RESPIRATORY THERAPIESANILKUMAR BR , LECTURER

SHREE JENUKAL

INTRODUCTION

Numerous treatment modalities are used when caring for clients with various respiratory conditions.

The choice of treatment modalities is based on the oxygenation disorder and whether there is a problem with gas ventilation, diffusion or both.

CLASSIFICATION OF RESPIRATORY MANAGEMENT MODALITIES

Non-invassive respiratory therapies Invasive respiratory therapies

NON – INVASIVE RESPIRATORY THERAPIES

Oxygen Therapy Incentive spirometry Mini – nebulizer Therapy Intermittent Positive –pressure breathing ( IPPB) Chest physiotherapy ( Postral drainage ,chest

percussion, breathing retraining

INVASIVE RESPIRATORY MODALITIES

Endotracheal intubation Tracheostomy Mechanical ventilation

OXYGEN THERAPY

Oxygen therapy is the administration of oxygen at a concentration greater than that found in the environmental atmosphere.

INDICATIONS OF OXYGEN THERAPY

A change in the clients respiratory rate or pattern may be one of the earliest indications of the need for oxygen therapy.

Hypoxemia or hypoxia

COMPLICATIONS OF OXYGEN THERAPY

Oxygen toxicity Suppression of ventilation Combustion

METHODS OF OXYGEN ADMINISTRATION

Low flow system High flow system

LOW FLOW SYSTEM

Cannula Oropharyngeal catheter Simple mask Partial rebreather mask Non breather mask

HIGH FLOW SYSTEMS

Transtracheal catheter Venturi mask Tracheostomy collar T – piece Face tent

INCENTIVE SPIROMETRY ( SUSTAINED MAXIMAL INSPIRATION)

Incentive spirometry is a method of deep breathing that provides visual feedback to encourage the clients to inhale slowly and deeply to minimize lung inflation and prevent or reduce atelectasis.

PURPOSE OF INCENTIVE SPIROMETRY

The incentive spirometer that volume of air inhaled is increased gradually as the patient takes deeper and deeper breaths.

TYPPES OF INCENTIVE SPIROMETRY

Volume or Flow spirometry

INDICATIONS OF SPIROMETRY

Incentive spirometry is used after surgery, especially Thoracic and abdominal surgery, to promote the expansion of the alveoli and to prevent or trat atelectasis.

INSTRUCTIONS REGARDING SPIROMETRY USING

Proper position Technique for using the spirometry Frequency of usage

MINI-NEBULIZER THERAPY

The mini-nebulizer is a handled appartus that disperses a moisturizing agent or mediation, such as bronchodilator or mucolytic agent, into microscopic particles and delivers it to the lungs as the client inhales.

INDICATIONS OF MINI-NEBULIZER THERAPY

In case of difficulty in clearing respiratory secreations

Reduced vital capacity with ineffective deep breathing and coughing.

Most commonly used in COPD clients

INTERMITTENT POSITIVE PRESSURE BREATHING

Intermittent Positive- pressure breathing ( IPPB) is an older form of assisted or controlled Respiration in which compressed gas is delivered under Positive pressure into a person’s airways unitil a preset pressure is reached today.

It is infrequently used currently

CHEST PHYSIOTHERAPY ( CPT)

Chest physiotherapy includes Postral drainage, chest percussion, and chest vibration and breathing retraining.

The goals of CPT are to remove bronchial secretions, improve ventilation, and increases the efficiency of the respiratory muscles.

INVASIVE RESPIRATORY MODALITIES

ENDOTRACHEAL INTUBATION

Endotracheal intubation involves passing an endotracheal tube through the mouth or nose into the trachea.

Endotracheal intubation provides a patent airway when the patient is having respiratory distress that cannot be treated with simpler methods and is the method of choice in emergency care.

TRACHEOSTOMY

A tracheostomy is a surgical procedure in which an opening is made into the trachea.

The indwelling tube inserted into the trachea is called a tracheostomy tube.

A tracheostomy either Temporary or permanent.

COMPLICATIONS OF TRACHEOSTOMY

Complications may occur early or late in the course of tracheostomy tube management.

They may even occur yees after the tube has been removed.

EARLY COMPLICATIONS INCLUDING

Bleeding Pneumothorax Air embolism Aspiration Subcutaneous or mediastinal emphysema Recurrent laryngeal nerve damage

LONG TERM COMPLICATIONS

Airway instructions from accumulation of secretions Infection Rupture of the innominate arteryDysphagia Tracheoesophageal fistula Tracheal ischmia and necrosis

MECHANICAL VENTILATION

Mechanical ventilation may be required for a variety of reasons.

To control the patient Respiration during surgery or during treatment of severe head injury, to oxygenate the blood when the patient ventilatory efforts are inadequate

MECHANICAL VENTILATION

A mechanical ventilator is a Positive or negative pressure breathing device that can maintain ventilation and oxygen delivery for a prolonged period

INDICATIONS

Continues decrease in oxygenation (PaO2), an increase in arterial carbon dioxide levels ( PaCO2) and persistent acidosis ( decreased pH) mechanical ventilation may be necessary. ( Any dramatic alterations in ABGs valves)

INDICATIONS

Conditions such as Thoracic or abdominal surgery Drugs over dose Neuromuscular injury and inhalation ingury COPD , multiple trauma, shock, multisysstem

failure and coma.

CLASSIFICATION OF VENTILATORS

Negative- pressure ventilators Positive- pressure ventilators

COMPLICATIONS

Alterations in cardiac function Barotrauma ( trauma to the trachea or alveoli

secondary to Positive pressure) Ventilator associated pneumonia Pulmonary infection Sepsis

WEANING THE PATIENT FROM THE VENTILATOR

Respiratory weaning, the process of withdrawing the patient from dependncce on the ventilator, takes place in three stages, the patient is gradually removed from the ventilator, then from the tube, and finnaly from oxygen.

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