N, Makhabah D. Comprehensive Physiotherapy Management in ARDS. Vol 792013
2. Chung F, Mueller D. Physical Therapy Management of Ventilated Patients with Acute Respiratory Distress Syndrome or Severe Acute Lung Injury. Physiotherapy Canada. 2011;63(2):191-198.
3. Hillegass, Ellen et al. Essentials of Cardiopulmonary Physical Therapy 4th Edition. 2017, 152-153
4. Murray. Pulmonary edema: pathophysiology and diagnosis. The international journal of tuberculosis and lung disease. 2011;15(2):155
5. Purvey M, Allen G. Managing acute pulmonary oedema. Australian Prescriber. 2017;40(2):59-63.