ZOE JOHNSTONE PHYSIOTHERAPIST...respiratory medicine 93; 660-665. • constantini d., brivio a.,...
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RESPIRATORY PHYSIOTHERAPY IN NEUROMUSCULAR CONDITIONS ZOE JOHNSTONE PHYSIOTHERAPIST
Transcript of ZOE JOHNSTONE PHYSIOTHERAPIST...respiratory medicine 93; 660-665. • constantini d., brivio a.,...
RESPIRATORY PHYSIOTHERAPY IN NEUROMUSCULAR CONDITIONS
ZOE JOHNSTONE
PHYSIOTHERAPIST
OBJECTIVES
bull TO UNDERSTAND THE AIMS OF AIRWAY CLEARANCE IN THE PAEDIATRIC POPULATION
bull TO UNDERSTAND THE RESPIRATORY RISK FACTORS FOR CHILDREN WITH NEUROMUSCULAR CONDITIONS
bull TO HAVE AN AWARENESS OF AIRWAY CLEARANCE TECHNIQUES AVAILABLE FOR USE WITHIN THE PAEDIATRIC POPULATION
bull TO UNDERSTAND SAFE AND EFFECTIVE USE OF AIRWAY CLEARANCE TECHNIQUES USED IN THE PAEDIATRIC POPULATION
0
50
100
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200
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300
350
400
0
50
100
150
200
250
300
350
400
Green
Yellow
Red
PCF Mouthpiece (Lmin)
PCF Mask (Lmin)
Key
Mouthpiece u
Mask n
Additional info (please comment)
Off feet
Ability to chew
Strength of voice Please refer to BTSACPRC Guideline ldquoPhysiotherapy management of the adult medical spontaneously breathing patientrdquo and ldquoGuidelines
Lothian University Hospitals NHS Trust
Paediatric Physiotherapy Service
Lead Physiotherapist Mairi McCrae
n PCF gt270lmin
Breathstacking tri-flow blowing
games
nPCF lt270lmin but gt 160lmin
Manual assisted cough manual
techniques ambu bag assisted
breaths
nPCF lt160lmin
NIV ambu-bag assisted breaths
MI-E
bull SHORT TERM TREATMENT AIMS TO MINIMISE INFECTION AND PREVENT
REPEATED LUNG DAMAGE
bull NORMALISE RESPIRATORY SYSTEM
bull MAXIMISE VENTILATION amp ENCOURAGE EQUAL FILLING
bull MAXIMISE EXPIRATORY FLOWVELOCITY
bull REMOVAL OF TRACHEOBRONCHIAL SECRETIONS FROM THE LUNGS
bull DECREASE WORK OF BREATHING
bull LONG TERM TREATMENT AIMS TO DELAY THE PROGRESSION OF RESPIRATORY
DISEASE AND MAINTAIN OPTIMAL RESPIRATORY FUNCTION
AIMS OF ACT
AIM OF ACT
bull COMPENSATE FOR IMPAIRED MUCOCILIARY CLEARANCE
bull COMPENSATE FOR INABILITY TO CREATE EXPIRATORY FLOW AND INSP EFFORT
bull IMPROVE VENTILATION BY PREVENTING OBSTRUCTION OF SMALL AIRWAYS
bull SLOW DOWN LUNG DISEASE
POOR AIRWAY CLEARANCE
INCREASED AIRWAY RESISTANCE
INCREASED WOB
HYPOXAEMIA
REPEATED INFECTIONS
LOSS OF RESPIRATORY RESERVE
AIRWAY DAMAGE
RESPIRATORY FAILURE
AIRWAY CLEARANCE TECHNIQUES
bull CHEST PHYSIO
bull DECREASED LUNG VOLUME
bull SECRETION RETENTION
bull INCREASED WOB
bull KETCHUP BOTTLE
bull GLASS
bull PLASTIC
bull SACHET
bull HUMIDIFICATION INHALATION THERAPY
bull MANUAL TECHNIQUES
bull BREATHING TECHNIQUES
bull MAXIMAL INSPIRATORY CAPACITY
bull PHYSIO WITH NIV
bull PEP
bull OSCILLATORY TECHNIQUES
bull HFCWO
bull MIE
bull SUCTION
ACT TECHNIQUES
MANUAL TECHNIQUES
bull PERCUSSION
bull VIBRATIONSHAKING
bull MANUAL ASSISTED COUGH
bull TRACHEAL PRESSURE
bull OVERPRESSURE
bull MANUALASSISTED AD
ACTIVE CYCLE OF BREATHING
Breathing control
3-5 Deep Breaths or TEE
with 3 sec inspiratory
hold
Breathing control
3-5 Deep Breaths or TEE
with 3 sec inspiratory
hold
Breathing control
2-3 FET huffs amp coughs
Clear mucus
Active Cycle
of Breathing
Technique
(ACBT)
AUTOGENIC DRAINAGE
bull JEAN CHEVALLIER 1967 IN BELGIUM
bull OBSERVED CHILDREN SLEEPING
bull LOW LV VrsquoS HIGH LVrsquoS
bull 3 PHASES OF BREATHING
bull LOW
bull MID
bull HIGH
bull MOVING FROM RESIDUAL VOLUME TO TOTAL LUNG CAPACITY
bull AIM TO GENERATE INCREASED EXPIRATORY AIRFLOW PROGRESSIVELY THROUGH EACH GENERATION OF BRONCHI
bull SECRETIONS LOOSEN AND MOVE INTO LARGER AIRWAYS TO AID EXPECTORATION
AD CONTrsquoD
bull METHOD bull DIAGNOSTIC BREATH WHERE ABLE
bull LOW FLOW ON INSPIRATION IE QUIET BREATH IN
bull FASTER EXPIRATORY FLOW
bull SPEED OF EXPIRATORY FLOW bull TRANSPORTS SECRETIONS
bull SHEARS SECRETIONS FROM BRONCHIAL WALL
bull COMBINE WITH TREATMENTS
bull BENEFICIAL IN PATIENTS WITH SIGNIFICANT HYPER-REACTIVITY amp
HAEMOPTYSIS
AD IN NMD
bull PASSIVE AD
bull THERAPIST CONTROLS DEPTH OF LUNG VOLUMES
bull SAME PRINCIPALS
bull OFTEN USED IN CONJUNCTION WITH PEP TO PREVENT SMALL AIRWAY COLLAPSE
bull DEMONSTRATION TO FOLLOW
bull EXHALATION AGAINST A CONSTANT POSITIVE PRESSURE
bull AIDS REMOVAL OF BRONCHIAL SECRETIONS
bull PREVENTING AIRWAY COLLAPSE BY STENTING THE AIRWAYS
bull RECRUITMENT OF PREVIOUSLY OBSTRUCTED AIRWAYS
bull IMPROVE VENTILATION REDUCE ATELECTASIS
bull INCREASING INTRATHORACIC PRESSURE DISTAL TO RETAINED SECRETIONS BY COLLATERAL VENTILATION OR BY INCREASING FRC
bull MAINTAIN PULMONARY FUNCTION
POSITIVE EXPIRATORY PRESSURE (PEP)
bull MASK VALVE RESISTOR amp MANOMETER
bull O2CAN BE CONNECTED TO THE INHALATION SIDE IF REQUIRED
bull SIT IN GOOD POSITION WITH GOOD SEAL AROUND MOUTHPIECEMASK
bull SLOW INHALATION JUST A LITTLE LARGER THAN A NORMAL BREATH IN
(HOLD FOR 3 SECS IF USING MOUTHPIECE)
bull STEADY ACTIVE amp FULL EXHALATION
bull AIM FOR 10-20 CM H2O FOR 3-5 SECS
bull REPEAT 12-15 TIMES FOLLOWED BY FET amp COUGH
bull COMPLETE FOR 15-30 MINS (6-8 CYCLES OR SETS OF ABOVE)
PEP TREATMENT
bull BEFORE OR AT LEAST 1 HR AFTER A FEED
bull START WITH THE SMALLEST HOLERESISTOR THAT BABY CAN TOLERATE
bull USE A MANOMETER
bull HOLD THE BABY IN ARMS OR ON PARENTS LAP SIT ON GYM BALL
bull PLACE THE MASK OVER THE BABYrsquoS MOUTH amp NOSE
bull AIM FOR FEW BREATHS 30-60 SECONDS WHICH CAN BE BUILT UP TO 1-2 MINUTES AS TOLERATED
bull AIM TO REACH PRESSURES BETWEEN 5-15 CM H2O
bull REST FOR 30-60 SECONDS THEN REPEAT FOR ABOUT 5-10 MINUTES
bull COMBINE THIS WITH OTHER TREATMENTS
BABY PEP TREATMENT
OSCILLATING PEP
OSCILLATING PEP
bull DEVICES CAN BE INTRA-THORACIC OR EXTRA-THORACIC
bull INTRA-THORACIC DEVICES ARE PLACED IN THE MOUTH AND PROVIDE RESISTANCE DURING EXHALATION
bull ALTERS EXPIRATORY AIRFLOW
bull VIBRATIONS ON THE AIRWAY SURFACE
bull REDUCES MUCOUS VISCOSITY
bull ACCELERATION OF THE EXPIRATORY FLOW
bull PREVENTS AND TREATS AIRWAY COMPRESSION ATELECTASIS
bull IMPROVES AIRWAY PATENCY amp VENTILATION
bull DECREASES HYPERINFLATION
bull IMPROVES LUNG FUNCTION PARAMETERS
bull INCLUDES EXERCISE
OSCILLATING PEP TREATMENT
bull SIMILAR TO PEP
bull GOOD POSITION
bull PLACE MOUTHPIECE BETWEEN LIPS AND TEETH OR USE MASK
bull SLOW INHALE JUST A LITTLE LARGER THAN A NORMAL BREATH IN
bull HOLD FOR 3 SECONDS
bull STEADY ACTIVE amp FULL EXHALATION
bull ADJUST THE RESISTANCE AS REQUIRED
bull REPEAT 12-15 TIMES FOLLOWED BY FET amp COUGH
bull COMPLETE FOR 5-10 MINS
bull COMBINE WITH OTHER TREATMENTS
ACAPELLA
bull DETACHABLE MOUTHPIECEFACEMASK
bull ONE-WAY INSPIRATORY VALVE
bull EXPIRATORY RESISTANCEFREQUENCY ADJUSTMENT DIAL
bull COUNTERWEIGHTED PLUG amp MAGNET
bull MAINTAINS A RAISED FRC LEVEL
TREATMENT
bull EASY TO USE IN DIFFERENT POSITIONS
bull INHALE amp EXHALE THROUGH THE ACAPELLA
bull ROTATE THE FREQUENCY RESISTANCE DIAL UNTIL MAXIMUM VIBRATIONS ARE FELT WITHIN THE CHEST WALL
AEROBIKA bull COMBINES PEP WITH HIGH FREQUENCY OSCILLATIONS
bull CAN BE USED WITH A MANOMETER
bull NEBULISER CAN BE ENTRAINED INTO THE SYSTEM
bull POSSIBLE INCREASE IN TREATMENT COMPLIANCE BY DECREASING
TREATMENT TIMES
TECHNIQUE AS OSCILLATING PEP
BUBBLE PEP
Suction tubing (~1cm diameter) The end MUST sit at the bottom of the bottle
Plastic bottle Any widthshapediameter must be gt20cm tall 15cm fresh tapsterile water
(depth of water determines the amount of pressure ie cm H20
Washing up bowl
INDICATIONS
bull REDUCED LUNG VOLUME (FVClt50)
bull WEAK COUGH (PCFlt270)
bull SECRETIONS RETENTION
bull ATELECTASIS
bull REDUCED MECHANICAL COMPLIANCE
bull CHILD ABLE TO COMPLY
BENEFITS
bull INCREASE LUNG VOLUME = IMPROVES PCF
bull SECRETION CLEARANCE
bull MAY REVERSE ATELECTASIS
bull IMPROVE MECHANICAL COMPLIANCE = LUNG AND CHEST WALL MOBILITY
bull IMPROVE VOICE STRENGTH
LUNG VOLUME RECRUITMENT
bull LABEL NOT FOR RESUSCITATION
bull BEST IN SITTING
bull SUCTION READY
bull AGREE SIGNAL WITH CHILD WHEN MIC ACHIEVED
bull ASK TO BREATH OUT
bull PLACE MOUTHPIECE +- NOSE CLIP OR MASK
bull ASK TO BREATH IN AND HOLD WHILE GENTLY SQUEEZING BAG
bull WITHOUT LETTING AIR OUT ASK CHILD TO TAKE ANOTHER BREATH IN ON TOP OF THE FIRST BREATH AND SQUEEZE BAG IN TIME WITH BREATH
bull REPEAT UNTIL LUNGS ARE FULL (NORMALLY 3-5 BREATHS) OR SIGNAL
bull REMOVE MASK OR MOUTHPIECE ASK TO HOLD FOR 3-5 SECONDS
bull EXHALE OR IF SECRETIONS ARE PRESENT ENCOURAGE TO HAVE A COUGH OR MAC
bull REPEATED X3-5 X2-4 DAY
LVR TREATMENT
bull AIRWAY CLEARANCE OR THORACIC MOBILITY
bull AMBU RESUS BAG
bull GREEN ldquoPHYSIOrdquo BAG
bull MANUAL TECHNIQUES WITH BAGGING
bull MHI AT HOME
bull MANOMETERS
MHI
PHYSIO WITH NIV
bull PHYSIO SETTINGS
bull SECRETIONS
bull THORACIC MOBILITY
bull ALLOWS REST PERIOD PRE ACT
bull HUMIDIFICATION
bull INFLATABLE VEST CONNECTED BY TUBES TO AN AIR PULSE GENERATOR WHICH RAPIDLY INFLATES AND DEFLATES THE VEST PRODUCING OSCILLATIONS TO THE CHEST WALL
bull RAPID CHEST MOVEMENT MIMICS A COUGH-LIKE EXPIRATORY FLOW THAT SHEARS MUCUS AWAY FROM THE AIRWAY WALLS AND HELPS TO MOVE IT ALONG TO THE CENTRAL AIRWAYS
bull PASSIVE TREATMENT amp NOT POSITION DEPENDANT
bull COMBINATION OF RX
bull CONTRAINDICATIONS
bull HEAD ANDOR NECK INJURY THAT HAS NOT BEEN STABILISED
bull ACTIVE HAEMORRHAGE WITH HEMODYNAMIC INSTABILITY
HFCWO
HFCWO INDICATIONS
bull CHRONIC MUCUS HYPERSECRETION OR RETENTION ASSOCIATED WITH A CHRONIC PULMONARY OR NEUROMUSCULAR CONDITION
bull LRT SECRETIONS AND FREQUENT LRTI REQUIRING HOSPITAL ADMISSION
bull INEFFECTIVE COUGH OR INABILITY TO REMOVE MUCUS BY COUGHING
bull TENACIOUS SECRETIONS THAT ARE NOT EASILY MOBILISED WITH STANDARD CPT
bull MECHANICALLY VENTILATED WITH EVIDENCE OF SECRETION RETENTION
bull ALTERNATIVE AIRWAY CLEARANCE THERAPY PROVEN INEFFECTIVE OR CONTRAINDICATEDDO NOT TOLERATE STANDARD CPT
bull CONSTANT FATIGUE LACK OF STRENGTH OR ABILITY TO PERFORM ACTIVE TREATMENT
bull SYMPTOMATIC
bull POOR COMPLIANCE WITH OTHER AIRWAY CLEARANCE METHODS
bull HIGH BURDEN OF CARE
bull PATIENT UNABLE TO TOLERATE THE INCREASED WORK OF BREATHING bull ACTIVE HAEMOPTYSIS bull UNTREATED PNEUMOTHORAX bull INTRACRANIAL PRESSURE (ICP) gt 20 MMHG bull HAEMODYNAMIC INSTABILITY bull SEVERE CARDIOVASCULAR INSULTDISEASE bull RECENT FACIAL ORAL OR SKULL SURGERY OR TRAUMA bull ACUTE SINUSITIS bull EPISTAXIS bull POST OESOPHAGEAL amp LUNG SURGERY bull KNOWN OR SUSPECTED TYMPANIC MEMBRANE RUPTURE OR OTHER MIDDLE EAR
PATHOLOGY
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
POSSIBLE HAZARDSCOMPLICATIONS
bull INCREASED WORK OF BREATHING THAT MAY LEAD TO HYPOVENTILATION AND
HYPERCARBIA
bull INCREASED INTRACRANIAL PRESSURE
bull CARDIOVASCULAR COMPROMISE
bull NAUSEA
bull MYOCARDIAL ISCHEMIA
bull DECREASED VENOUS RETURN
bull AIR SWALLOWING WITH INCREASED LIKELIHOOD OF VOMITING AND
ASPIRATION
bull CLAUSTROPHOBIA
bull SKIN BREAK DOWN AND DISCOMFORT FROM MASK
bull PULMONARY BAROTRAUMA
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
MI-E
bull USED WITH CHILDREN WHO HAVE DECREASED INSPIRATORY EFFORT DUE TO EITHER SPINAL CORD INJURY OR NMW AND WHO HAVE AN IMPAIRED OR INEFFECTIVE COUGH WITH APPROPRIATE RESPIRATORY SYMPTOMS
bull CONSIDERED WHEN CONVENTIONAL COUGH ASSISTANCE TECHNIQUES BECOME INEFFECTIVE
bull ACCEPTED AS THE CORE STANDARD FOR CHILD WITH NMW
bull MIE WORKS BY
bull INFLATING THE LUNGS WITH GRADUAL POSITIVE AIRWAY PRESSURE ASSISTING INSPIRATION CALLED INSUFFLATION
bull FOLLOWED BY A RAPID SWITCH TO NEGATIVE PRESSURE WHICH SIMULATES THE FLOW CHANGES THAT OCCUR DURING A COUGH THEREBY ENHANCING EXPIRATORY FLOW CALLED EXSUFFLATION AND ASSISTING EXPECTORATION OF SECRETIONS
bull MOVEMENT AND EXERCISE BEST FUNCTIONAL METHOD OF AIRWAY CLEARANCE
bull CPET BETTER CORRELATION THAN LUNG FUNCTION IN SURVIVAL RATES IN PEOPLE WITH
CYSTIC FIBROSIS
bull RUNNINGWALKING BETTER FOR SECRETION CLEARANCE THAN BIKE DURING TO SHEARING
MECHANISM
bull CONSIDER ADDING IN HUFFS (DYER)
bull CONSIDER USE OF AD BELT
EXERCISE
bull APCP SUCTION GUIDELINES
bull TYPESNASOPHARANGEAL OROPHARANGEAL AND TRACHEOSTOMY
bull MAIN VARIABLES SUCTION TYPE AND SIZE DEPTH OF SUCTION
PRESSURE TECHNIQUE
SUCTION
SPUTUM
bull SPUTUM bull 95 WATER bull COLOUR bull VOLUME bull CONSISTENCY bull ODOUR
bull PURPOSE bull HUMIDIFICATION bull WATERPROOFING bull PROTECTION OF EPITHELIUM
HUMIDIFICATION
bull METABOLIC AND VENTILATORY REQUIREMENTS ARE X2-3 OF ADULTS
IMPLICATION
bull HEAT AND MOISTURE LOSSES FROM RESPIRATION WILL INCREASE BY X2-3
bull CONSUME GREATER AMOUNTS OF ENERGY AND WATER
HUMIDIFICATION INHALATION
THERAPY
bull TRACHEOSTOMY HME
bull WET DRY CIRCUIT
bull NEBULISERS INHALERS MUCOLYTICS
bull HUMIDIFIERS WITH NIV
bull OXYGEN
bull SYSTEMIC HYDRATION ENVIRONMENT
NEBULISERS
bull NEBULISER CHAMBER CONVERTS LIQUID INTO
RESPIRABLE PARTICLES
bull MOISTURE DESCENDS THROUGH THE HOLES IN THE SUPERFICIAL GEL LAYER
bull INCREASES THE SOL LAYER SO THE CILIARY BEAT IS OPTIMAL FOR MUCUS TRANSPORT
bull SHORT TERM HUMIDIFICATION
bull DAILY WASHING OF NEBULISER SYSTEM
TIMING OF DRUG AND PHYSIOTHERAPY
BEFORE TREATMENT
bull DNASE (PULMOZYME)
bull SALBUTAMOL
(VENTOLIN BLUE)
bull SALINE NEBS
AFTER TREATMENT
bull SERETIDE (PURPLE)
bull BECLOMETHASONE (BECOTIDE BROWN)
bull COLISTIN (COLOMYCIN PROMIXIN)
bull TOBRAMYCIN
CONCLUSION
bull BE AWARE OF CHILDrsquoS RESPIRATORY FUNCTION
bull CHOSE ACT BEST FOR THEM bull TYPE OF KETCHUP BOTTLE bull LV SECRETION RETENTION WOB
bull EARLY RESPIRATORY REFERRAL
bull RESPIRATORY CARE COMPETENCIES
bull EFFECTIVE SECRETION CLEARANCE AT HOMERESPITESCHOOL
bull USE OF PEAK COUGH FLOWS TO AID CHOICE OF ADJUNCT
0
50
100
150
200
250
300
350
400
0
50
100
150
200
250
300
350
400
Green
Key
Additional info
(please comment) Please refer to BTSACPRC Guideline
Lothian University Hospitals NHS Trust
n PCF
gt270lmin
Breathstack
ing tri-
flow
blowing
REFERENCES bull BTSACPRC GUIDELINE IS PUBLISHED IN THORAX VOL 67 SUPPLEMENT 1
bull AVAILABLE ONLINE AT HTTPTHORAXBMJCOMCONTENTVOL64ISSUESUPPLI
bull HTTPWWWBRIT-THORACICORGUKPHYSIOGUIDE
bull BRITISH THORACIC SOCIETY REPORTS VOL 1 NO 1 2009
bull ADAPTED PRYOR AJ AND PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS3RD ED
bull HOUGH A PHYSIOTHERAPY IN RESPIRATORY CARE LONDON CHAPMAN AND HALL 1993
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1997) POSTURAL DRAINAGE AND GASTRO-OESOPHAGEAL REFLUX IN INFANTS WITH CYSTIC FIBROSIS ARCHIVES OF DISEASE IN CHILDHOOD 76 148-150
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1998) POSTURAL DRAINAGE IN CYSTIC FIBROSIS IS THERE A LINK WITH GASTRO-OESOPHAGEAL REFLUX JOURNAL OF PAEDIATRIC CHILD HEALTH 34 330-334
bull CECINS NM JENKINS SC PENGELLEY J ET AL (1999) THE ACTIVE CYCLE OF BREATHING TECHNIQUES-TO TIP OR NOT TO TIP RESPIRATORY MEDICINE 93 660-665
bull CONSTANTINI D BRIVIO A BRUSA D ET AL (2001) PEP MASK VERSUS POSTURAL DRAINAGE IN INFANTS A LONG-TERM COMPARATIVE TRIAL PEADIATRIC PULMONOLOGY
bull HOUGH A (2001) PHYSIOTHERAPY IN RESPIRATORY CARE AN EVIDENCE-BASED APPROACH TO RESPIRATORY AND CARDIAC MANAGEMENT CENGAGE LEARNING EMEA
bull INTERNATIONAL PHYSIOTHERAPY GROUP FOR CYSTIC FIBROSIS PHYSIOTHERAPY IN THE TREATMENT OF CYSTIC FIBROSIS (2009) HTTPSWWWECFSEUIPG_CFBOOKLET INTERNATIONAL PHYSIOTHERAPY GROUP ndash THE BLUE BOOKLET
bull KONSTAN MW STERN RC DOERSHUK CF (1994) EFFICACY OF THE FLUTTER DEVICE FOR AIRWAY MUCUS CLEARANCE IN PATIENTS WITH CYSTIC FIBROSIS JOURNAL OF PEDIATRICS 124 (5 (PT 1) 689-693
bull MCILWAINE M BUTTON B AND DWAN K (2015) POSITIVE EXPIRATORY PRESSURE PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 6 ART NO CD003147 DOI 10100214651858CD003147PUB4
bull MESTRINER RG FERNANDES RO STAFFEN LC ET AL (2009) OPTIMUM DESIGN PARAMETERS FOR A THERAPIST-CONSTRUCTED POSITIVE-EXPIRATORY-PRESSURE THERAPY BOTTLE DEVICE RESPIRATORY CARE 54 504-8
bull MORRISON L AND AGNEW J (2014) OSCILLATING DEVICES FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 7 ART NO CD006842 DOI 10100214651858CD006842PUB
bull OERMANN CM SOCKRIDER MM GILES D ET AL (2001) COMPARISON OF HIGH-FREQUENCY CHEST WALL OSCILLATION AND OSCILLATING POSITIVE EXPIRATORY PRESSURE IN THE HOME MANAGEMENT OF CYSTIC FIBROSIS A PILOT STUDY PEDIATRIC PULMONOLOGY 32 (5) 372-7
bull PRASAD SA AND HUSSEY J (1995) PAEDIATRIC RESPIRATORY CARE A GUIDE FOR PHYSIOTHERAPISTS AND HEALTH PROFESSIONALS CHAPMAN amp HALL
bull PRYOR J (1999) PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN ADULTS EUROPEAN RESPIRATORY JOURNAL 14 (6) 1418-1424
bull PRYOR JA amp PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS CHURCHILL LIVINGSTONE
bull PRYOR JA WEBBER BA HODSON ME ET AL (1994) THE FLUTTER VRP1 AS AN ADJUNCT TO CHEST PHYSIOTHERAPY IN CYSTIC FIBROSIS RESPIRATORY MEDICINE 88677-81
bull WEST K WALLEN M FOLLETT J (2010) ACAPELLA VS PEP MASK THERAPY A RANDOMISED TRIAL IN CHILDREN WITH CYSTIC FIBROSIS DURING RESPIRATORY EXACERBATION PHYSIOTHERAPY THEORY PRACTICE 26143-9
bull WILSONLM AGNEW J MORRISON L ET AL (2014) AIRWAY CLEARANCE TECHNIQUES FOR CYSTIC FIBROSIS AN OVERVIEW OF COCHRANE SYSTEMATIC REVIEWS COCHRANE DATABASE OF SYSTEMATIC REVIEWS DOI 10100214651858CD011231
bull VOLSKO TA DIFIORE JM CHATBURN RL (2003) PERFORMANCE COMPARISON OF TWO OSCILLATORY POSITIVE PRESSURE DEVICES ACAPELLA VERSUS FLUTTER RESPIRATORY CARE 48 (2) 124- 130
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SEDDON PC KHAN Y RESPIRATORY PROBLEMS IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT ARCHIVES OF DISEASE IN CHILDHOOD 2003 01 JAN88(1)75-8
bull MARKS JH PULMONARY CARE OF CHILDREN AND ADOLESCENTS WITH DEVELOPMENTAL DISABILITIES PEDIATR CLIN NORTH AM 2008 DECEMBER55(6)1299-314
bull ARENS R MUZUMDAR H SLEEP SLEEP DISORDERED BREATHING AND NOCTURNAL HYPOVENTILATION IN CHILDREN WITH NEUROMUSCULAR DISEASES PAEDIATRIC RESPIRATORY REVIEWS 2010 MAR11(1)24-30
bull FITZGERALD DA FOLLETT J VAN ASPEREN PP ASSESSING AND MANAGING LUNG DISEASE AND SLEEP DISORDERED BREATHING IN CHILDREN WITH CEREBRAL PALSY PAEDIATRIC RESPIRATORY REVIEWS 2009 MARCH10(1)18-24
bull HSIAO KH NIXON GM THE EFFECT OF TREATMENT OF OBSTRUCTIVE SLEEP APNEA ON QUALITY OF LIFE IN CHILDREN WITH CEREBRAL PALSY RES DEV DISABIL 2008 MAR-APR29(2)133-40
bull LUNDBERG A OXYGEN CONSUMPTION IN RELATION TO WORKLOAD IN STUDENTS WITH CEREBRAL PALSY J APPL PHYSIO 197640873-5
bull SULLIVAN PB ROSENBLOOM L FEEDING THE DISABLED CHILD CLINICS IN DEVELOPMENTAL MEDICINE MACKEITH PRESS 1999140
bull MARTIN TR THE RELATIONSHIP BETWEEN MALNUTRITION AND LUNG INFECTIONS CLIN CHEST MED 19878359
bull MOSTAFA SM BHANDARI S RITCHIE G ET AL CONSTIPATION AND ITS IMPLICATIONS IN THE CRITICALLY ILL PATIENT BR J ANAESTH 200391815-9 3
bull GACOUIN A CAMUS C GROS A ET AL CONSTIPATION IN LONGTERM VENTILATED PATIENTS ASSOCIATED FACTORS AND IMPACT ON INTENSIVE CARE UNIT OUTCOMES CRIT CARE MED 2010381933- 8
bull NGUYEN T FRENETTE AJ JOHANSON C ET AL IMPAIRED GASTROINTESTINAL TRANSIT AND ITS ASSOCIATED MORBIDITY IN THE INTENSIVE CARE UNIT J CRIT CARE 201328537
bull ASAI T CONSTIPATION DOES IT INCREASE MORBIDITY AND MORTALITY IN CRITICALLY ILL PATIENTS CRIT CARE MED 2007352861-2
bull UNDERSTANDING THE PHYSIOLOGICAL EFFECTS OF UNTREATED PAIN NURSING TIMES VOL 99 ISSUE 37 PAGE NO 28
bull WINFIELD ET AL NON-PHARMACEUTICAL MANAGEMENT OF RESPIRATORY MORBIDITY IN CHILDREN WITH SEVERE GLOBAL DEVELOPMENTAL DELAY THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014
bull OLOUGHLIN EV SOMERVILLE HM SOMERVILLE ER DEALING WITH MULTISYSTEM DISEASE IN PEOPLE WITH A DEVELOPMENTAL DISABILITY MEDICAL JOURNAL OF AUSTRALIA 2009 JUN 1190(11)616-7
bull MESTROVIC J KARDUM G POLIC B MESTROVIC M MARKIC J SUSTIC A ET AL THE INFLUENCE OF CHRONIC HEALTH CONDITIONS ON SUSCEPTIBILITY TO SEVERE ACUTE ILLNESS OF CHILDREN TREATED IN PICU EUROPEAN JOURNAL OF PEDIATRICS 2006 AUG165(8)526-
9
bull HEALY F PANITCH HB PULMONARY COMPLICATIONS OF PEDIATRIC NEUROLOGICAL DISEASES PEDIATR ANN 2010 APR39(4)216-24
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SRIVASTAVA R JACKSON WD BARNHART DC DYSPHAGIA AND GASTROESOPHAGEAL REFLUX DISEASE DILEMMAS IN DIAGNOSIS AND MANAGEMENT IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT PEDIATR ANN 2010 APR39(4)225-31
bull SULLIVAN PB JUSZCZAK E BACHLET AME LAMBERT B VERNON-ROBERTS A GRANT HW ET AL GASTROSTOMY TUBE FEEDING IN CHILDREN WITH CEREBRAL PALSY A PROSPECTIVE LONGITUDINAL STUDY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 2005
FEBRUARY47(2)77-85
bull SOMERVILLE H TZANNES G WOOD J SHUN A HILL C ARROWSMITH F ET AL GASTROINTESTINAL AND NUTRITIONAL PROBLEMS IN SEVERE DEVELOPMENTAL DISABILITY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 200850(9)712-6
bull TODER DS RESPIRATORY PROBLEMS IN THE ADOLESCENT WITH DEVELOPMENTAL DELAY ADOLESCENT MEDICINE 2000 3 OCTOBER 200011(3)617-31
bull LEVIN K COLON A DIPALMA J FITZPATRICK S USING THE RADIONUCLIDE SALIVAGRAM TO DETECT PULMONARY ASPIRATION AND ESOPHAGEAL DYSMOTILITY CLIN NUCL MED 1993 FEB18(2)110-4
bull SCHROEDER AS KLING T HUSS K BORGGRAEFE I KOERTE IK BLASCHEK A ET AL BOTULINUM TOXIN TYPE A AND B FOR THE REDUCTION OF HYPERSALIVATION IN CHILDREN WITH NEUROLOGICAL DISORDERS A FOCUS ON EFFECTIVENESS AND THERAPY ADHERENCE
NEUROPEDIATRICS 201243(1)27-36
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull GOEMINNE P AND DUPONT L (2010) NON-CYSTIC FIBROSIS BRONCHIECTASIS DIAGNOSIS AND MANAGEMENT IN 21ST CENTURY POSTGRADUATE MEDICAL JOURNAL 86(1018) PP493-501
bull LEE A BUTTON B AND TANNENBAUM E (2017) AIRWAY-CLEARANCE TECHNIQUES IN CHILDREN AND ADOLESCENTS WITH CHRONIC SUPPURATIVE LUNG DISEASE AND BRONCHIECTASIS FRONTIERS IN PEDIATRICS 5
bull MANDAL P SIDHU M KOPE L POLLOCK W STEVENSON L PENTLAND J TURNBULL K MAC QUARRIE S AND HILL A (2012) A PILOT STUDY OF PULMONARY REHABILITATION AND CHEST PHYSIOTHERAPY VERSUS CHEST PHYSIOTHERAPY ALONE IN
BRONCHIECTASIS RESPIRATORY MEDICINE 106(12) PP1647-1654
bull MURRAY M PENTLAND J AND HILL A (2009) A RANDOMISED CROSSOVER TRIAL OF CHEST PHYSIOTHERAPY IN NON-CYSTIC FIBROSIS BRONCHIECTASIS EUROPEAN RESPIRATORY JOURNAL 34(5) PP1086-1092
bull NEWALL C STOCKLEY R AND HILL S (2005) EXERCISE TRAINING AND INSPIRATORY MUSCLE TRAINING IN PATIENTS WITH BRONCHIECTASIS THORAX 60(11) PP943-948
bull ONG H LEE A HILL C HOLLAND A AND DENEHY L (2011) EFFECTS OF PULMONARY REHABILITATION IN BRONCHIECTASIS A RETROSPECTIVE STUDY CHRONIC RESPIRATORY DISEASE 8(1) PP21-30
bull QUINT J MILLETT E JOSHI M NAVARATNAM V THOMAS S HURST J SMEETH L AND BROWN J (2015) CHANGES IN THE INCIDENCE PREVALENCE AND MORTALITY OF BRONCHIECTASIS IN THE UK FROM 2004 TO 2013 A POPULATION-BASED COHORT
STUDY EUROPEAN RESPIRATORY JOURNAL 47(1) PP186-193
bull SNIJDERS D FERNANDEZ DOMINGUEZ B CALGARO S BERTOZZI I ESCRIBANO MONTANER A PERILONGO G AND BARBATO A (2015) MUCOCILIARY CLEARANCE TECHNIQUES FOR TREATING NON-CYSTIC FIBROSIS BRONCHIECTASIS IS THERE
EVIDENCE INTERNATIONAL JOURNAL OF IMMUNOPATHOLOGY AND PHARMACOLOGY 28(2) PP150-159
OBJECTIVES
bull TO UNDERSTAND THE AIMS OF AIRWAY CLEARANCE IN THE PAEDIATRIC POPULATION
bull TO UNDERSTAND THE RESPIRATORY RISK FACTORS FOR CHILDREN WITH NEUROMUSCULAR CONDITIONS
bull TO HAVE AN AWARENESS OF AIRWAY CLEARANCE TECHNIQUES AVAILABLE FOR USE WITHIN THE PAEDIATRIC POPULATION
bull TO UNDERSTAND SAFE AND EFFECTIVE USE OF AIRWAY CLEARANCE TECHNIQUES USED IN THE PAEDIATRIC POPULATION
0
50
100
150
200
250
300
350
400
0
50
100
150
200
250
300
350
400
Green
Yellow
Red
PCF Mouthpiece (Lmin)
PCF Mask (Lmin)
Key
Mouthpiece u
Mask n
Additional info (please comment)
Off feet
Ability to chew
Strength of voice Please refer to BTSACPRC Guideline ldquoPhysiotherapy management of the adult medical spontaneously breathing patientrdquo and ldquoGuidelines
Lothian University Hospitals NHS Trust
Paediatric Physiotherapy Service
Lead Physiotherapist Mairi McCrae
n PCF gt270lmin
Breathstacking tri-flow blowing
games
nPCF lt270lmin but gt 160lmin
Manual assisted cough manual
techniques ambu bag assisted
breaths
nPCF lt160lmin
NIV ambu-bag assisted breaths
MI-E
bull SHORT TERM TREATMENT AIMS TO MINIMISE INFECTION AND PREVENT
REPEATED LUNG DAMAGE
bull NORMALISE RESPIRATORY SYSTEM
bull MAXIMISE VENTILATION amp ENCOURAGE EQUAL FILLING
bull MAXIMISE EXPIRATORY FLOWVELOCITY
bull REMOVAL OF TRACHEOBRONCHIAL SECRETIONS FROM THE LUNGS
bull DECREASE WORK OF BREATHING
bull LONG TERM TREATMENT AIMS TO DELAY THE PROGRESSION OF RESPIRATORY
DISEASE AND MAINTAIN OPTIMAL RESPIRATORY FUNCTION
AIMS OF ACT
AIM OF ACT
bull COMPENSATE FOR IMPAIRED MUCOCILIARY CLEARANCE
bull COMPENSATE FOR INABILITY TO CREATE EXPIRATORY FLOW AND INSP EFFORT
bull IMPROVE VENTILATION BY PREVENTING OBSTRUCTION OF SMALL AIRWAYS
bull SLOW DOWN LUNG DISEASE
POOR AIRWAY CLEARANCE
INCREASED AIRWAY RESISTANCE
INCREASED WOB
HYPOXAEMIA
REPEATED INFECTIONS
LOSS OF RESPIRATORY RESERVE
AIRWAY DAMAGE
RESPIRATORY FAILURE
AIRWAY CLEARANCE TECHNIQUES
bull CHEST PHYSIO
bull DECREASED LUNG VOLUME
bull SECRETION RETENTION
bull INCREASED WOB
bull KETCHUP BOTTLE
bull GLASS
bull PLASTIC
bull SACHET
bull HUMIDIFICATION INHALATION THERAPY
bull MANUAL TECHNIQUES
bull BREATHING TECHNIQUES
bull MAXIMAL INSPIRATORY CAPACITY
bull PHYSIO WITH NIV
bull PEP
bull OSCILLATORY TECHNIQUES
bull HFCWO
bull MIE
bull SUCTION
ACT TECHNIQUES
MANUAL TECHNIQUES
bull PERCUSSION
bull VIBRATIONSHAKING
bull MANUAL ASSISTED COUGH
bull TRACHEAL PRESSURE
bull OVERPRESSURE
bull MANUALASSISTED AD
ACTIVE CYCLE OF BREATHING
Breathing control
3-5 Deep Breaths or TEE
with 3 sec inspiratory
hold
Breathing control
3-5 Deep Breaths or TEE
with 3 sec inspiratory
hold
Breathing control
2-3 FET huffs amp coughs
Clear mucus
Active Cycle
of Breathing
Technique
(ACBT)
AUTOGENIC DRAINAGE
bull JEAN CHEVALLIER 1967 IN BELGIUM
bull OBSERVED CHILDREN SLEEPING
bull LOW LV VrsquoS HIGH LVrsquoS
bull 3 PHASES OF BREATHING
bull LOW
bull MID
bull HIGH
bull MOVING FROM RESIDUAL VOLUME TO TOTAL LUNG CAPACITY
bull AIM TO GENERATE INCREASED EXPIRATORY AIRFLOW PROGRESSIVELY THROUGH EACH GENERATION OF BRONCHI
bull SECRETIONS LOOSEN AND MOVE INTO LARGER AIRWAYS TO AID EXPECTORATION
AD CONTrsquoD
bull METHOD bull DIAGNOSTIC BREATH WHERE ABLE
bull LOW FLOW ON INSPIRATION IE QUIET BREATH IN
bull FASTER EXPIRATORY FLOW
bull SPEED OF EXPIRATORY FLOW bull TRANSPORTS SECRETIONS
bull SHEARS SECRETIONS FROM BRONCHIAL WALL
bull COMBINE WITH TREATMENTS
bull BENEFICIAL IN PATIENTS WITH SIGNIFICANT HYPER-REACTIVITY amp
HAEMOPTYSIS
AD IN NMD
bull PASSIVE AD
bull THERAPIST CONTROLS DEPTH OF LUNG VOLUMES
bull SAME PRINCIPALS
bull OFTEN USED IN CONJUNCTION WITH PEP TO PREVENT SMALL AIRWAY COLLAPSE
bull DEMONSTRATION TO FOLLOW
bull EXHALATION AGAINST A CONSTANT POSITIVE PRESSURE
bull AIDS REMOVAL OF BRONCHIAL SECRETIONS
bull PREVENTING AIRWAY COLLAPSE BY STENTING THE AIRWAYS
bull RECRUITMENT OF PREVIOUSLY OBSTRUCTED AIRWAYS
bull IMPROVE VENTILATION REDUCE ATELECTASIS
bull INCREASING INTRATHORACIC PRESSURE DISTAL TO RETAINED SECRETIONS BY COLLATERAL VENTILATION OR BY INCREASING FRC
bull MAINTAIN PULMONARY FUNCTION
POSITIVE EXPIRATORY PRESSURE (PEP)
bull MASK VALVE RESISTOR amp MANOMETER
bull O2CAN BE CONNECTED TO THE INHALATION SIDE IF REQUIRED
bull SIT IN GOOD POSITION WITH GOOD SEAL AROUND MOUTHPIECEMASK
bull SLOW INHALATION JUST A LITTLE LARGER THAN A NORMAL BREATH IN
(HOLD FOR 3 SECS IF USING MOUTHPIECE)
bull STEADY ACTIVE amp FULL EXHALATION
bull AIM FOR 10-20 CM H2O FOR 3-5 SECS
bull REPEAT 12-15 TIMES FOLLOWED BY FET amp COUGH
bull COMPLETE FOR 15-30 MINS (6-8 CYCLES OR SETS OF ABOVE)
PEP TREATMENT
bull BEFORE OR AT LEAST 1 HR AFTER A FEED
bull START WITH THE SMALLEST HOLERESISTOR THAT BABY CAN TOLERATE
bull USE A MANOMETER
bull HOLD THE BABY IN ARMS OR ON PARENTS LAP SIT ON GYM BALL
bull PLACE THE MASK OVER THE BABYrsquoS MOUTH amp NOSE
bull AIM FOR FEW BREATHS 30-60 SECONDS WHICH CAN BE BUILT UP TO 1-2 MINUTES AS TOLERATED
bull AIM TO REACH PRESSURES BETWEEN 5-15 CM H2O
bull REST FOR 30-60 SECONDS THEN REPEAT FOR ABOUT 5-10 MINUTES
bull COMBINE THIS WITH OTHER TREATMENTS
BABY PEP TREATMENT
OSCILLATING PEP
OSCILLATING PEP
bull DEVICES CAN BE INTRA-THORACIC OR EXTRA-THORACIC
bull INTRA-THORACIC DEVICES ARE PLACED IN THE MOUTH AND PROVIDE RESISTANCE DURING EXHALATION
bull ALTERS EXPIRATORY AIRFLOW
bull VIBRATIONS ON THE AIRWAY SURFACE
bull REDUCES MUCOUS VISCOSITY
bull ACCELERATION OF THE EXPIRATORY FLOW
bull PREVENTS AND TREATS AIRWAY COMPRESSION ATELECTASIS
bull IMPROVES AIRWAY PATENCY amp VENTILATION
bull DECREASES HYPERINFLATION
bull IMPROVES LUNG FUNCTION PARAMETERS
bull INCLUDES EXERCISE
OSCILLATING PEP TREATMENT
bull SIMILAR TO PEP
bull GOOD POSITION
bull PLACE MOUTHPIECE BETWEEN LIPS AND TEETH OR USE MASK
bull SLOW INHALE JUST A LITTLE LARGER THAN A NORMAL BREATH IN
bull HOLD FOR 3 SECONDS
bull STEADY ACTIVE amp FULL EXHALATION
bull ADJUST THE RESISTANCE AS REQUIRED
bull REPEAT 12-15 TIMES FOLLOWED BY FET amp COUGH
bull COMPLETE FOR 5-10 MINS
bull COMBINE WITH OTHER TREATMENTS
ACAPELLA
bull DETACHABLE MOUTHPIECEFACEMASK
bull ONE-WAY INSPIRATORY VALVE
bull EXPIRATORY RESISTANCEFREQUENCY ADJUSTMENT DIAL
bull COUNTERWEIGHTED PLUG amp MAGNET
bull MAINTAINS A RAISED FRC LEVEL
TREATMENT
bull EASY TO USE IN DIFFERENT POSITIONS
bull INHALE amp EXHALE THROUGH THE ACAPELLA
bull ROTATE THE FREQUENCY RESISTANCE DIAL UNTIL MAXIMUM VIBRATIONS ARE FELT WITHIN THE CHEST WALL
AEROBIKA bull COMBINES PEP WITH HIGH FREQUENCY OSCILLATIONS
bull CAN BE USED WITH A MANOMETER
bull NEBULISER CAN BE ENTRAINED INTO THE SYSTEM
bull POSSIBLE INCREASE IN TREATMENT COMPLIANCE BY DECREASING
TREATMENT TIMES
TECHNIQUE AS OSCILLATING PEP
BUBBLE PEP
Suction tubing (~1cm diameter) The end MUST sit at the bottom of the bottle
Plastic bottle Any widthshapediameter must be gt20cm tall 15cm fresh tapsterile water
(depth of water determines the amount of pressure ie cm H20
Washing up bowl
INDICATIONS
bull REDUCED LUNG VOLUME (FVClt50)
bull WEAK COUGH (PCFlt270)
bull SECRETIONS RETENTION
bull ATELECTASIS
bull REDUCED MECHANICAL COMPLIANCE
bull CHILD ABLE TO COMPLY
BENEFITS
bull INCREASE LUNG VOLUME = IMPROVES PCF
bull SECRETION CLEARANCE
bull MAY REVERSE ATELECTASIS
bull IMPROVE MECHANICAL COMPLIANCE = LUNG AND CHEST WALL MOBILITY
bull IMPROVE VOICE STRENGTH
LUNG VOLUME RECRUITMENT
bull LABEL NOT FOR RESUSCITATION
bull BEST IN SITTING
bull SUCTION READY
bull AGREE SIGNAL WITH CHILD WHEN MIC ACHIEVED
bull ASK TO BREATH OUT
bull PLACE MOUTHPIECE +- NOSE CLIP OR MASK
bull ASK TO BREATH IN AND HOLD WHILE GENTLY SQUEEZING BAG
bull WITHOUT LETTING AIR OUT ASK CHILD TO TAKE ANOTHER BREATH IN ON TOP OF THE FIRST BREATH AND SQUEEZE BAG IN TIME WITH BREATH
bull REPEAT UNTIL LUNGS ARE FULL (NORMALLY 3-5 BREATHS) OR SIGNAL
bull REMOVE MASK OR MOUTHPIECE ASK TO HOLD FOR 3-5 SECONDS
bull EXHALE OR IF SECRETIONS ARE PRESENT ENCOURAGE TO HAVE A COUGH OR MAC
bull REPEATED X3-5 X2-4 DAY
LVR TREATMENT
bull AIRWAY CLEARANCE OR THORACIC MOBILITY
bull AMBU RESUS BAG
bull GREEN ldquoPHYSIOrdquo BAG
bull MANUAL TECHNIQUES WITH BAGGING
bull MHI AT HOME
bull MANOMETERS
MHI
PHYSIO WITH NIV
bull PHYSIO SETTINGS
bull SECRETIONS
bull THORACIC MOBILITY
bull ALLOWS REST PERIOD PRE ACT
bull HUMIDIFICATION
bull INFLATABLE VEST CONNECTED BY TUBES TO AN AIR PULSE GENERATOR WHICH RAPIDLY INFLATES AND DEFLATES THE VEST PRODUCING OSCILLATIONS TO THE CHEST WALL
bull RAPID CHEST MOVEMENT MIMICS A COUGH-LIKE EXPIRATORY FLOW THAT SHEARS MUCUS AWAY FROM THE AIRWAY WALLS AND HELPS TO MOVE IT ALONG TO THE CENTRAL AIRWAYS
bull PASSIVE TREATMENT amp NOT POSITION DEPENDANT
bull COMBINATION OF RX
bull CONTRAINDICATIONS
bull HEAD ANDOR NECK INJURY THAT HAS NOT BEEN STABILISED
bull ACTIVE HAEMORRHAGE WITH HEMODYNAMIC INSTABILITY
HFCWO
HFCWO INDICATIONS
bull CHRONIC MUCUS HYPERSECRETION OR RETENTION ASSOCIATED WITH A CHRONIC PULMONARY OR NEUROMUSCULAR CONDITION
bull LRT SECRETIONS AND FREQUENT LRTI REQUIRING HOSPITAL ADMISSION
bull INEFFECTIVE COUGH OR INABILITY TO REMOVE MUCUS BY COUGHING
bull TENACIOUS SECRETIONS THAT ARE NOT EASILY MOBILISED WITH STANDARD CPT
bull MECHANICALLY VENTILATED WITH EVIDENCE OF SECRETION RETENTION
bull ALTERNATIVE AIRWAY CLEARANCE THERAPY PROVEN INEFFECTIVE OR CONTRAINDICATEDDO NOT TOLERATE STANDARD CPT
bull CONSTANT FATIGUE LACK OF STRENGTH OR ABILITY TO PERFORM ACTIVE TREATMENT
bull SYMPTOMATIC
bull POOR COMPLIANCE WITH OTHER AIRWAY CLEARANCE METHODS
bull HIGH BURDEN OF CARE
bull PATIENT UNABLE TO TOLERATE THE INCREASED WORK OF BREATHING bull ACTIVE HAEMOPTYSIS bull UNTREATED PNEUMOTHORAX bull INTRACRANIAL PRESSURE (ICP) gt 20 MMHG bull HAEMODYNAMIC INSTABILITY bull SEVERE CARDIOVASCULAR INSULTDISEASE bull RECENT FACIAL ORAL OR SKULL SURGERY OR TRAUMA bull ACUTE SINUSITIS bull EPISTAXIS bull POST OESOPHAGEAL amp LUNG SURGERY bull KNOWN OR SUSPECTED TYMPANIC MEMBRANE RUPTURE OR OTHER MIDDLE EAR
PATHOLOGY
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
POSSIBLE HAZARDSCOMPLICATIONS
bull INCREASED WORK OF BREATHING THAT MAY LEAD TO HYPOVENTILATION AND
HYPERCARBIA
bull INCREASED INTRACRANIAL PRESSURE
bull CARDIOVASCULAR COMPROMISE
bull NAUSEA
bull MYOCARDIAL ISCHEMIA
bull DECREASED VENOUS RETURN
bull AIR SWALLOWING WITH INCREASED LIKELIHOOD OF VOMITING AND
ASPIRATION
bull CLAUSTROPHOBIA
bull SKIN BREAK DOWN AND DISCOMFORT FROM MASK
bull PULMONARY BAROTRAUMA
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
MI-E
bull USED WITH CHILDREN WHO HAVE DECREASED INSPIRATORY EFFORT DUE TO EITHER SPINAL CORD INJURY OR NMW AND WHO HAVE AN IMPAIRED OR INEFFECTIVE COUGH WITH APPROPRIATE RESPIRATORY SYMPTOMS
bull CONSIDERED WHEN CONVENTIONAL COUGH ASSISTANCE TECHNIQUES BECOME INEFFECTIVE
bull ACCEPTED AS THE CORE STANDARD FOR CHILD WITH NMW
bull MIE WORKS BY
bull INFLATING THE LUNGS WITH GRADUAL POSITIVE AIRWAY PRESSURE ASSISTING INSPIRATION CALLED INSUFFLATION
bull FOLLOWED BY A RAPID SWITCH TO NEGATIVE PRESSURE WHICH SIMULATES THE FLOW CHANGES THAT OCCUR DURING A COUGH THEREBY ENHANCING EXPIRATORY FLOW CALLED EXSUFFLATION AND ASSISTING EXPECTORATION OF SECRETIONS
bull MOVEMENT AND EXERCISE BEST FUNCTIONAL METHOD OF AIRWAY CLEARANCE
bull CPET BETTER CORRELATION THAN LUNG FUNCTION IN SURVIVAL RATES IN PEOPLE WITH
CYSTIC FIBROSIS
bull RUNNINGWALKING BETTER FOR SECRETION CLEARANCE THAN BIKE DURING TO SHEARING
MECHANISM
bull CONSIDER ADDING IN HUFFS (DYER)
bull CONSIDER USE OF AD BELT
EXERCISE
bull APCP SUCTION GUIDELINES
bull TYPESNASOPHARANGEAL OROPHARANGEAL AND TRACHEOSTOMY
bull MAIN VARIABLES SUCTION TYPE AND SIZE DEPTH OF SUCTION
PRESSURE TECHNIQUE
SUCTION
SPUTUM
bull SPUTUM bull 95 WATER bull COLOUR bull VOLUME bull CONSISTENCY bull ODOUR
bull PURPOSE bull HUMIDIFICATION bull WATERPROOFING bull PROTECTION OF EPITHELIUM
HUMIDIFICATION
bull METABOLIC AND VENTILATORY REQUIREMENTS ARE X2-3 OF ADULTS
IMPLICATION
bull HEAT AND MOISTURE LOSSES FROM RESPIRATION WILL INCREASE BY X2-3
bull CONSUME GREATER AMOUNTS OF ENERGY AND WATER
HUMIDIFICATION INHALATION
THERAPY
bull TRACHEOSTOMY HME
bull WET DRY CIRCUIT
bull NEBULISERS INHALERS MUCOLYTICS
bull HUMIDIFIERS WITH NIV
bull OXYGEN
bull SYSTEMIC HYDRATION ENVIRONMENT
NEBULISERS
bull NEBULISER CHAMBER CONVERTS LIQUID INTO
RESPIRABLE PARTICLES
bull MOISTURE DESCENDS THROUGH THE HOLES IN THE SUPERFICIAL GEL LAYER
bull INCREASES THE SOL LAYER SO THE CILIARY BEAT IS OPTIMAL FOR MUCUS TRANSPORT
bull SHORT TERM HUMIDIFICATION
bull DAILY WASHING OF NEBULISER SYSTEM
TIMING OF DRUG AND PHYSIOTHERAPY
BEFORE TREATMENT
bull DNASE (PULMOZYME)
bull SALBUTAMOL
(VENTOLIN BLUE)
bull SALINE NEBS
AFTER TREATMENT
bull SERETIDE (PURPLE)
bull BECLOMETHASONE (BECOTIDE BROWN)
bull COLISTIN (COLOMYCIN PROMIXIN)
bull TOBRAMYCIN
CONCLUSION
bull BE AWARE OF CHILDrsquoS RESPIRATORY FUNCTION
bull CHOSE ACT BEST FOR THEM bull TYPE OF KETCHUP BOTTLE bull LV SECRETION RETENTION WOB
bull EARLY RESPIRATORY REFERRAL
bull RESPIRATORY CARE COMPETENCIES
bull EFFECTIVE SECRETION CLEARANCE AT HOMERESPITESCHOOL
bull USE OF PEAK COUGH FLOWS TO AID CHOICE OF ADJUNCT
0
50
100
150
200
250
300
350
400
0
50
100
150
200
250
300
350
400
Green
Key
Additional info
(please comment) Please refer to BTSACPRC Guideline
Lothian University Hospitals NHS Trust
n PCF
gt270lmin
Breathstack
ing tri-
flow
blowing
REFERENCES bull BTSACPRC GUIDELINE IS PUBLISHED IN THORAX VOL 67 SUPPLEMENT 1
bull AVAILABLE ONLINE AT HTTPTHORAXBMJCOMCONTENTVOL64ISSUESUPPLI
bull HTTPWWWBRIT-THORACICORGUKPHYSIOGUIDE
bull BRITISH THORACIC SOCIETY REPORTS VOL 1 NO 1 2009
bull ADAPTED PRYOR AJ AND PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS3RD ED
bull HOUGH A PHYSIOTHERAPY IN RESPIRATORY CARE LONDON CHAPMAN AND HALL 1993
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1997) POSTURAL DRAINAGE AND GASTRO-OESOPHAGEAL REFLUX IN INFANTS WITH CYSTIC FIBROSIS ARCHIVES OF DISEASE IN CHILDHOOD 76 148-150
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1998) POSTURAL DRAINAGE IN CYSTIC FIBROSIS IS THERE A LINK WITH GASTRO-OESOPHAGEAL REFLUX JOURNAL OF PAEDIATRIC CHILD HEALTH 34 330-334
bull CECINS NM JENKINS SC PENGELLEY J ET AL (1999) THE ACTIVE CYCLE OF BREATHING TECHNIQUES-TO TIP OR NOT TO TIP RESPIRATORY MEDICINE 93 660-665
bull CONSTANTINI D BRIVIO A BRUSA D ET AL (2001) PEP MASK VERSUS POSTURAL DRAINAGE IN INFANTS A LONG-TERM COMPARATIVE TRIAL PEADIATRIC PULMONOLOGY
bull HOUGH A (2001) PHYSIOTHERAPY IN RESPIRATORY CARE AN EVIDENCE-BASED APPROACH TO RESPIRATORY AND CARDIAC MANAGEMENT CENGAGE LEARNING EMEA
bull INTERNATIONAL PHYSIOTHERAPY GROUP FOR CYSTIC FIBROSIS PHYSIOTHERAPY IN THE TREATMENT OF CYSTIC FIBROSIS (2009) HTTPSWWWECFSEUIPG_CFBOOKLET INTERNATIONAL PHYSIOTHERAPY GROUP ndash THE BLUE BOOKLET
bull KONSTAN MW STERN RC DOERSHUK CF (1994) EFFICACY OF THE FLUTTER DEVICE FOR AIRWAY MUCUS CLEARANCE IN PATIENTS WITH CYSTIC FIBROSIS JOURNAL OF PEDIATRICS 124 (5 (PT 1) 689-693
bull MCILWAINE M BUTTON B AND DWAN K (2015) POSITIVE EXPIRATORY PRESSURE PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 6 ART NO CD003147 DOI 10100214651858CD003147PUB4
bull MESTRINER RG FERNANDES RO STAFFEN LC ET AL (2009) OPTIMUM DESIGN PARAMETERS FOR A THERAPIST-CONSTRUCTED POSITIVE-EXPIRATORY-PRESSURE THERAPY BOTTLE DEVICE RESPIRATORY CARE 54 504-8
bull MORRISON L AND AGNEW J (2014) OSCILLATING DEVICES FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 7 ART NO CD006842 DOI 10100214651858CD006842PUB
bull OERMANN CM SOCKRIDER MM GILES D ET AL (2001) COMPARISON OF HIGH-FREQUENCY CHEST WALL OSCILLATION AND OSCILLATING POSITIVE EXPIRATORY PRESSURE IN THE HOME MANAGEMENT OF CYSTIC FIBROSIS A PILOT STUDY PEDIATRIC PULMONOLOGY 32 (5) 372-7
bull PRASAD SA AND HUSSEY J (1995) PAEDIATRIC RESPIRATORY CARE A GUIDE FOR PHYSIOTHERAPISTS AND HEALTH PROFESSIONALS CHAPMAN amp HALL
bull PRYOR J (1999) PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN ADULTS EUROPEAN RESPIRATORY JOURNAL 14 (6) 1418-1424
bull PRYOR JA amp PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS CHURCHILL LIVINGSTONE
bull PRYOR JA WEBBER BA HODSON ME ET AL (1994) THE FLUTTER VRP1 AS AN ADJUNCT TO CHEST PHYSIOTHERAPY IN CYSTIC FIBROSIS RESPIRATORY MEDICINE 88677-81
bull WEST K WALLEN M FOLLETT J (2010) ACAPELLA VS PEP MASK THERAPY A RANDOMISED TRIAL IN CHILDREN WITH CYSTIC FIBROSIS DURING RESPIRATORY EXACERBATION PHYSIOTHERAPY THEORY PRACTICE 26143-9
bull WILSONLM AGNEW J MORRISON L ET AL (2014) AIRWAY CLEARANCE TECHNIQUES FOR CYSTIC FIBROSIS AN OVERVIEW OF COCHRANE SYSTEMATIC REVIEWS COCHRANE DATABASE OF SYSTEMATIC REVIEWS DOI 10100214651858CD011231
bull VOLSKO TA DIFIORE JM CHATBURN RL (2003) PERFORMANCE COMPARISON OF TWO OSCILLATORY POSITIVE PRESSURE DEVICES ACAPELLA VERSUS FLUTTER RESPIRATORY CARE 48 (2) 124- 130
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SEDDON PC KHAN Y RESPIRATORY PROBLEMS IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT ARCHIVES OF DISEASE IN CHILDHOOD 2003 01 JAN88(1)75-8
bull MARKS JH PULMONARY CARE OF CHILDREN AND ADOLESCENTS WITH DEVELOPMENTAL DISABILITIES PEDIATR CLIN NORTH AM 2008 DECEMBER55(6)1299-314
bull ARENS R MUZUMDAR H SLEEP SLEEP DISORDERED BREATHING AND NOCTURNAL HYPOVENTILATION IN CHILDREN WITH NEUROMUSCULAR DISEASES PAEDIATRIC RESPIRATORY REVIEWS 2010 MAR11(1)24-30
bull FITZGERALD DA FOLLETT J VAN ASPEREN PP ASSESSING AND MANAGING LUNG DISEASE AND SLEEP DISORDERED BREATHING IN CHILDREN WITH CEREBRAL PALSY PAEDIATRIC RESPIRATORY REVIEWS 2009 MARCH10(1)18-24
bull HSIAO KH NIXON GM THE EFFECT OF TREATMENT OF OBSTRUCTIVE SLEEP APNEA ON QUALITY OF LIFE IN CHILDREN WITH CEREBRAL PALSY RES DEV DISABIL 2008 MAR-APR29(2)133-40
bull LUNDBERG A OXYGEN CONSUMPTION IN RELATION TO WORKLOAD IN STUDENTS WITH CEREBRAL PALSY J APPL PHYSIO 197640873-5
bull SULLIVAN PB ROSENBLOOM L FEEDING THE DISABLED CHILD CLINICS IN DEVELOPMENTAL MEDICINE MACKEITH PRESS 1999140
bull MARTIN TR THE RELATIONSHIP BETWEEN MALNUTRITION AND LUNG INFECTIONS CLIN CHEST MED 19878359
bull MOSTAFA SM BHANDARI S RITCHIE G ET AL CONSTIPATION AND ITS IMPLICATIONS IN THE CRITICALLY ILL PATIENT BR J ANAESTH 200391815-9 3
bull GACOUIN A CAMUS C GROS A ET AL CONSTIPATION IN LONGTERM VENTILATED PATIENTS ASSOCIATED FACTORS AND IMPACT ON INTENSIVE CARE UNIT OUTCOMES CRIT CARE MED 2010381933- 8
bull NGUYEN T FRENETTE AJ JOHANSON C ET AL IMPAIRED GASTROINTESTINAL TRANSIT AND ITS ASSOCIATED MORBIDITY IN THE INTENSIVE CARE UNIT J CRIT CARE 201328537
bull ASAI T CONSTIPATION DOES IT INCREASE MORBIDITY AND MORTALITY IN CRITICALLY ILL PATIENTS CRIT CARE MED 2007352861-2
bull UNDERSTANDING THE PHYSIOLOGICAL EFFECTS OF UNTREATED PAIN NURSING TIMES VOL 99 ISSUE 37 PAGE NO 28
bull WINFIELD ET AL NON-PHARMACEUTICAL MANAGEMENT OF RESPIRATORY MORBIDITY IN CHILDREN WITH SEVERE GLOBAL DEVELOPMENTAL DELAY THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014
bull OLOUGHLIN EV SOMERVILLE HM SOMERVILLE ER DEALING WITH MULTISYSTEM DISEASE IN PEOPLE WITH A DEVELOPMENTAL DISABILITY MEDICAL JOURNAL OF AUSTRALIA 2009 JUN 1190(11)616-7
bull MESTROVIC J KARDUM G POLIC B MESTROVIC M MARKIC J SUSTIC A ET AL THE INFLUENCE OF CHRONIC HEALTH CONDITIONS ON SUSCEPTIBILITY TO SEVERE ACUTE ILLNESS OF CHILDREN TREATED IN PICU EUROPEAN JOURNAL OF PEDIATRICS 2006 AUG165(8)526-
9
bull HEALY F PANITCH HB PULMONARY COMPLICATIONS OF PEDIATRIC NEUROLOGICAL DISEASES PEDIATR ANN 2010 APR39(4)216-24
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SRIVASTAVA R JACKSON WD BARNHART DC DYSPHAGIA AND GASTROESOPHAGEAL REFLUX DISEASE DILEMMAS IN DIAGNOSIS AND MANAGEMENT IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT PEDIATR ANN 2010 APR39(4)225-31
bull SULLIVAN PB JUSZCZAK E BACHLET AME LAMBERT B VERNON-ROBERTS A GRANT HW ET AL GASTROSTOMY TUBE FEEDING IN CHILDREN WITH CEREBRAL PALSY A PROSPECTIVE LONGITUDINAL STUDY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 2005
FEBRUARY47(2)77-85
bull SOMERVILLE H TZANNES G WOOD J SHUN A HILL C ARROWSMITH F ET AL GASTROINTESTINAL AND NUTRITIONAL PROBLEMS IN SEVERE DEVELOPMENTAL DISABILITY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 200850(9)712-6
bull TODER DS RESPIRATORY PROBLEMS IN THE ADOLESCENT WITH DEVELOPMENTAL DELAY ADOLESCENT MEDICINE 2000 3 OCTOBER 200011(3)617-31
bull LEVIN K COLON A DIPALMA J FITZPATRICK S USING THE RADIONUCLIDE SALIVAGRAM TO DETECT PULMONARY ASPIRATION AND ESOPHAGEAL DYSMOTILITY CLIN NUCL MED 1993 FEB18(2)110-4
bull SCHROEDER AS KLING T HUSS K BORGGRAEFE I KOERTE IK BLASCHEK A ET AL BOTULINUM TOXIN TYPE A AND B FOR THE REDUCTION OF HYPERSALIVATION IN CHILDREN WITH NEUROLOGICAL DISORDERS A FOCUS ON EFFECTIVENESS AND THERAPY ADHERENCE
NEUROPEDIATRICS 201243(1)27-36
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull GOEMINNE P AND DUPONT L (2010) NON-CYSTIC FIBROSIS BRONCHIECTASIS DIAGNOSIS AND MANAGEMENT IN 21ST CENTURY POSTGRADUATE MEDICAL JOURNAL 86(1018) PP493-501
bull LEE A BUTTON B AND TANNENBAUM E (2017) AIRWAY-CLEARANCE TECHNIQUES IN CHILDREN AND ADOLESCENTS WITH CHRONIC SUPPURATIVE LUNG DISEASE AND BRONCHIECTASIS FRONTIERS IN PEDIATRICS 5
bull MANDAL P SIDHU M KOPE L POLLOCK W STEVENSON L PENTLAND J TURNBULL K MAC QUARRIE S AND HILL A (2012) A PILOT STUDY OF PULMONARY REHABILITATION AND CHEST PHYSIOTHERAPY VERSUS CHEST PHYSIOTHERAPY ALONE IN
BRONCHIECTASIS RESPIRATORY MEDICINE 106(12) PP1647-1654
bull MURRAY M PENTLAND J AND HILL A (2009) A RANDOMISED CROSSOVER TRIAL OF CHEST PHYSIOTHERAPY IN NON-CYSTIC FIBROSIS BRONCHIECTASIS EUROPEAN RESPIRATORY JOURNAL 34(5) PP1086-1092
bull NEWALL C STOCKLEY R AND HILL S (2005) EXERCISE TRAINING AND INSPIRATORY MUSCLE TRAINING IN PATIENTS WITH BRONCHIECTASIS THORAX 60(11) PP943-948
bull ONG H LEE A HILL C HOLLAND A AND DENEHY L (2011) EFFECTS OF PULMONARY REHABILITATION IN BRONCHIECTASIS A RETROSPECTIVE STUDY CHRONIC RESPIRATORY DISEASE 8(1) PP21-30
bull QUINT J MILLETT E JOSHI M NAVARATNAM V THOMAS S HURST J SMEETH L AND BROWN J (2015) CHANGES IN THE INCIDENCE PREVALENCE AND MORTALITY OF BRONCHIECTASIS IN THE UK FROM 2004 TO 2013 A POPULATION-BASED COHORT
STUDY EUROPEAN RESPIRATORY JOURNAL 47(1) PP186-193
bull SNIJDERS D FERNANDEZ DOMINGUEZ B CALGARO S BERTOZZI I ESCRIBANO MONTANER A PERILONGO G AND BARBATO A (2015) MUCOCILIARY CLEARANCE TECHNIQUES FOR TREATING NON-CYSTIC FIBROSIS BRONCHIECTASIS IS THERE
EVIDENCE INTERNATIONAL JOURNAL OF IMMUNOPATHOLOGY AND PHARMACOLOGY 28(2) PP150-159
0
50
100
150
200
250
300
350
400
0
50
100
150
200
250
300
350
400
Green
Yellow
Red
PCF Mouthpiece (Lmin)
PCF Mask (Lmin)
Key
Mouthpiece u
Mask n
Additional info (please comment)
Off feet
Ability to chew
Strength of voice Please refer to BTSACPRC Guideline ldquoPhysiotherapy management of the adult medical spontaneously breathing patientrdquo and ldquoGuidelines
Lothian University Hospitals NHS Trust
Paediatric Physiotherapy Service
Lead Physiotherapist Mairi McCrae
n PCF gt270lmin
Breathstacking tri-flow blowing
games
nPCF lt270lmin but gt 160lmin
Manual assisted cough manual
techniques ambu bag assisted
breaths
nPCF lt160lmin
NIV ambu-bag assisted breaths
MI-E
bull SHORT TERM TREATMENT AIMS TO MINIMISE INFECTION AND PREVENT
REPEATED LUNG DAMAGE
bull NORMALISE RESPIRATORY SYSTEM
bull MAXIMISE VENTILATION amp ENCOURAGE EQUAL FILLING
bull MAXIMISE EXPIRATORY FLOWVELOCITY
bull REMOVAL OF TRACHEOBRONCHIAL SECRETIONS FROM THE LUNGS
bull DECREASE WORK OF BREATHING
bull LONG TERM TREATMENT AIMS TO DELAY THE PROGRESSION OF RESPIRATORY
DISEASE AND MAINTAIN OPTIMAL RESPIRATORY FUNCTION
AIMS OF ACT
AIM OF ACT
bull COMPENSATE FOR IMPAIRED MUCOCILIARY CLEARANCE
bull COMPENSATE FOR INABILITY TO CREATE EXPIRATORY FLOW AND INSP EFFORT
bull IMPROVE VENTILATION BY PREVENTING OBSTRUCTION OF SMALL AIRWAYS
bull SLOW DOWN LUNG DISEASE
POOR AIRWAY CLEARANCE
INCREASED AIRWAY RESISTANCE
INCREASED WOB
HYPOXAEMIA
REPEATED INFECTIONS
LOSS OF RESPIRATORY RESERVE
AIRWAY DAMAGE
RESPIRATORY FAILURE
AIRWAY CLEARANCE TECHNIQUES
bull CHEST PHYSIO
bull DECREASED LUNG VOLUME
bull SECRETION RETENTION
bull INCREASED WOB
bull KETCHUP BOTTLE
bull GLASS
bull PLASTIC
bull SACHET
bull HUMIDIFICATION INHALATION THERAPY
bull MANUAL TECHNIQUES
bull BREATHING TECHNIQUES
bull MAXIMAL INSPIRATORY CAPACITY
bull PHYSIO WITH NIV
bull PEP
bull OSCILLATORY TECHNIQUES
bull HFCWO
bull MIE
bull SUCTION
ACT TECHNIQUES
MANUAL TECHNIQUES
bull PERCUSSION
bull VIBRATIONSHAKING
bull MANUAL ASSISTED COUGH
bull TRACHEAL PRESSURE
bull OVERPRESSURE
bull MANUALASSISTED AD
ACTIVE CYCLE OF BREATHING
Breathing control
3-5 Deep Breaths or TEE
with 3 sec inspiratory
hold
Breathing control
3-5 Deep Breaths or TEE
with 3 sec inspiratory
hold
Breathing control
2-3 FET huffs amp coughs
Clear mucus
Active Cycle
of Breathing
Technique
(ACBT)
AUTOGENIC DRAINAGE
bull JEAN CHEVALLIER 1967 IN BELGIUM
bull OBSERVED CHILDREN SLEEPING
bull LOW LV VrsquoS HIGH LVrsquoS
bull 3 PHASES OF BREATHING
bull LOW
bull MID
bull HIGH
bull MOVING FROM RESIDUAL VOLUME TO TOTAL LUNG CAPACITY
bull AIM TO GENERATE INCREASED EXPIRATORY AIRFLOW PROGRESSIVELY THROUGH EACH GENERATION OF BRONCHI
bull SECRETIONS LOOSEN AND MOVE INTO LARGER AIRWAYS TO AID EXPECTORATION
AD CONTrsquoD
bull METHOD bull DIAGNOSTIC BREATH WHERE ABLE
bull LOW FLOW ON INSPIRATION IE QUIET BREATH IN
bull FASTER EXPIRATORY FLOW
bull SPEED OF EXPIRATORY FLOW bull TRANSPORTS SECRETIONS
bull SHEARS SECRETIONS FROM BRONCHIAL WALL
bull COMBINE WITH TREATMENTS
bull BENEFICIAL IN PATIENTS WITH SIGNIFICANT HYPER-REACTIVITY amp
HAEMOPTYSIS
AD IN NMD
bull PASSIVE AD
bull THERAPIST CONTROLS DEPTH OF LUNG VOLUMES
bull SAME PRINCIPALS
bull OFTEN USED IN CONJUNCTION WITH PEP TO PREVENT SMALL AIRWAY COLLAPSE
bull DEMONSTRATION TO FOLLOW
bull EXHALATION AGAINST A CONSTANT POSITIVE PRESSURE
bull AIDS REMOVAL OF BRONCHIAL SECRETIONS
bull PREVENTING AIRWAY COLLAPSE BY STENTING THE AIRWAYS
bull RECRUITMENT OF PREVIOUSLY OBSTRUCTED AIRWAYS
bull IMPROVE VENTILATION REDUCE ATELECTASIS
bull INCREASING INTRATHORACIC PRESSURE DISTAL TO RETAINED SECRETIONS BY COLLATERAL VENTILATION OR BY INCREASING FRC
bull MAINTAIN PULMONARY FUNCTION
POSITIVE EXPIRATORY PRESSURE (PEP)
bull MASK VALVE RESISTOR amp MANOMETER
bull O2CAN BE CONNECTED TO THE INHALATION SIDE IF REQUIRED
bull SIT IN GOOD POSITION WITH GOOD SEAL AROUND MOUTHPIECEMASK
bull SLOW INHALATION JUST A LITTLE LARGER THAN A NORMAL BREATH IN
(HOLD FOR 3 SECS IF USING MOUTHPIECE)
bull STEADY ACTIVE amp FULL EXHALATION
bull AIM FOR 10-20 CM H2O FOR 3-5 SECS
bull REPEAT 12-15 TIMES FOLLOWED BY FET amp COUGH
bull COMPLETE FOR 15-30 MINS (6-8 CYCLES OR SETS OF ABOVE)
PEP TREATMENT
bull BEFORE OR AT LEAST 1 HR AFTER A FEED
bull START WITH THE SMALLEST HOLERESISTOR THAT BABY CAN TOLERATE
bull USE A MANOMETER
bull HOLD THE BABY IN ARMS OR ON PARENTS LAP SIT ON GYM BALL
bull PLACE THE MASK OVER THE BABYrsquoS MOUTH amp NOSE
bull AIM FOR FEW BREATHS 30-60 SECONDS WHICH CAN BE BUILT UP TO 1-2 MINUTES AS TOLERATED
bull AIM TO REACH PRESSURES BETWEEN 5-15 CM H2O
bull REST FOR 30-60 SECONDS THEN REPEAT FOR ABOUT 5-10 MINUTES
bull COMBINE THIS WITH OTHER TREATMENTS
BABY PEP TREATMENT
OSCILLATING PEP
OSCILLATING PEP
bull DEVICES CAN BE INTRA-THORACIC OR EXTRA-THORACIC
bull INTRA-THORACIC DEVICES ARE PLACED IN THE MOUTH AND PROVIDE RESISTANCE DURING EXHALATION
bull ALTERS EXPIRATORY AIRFLOW
bull VIBRATIONS ON THE AIRWAY SURFACE
bull REDUCES MUCOUS VISCOSITY
bull ACCELERATION OF THE EXPIRATORY FLOW
bull PREVENTS AND TREATS AIRWAY COMPRESSION ATELECTASIS
bull IMPROVES AIRWAY PATENCY amp VENTILATION
bull DECREASES HYPERINFLATION
bull IMPROVES LUNG FUNCTION PARAMETERS
bull INCLUDES EXERCISE
OSCILLATING PEP TREATMENT
bull SIMILAR TO PEP
bull GOOD POSITION
bull PLACE MOUTHPIECE BETWEEN LIPS AND TEETH OR USE MASK
bull SLOW INHALE JUST A LITTLE LARGER THAN A NORMAL BREATH IN
bull HOLD FOR 3 SECONDS
bull STEADY ACTIVE amp FULL EXHALATION
bull ADJUST THE RESISTANCE AS REQUIRED
bull REPEAT 12-15 TIMES FOLLOWED BY FET amp COUGH
bull COMPLETE FOR 5-10 MINS
bull COMBINE WITH OTHER TREATMENTS
ACAPELLA
bull DETACHABLE MOUTHPIECEFACEMASK
bull ONE-WAY INSPIRATORY VALVE
bull EXPIRATORY RESISTANCEFREQUENCY ADJUSTMENT DIAL
bull COUNTERWEIGHTED PLUG amp MAGNET
bull MAINTAINS A RAISED FRC LEVEL
TREATMENT
bull EASY TO USE IN DIFFERENT POSITIONS
bull INHALE amp EXHALE THROUGH THE ACAPELLA
bull ROTATE THE FREQUENCY RESISTANCE DIAL UNTIL MAXIMUM VIBRATIONS ARE FELT WITHIN THE CHEST WALL
AEROBIKA bull COMBINES PEP WITH HIGH FREQUENCY OSCILLATIONS
bull CAN BE USED WITH A MANOMETER
bull NEBULISER CAN BE ENTRAINED INTO THE SYSTEM
bull POSSIBLE INCREASE IN TREATMENT COMPLIANCE BY DECREASING
TREATMENT TIMES
TECHNIQUE AS OSCILLATING PEP
BUBBLE PEP
Suction tubing (~1cm diameter) The end MUST sit at the bottom of the bottle
Plastic bottle Any widthshapediameter must be gt20cm tall 15cm fresh tapsterile water
(depth of water determines the amount of pressure ie cm H20
Washing up bowl
INDICATIONS
bull REDUCED LUNG VOLUME (FVClt50)
bull WEAK COUGH (PCFlt270)
bull SECRETIONS RETENTION
bull ATELECTASIS
bull REDUCED MECHANICAL COMPLIANCE
bull CHILD ABLE TO COMPLY
BENEFITS
bull INCREASE LUNG VOLUME = IMPROVES PCF
bull SECRETION CLEARANCE
bull MAY REVERSE ATELECTASIS
bull IMPROVE MECHANICAL COMPLIANCE = LUNG AND CHEST WALL MOBILITY
bull IMPROVE VOICE STRENGTH
LUNG VOLUME RECRUITMENT
bull LABEL NOT FOR RESUSCITATION
bull BEST IN SITTING
bull SUCTION READY
bull AGREE SIGNAL WITH CHILD WHEN MIC ACHIEVED
bull ASK TO BREATH OUT
bull PLACE MOUTHPIECE +- NOSE CLIP OR MASK
bull ASK TO BREATH IN AND HOLD WHILE GENTLY SQUEEZING BAG
bull WITHOUT LETTING AIR OUT ASK CHILD TO TAKE ANOTHER BREATH IN ON TOP OF THE FIRST BREATH AND SQUEEZE BAG IN TIME WITH BREATH
bull REPEAT UNTIL LUNGS ARE FULL (NORMALLY 3-5 BREATHS) OR SIGNAL
bull REMOVE MASK OR MOUTHPIECE ASK TO HOLD FOR 3-5 SECONDS
bull EXHALE OR IF SECRETIONS ARE PRESENT ENCOURAGE TO HAVE A COUGH OR MAC
bull REPEATED X3-5 X2-4 DAY
LVR TREATMENT
bull AIRWAY CLEARANCE OR THORACIC MOBILITY
bull AMBU RESUS BAG
bull GREEN ldquoPHYSIOrdquo BAG
bull MANUAL TECHNIQUES WITH BAGGING
bull MHI AT HOME
bull MANOMETERS
MHI
PHYSIO WITH NIV
bull PHYSIO SETTINGS
bull SECRETIONS
bull THORACIC MOBILITY
bull ALLOWS REST PERIOD PRE ACT
bull HUMIDIFICATION
bull INFLATABLE VEST CONNECTED BY TUBES TO AN AIR PULSE GENERATOR WHICH RAPIDLY INFLATES AND DEFLATES THE VEST PRODUCING OSCILLATIONS TO THE CHEST WALL
bull RAPID CHEST MOVEMENT MIMICS A COUGH-LIKE EXPIRATORY FLOW THAT SHEARS MUCUS AWAY FROM THE AIRWAY WALLS AND HELPS TO MOVE IT ALONG TO THE CENTRAL AIRWAYS
bull PASSIVE TREATMENT amp NOT POSITION DEPENDANT
bull COMBINATION OF RX
bull CONTRAINDICATIONS
bull HEAD ANDOR NECK INJURY THAT HAS NOT BEEN STABILISED
bull ACTIVE HAEMORRHAGE WITH HEMODYNAMIC INSTABILITY
HFCWO
HFCWO INDICATIONS
bull CHRONIC MUCUS HYPERSECRETION OR RETENTION ASSOCIATED WITH A CHRONIC PULMONARY OR NEUROMUSCULAR CONDITION
bull LRT SECRETIONS AND FREQUENT LRTI REQUIRING HOSPITAL ADMISSION
bull INEFFECTIVE COUGH OR INABILITY TO REMOVE MUCUS BY COUGHING
bull TENACIOUS SECRETIONS THAT ARE NOT EASILY MOBILISED WITH STANDARD CPT
bull MECHANICALLY VENTILATED WITH EVIDENCE OF SECRETION RETENTION
bull ALTERNATIVE AIRWAY CLEARANCE THERAPY PROVEN INEFFECTIVE OR CONTRAINDICATEDDO NOT TOLERATE STANDARD CPT
bull CONSTANT FATIGUE LACK OF STRENGTH OR ABILITY TO PERFORM ACTIVE TREATMENT
bull SYMPTOMATIC
bull POOR COMPLIANCE WITH OTHER AIRWAY CLEARANCE METHODS
bull HIGH BURDEN OF CARE
bull PATIENT UNABLE TO TOLERATE THE INCREASED WORK OF BREATHING bull ACTIVE HAEMOPTYSIS bull UNTREATED PNEUMOTHORAX bull INTRACRANIAL PRESSURE (ICP) gt 20 MMHG bull HAEMODYNAMIC INSTABILITY bull SEVERE CARDIOVASCULAR INSULTDISEASE bull RECENT FACIAL ORAL OR SKULL SURGERY OR TRAUMA bull ACUTE SINUSITIS bull EPISTAXIS bull POST OESOPHAGEAL amp LUNG SURGERY bull KNOWN OR SUSPECTED TYMPANIC MEMBRANE RUPTURE OR OTHER MIDDLE EAR
PATHOLOGY
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
POSSIBLE HAZARDSCOMPLICATIONS
bull INCREASED WORK OF BREATHING THAT MAY LEAD TO HYPOVENTILATION AND
HYPERCARBIA
bull INCREASED INTRACRANIAL PRESSURE
bull CARDIOVASCULAR COMPROMISE
bull NAUSEA
bull MYOCARDIAL ISCHEMIA
bull DECREASED VENOUS RETURN
bull AIR SWALLOWING WITH INCREASED LIKELIHOOD OF VOMITING AND
ASPIRATION
bull CLAUSTROPHOBIA
bull SKIN BREAK DOWN AND DISCOMFORT FROM MASK
bull PULMONARY BAROTRAUMA
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
MI-E
bull USED WITH CHILDREN WHO HAVE DECREASED INSPIRATORY EFFORT DUE TO EITHER SPINAL CORD INJURY OR NMW AND WHO HAVE AN IMPAIRED OR INEFFECTIVE COUGH WITH APPROPRIATE RESPIRATORY SYMPTOMS
bull CONSIDERED WHEN CONVENTIONAL COUGH ASSISTANCE TECHNIQUES BECOME INEFFECTIVE
bull ACCEPTED AS THE CORE STANDARD FOR CHILD WITH NMW
bull MIE WORKS BY
bull INFLATING THE LUNGS WITH GRADUAL POSITIVE AIRWAY PRESSURE ASSISTING INSPIRATION CALLED INSUFFLATION
bull FOLLOWED BY A RAPID SWITCH TO NEGATIVE PRESSURE WHICH SIMULATES THE FLOW CHANGES THAT OCCUR DURING A COUGH THEREBY ENHANCING EXPIRATORY FLOW CALLED EXSUFFLATION AND ASSISTING EXPECTORATION OF SECRETIONS
bull MOVEMENT AND EXERCISE BEST FUNCTIONAL METHOD OF AIRWAY CLEARANCE
bull CPET BETTER CORRELATION THAN LUNG FUNCTION IN SURVIVAL RATES IN PEOPLE WITH
CYSTIC FIBROSIS
bull RUNNINGWALKING BETTER FOR SECRETION CLEARANCE THAN BIKE DURING TO SHEARING
MECHANISM
bull CONSIDER ADDING IN HUFFS (DYER)
bull CONSIDER USE OF AD BELT
EXERCISE
bull APCP SUCTION GUIDELINES
bull TYPESNASOPHARANGEAL OROPHARANGEAL AND TRACHEOSTOMY
bull MAIN VARIABLES SUCTION TYPE AND SIZE DEPTH OF SUCTION
PRESSURE TECHNIQUE
SUCTION
SPUTUM
bull SPUTUM bull 95 WATER bull COLOUR bull VOLUME bull CONSISTENCY bull ODOUR
bull PURPOSE bull HUMIDIFICATION bull WATERPROOFING bull PROTECTION OF EPITHELIUM
HUMIDIFICATION
bull METABOLIC AND VENTILATORY REQUIREMENTS ARE X2-3 OF ADULTS
IMPLICATION
bull HEAT AND MOISTURE LOSSES FROM RESPIRATION WILL INCREASE BY X2-3
bull CONSUME GREATER AMOUNTS OF ENERGY AND WATER
HUMIDIFICATION INHALATION
THERAPY
bull TRACHEOSTOMY HME
bull WET DRY CIRCUIT
bull NEBULISERS INHALERS MUCOLYTICS
bull HUMIDIFIERS WITH NIV
bull OXYGEN
bull SYSTEMIC HYDRATION ENVIRONMENT
NEBULISERS
bull NEBULISER CHAMBER CONVERTS LIQUID INTO
RESPIRABLE PARTICLES
bull MOISTURE DESCENDS THROUGH THE HOLES IN THE SUPERFICIAL GEL LAYER
bull INCREASES THE SOL LAYER SO THE CILIARY BEAT IS OPTIMAL FOR MUCUS TRANSPORT
bull SHORT TERM HUMIDIFICATION
bull DAILY WASHING OF NEBULISER SYSTEM
TIMING OF DRUG AND PHYSIOTHERAPY
BEFORE TREATMENT
bull DNASE (PULMOZYME)
bull SALBUTAMOL
(VENTOLIN BLUE)
bull SALINE NEBS
AFTER TREATMENT
bull SERETIDE (PURPLE)
bull BECLOMETHASONE (BECOTIDE BROWN)
bull COLISTIN (COLOMYCIN PROMIXIN)
bull TOBRAMYCIN
CONCLUSION
bull BE AWARE OF CHILDrsquoS RESPIRATORY FUNCTION
bull CHOSE ACT BEST FOR THEM bull TYPE OF KETCHUP BOTTLE bull LV SECRETION RETENTION WOB
bull EARLY RESPIRATORY REFERRAL
bull RESPIRATORY CARE COMPETENCIES
bull EFFECTIVE SECRETION CLEARANCE AT HOMERESPITESCHOOL
bull USE OF PEAK COUGH FLOWS TO AID CHOICE OF ADJUNCT
0
50
100
150
200
250
300
350
400
0
50
100
150
200
250
300
350
400
Green
Key
Additional info
(please comment) Please refer to BTSACPRC Guideline
Lothian University Hospitals NHS Trust
n PCF
gt270lmin
Breathstack
ing tri-
flow
blowing
REFERENCES bull BTSACPRC GUIDELINE IS PUBLISHED IN THORAX VOL 67 SUPPLEMENT 1
bull AVAILABLE ONLINE AT HTTPTHORAXBMJCOMCONTENTVOL64ISSUESUPPLI
bull HTTPWWWBRIT-THORACICORGUKPHYSIOGUIDE
bull BRITISH THORACIC SOCIETY REPORTS VOL 1 NO 1 2009
bull ADAPTED PRYOR AJ AND PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS3RD ED
bull HOUGH A PHYSIOTHERAPY IN RESPIRATORY CARE LONDON CHAPMAN AND HALL 1993
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1997) POSTURAL DRAINAGE AND GASTRO-OESOPHAGEAL REFLUX IN INFANTS WITH CYSTIC FIBROSIS ARCHIVES OF DISEASE IN CHILDHOOD 76 148-150
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1998) POSTURAL DRAINAGE IN CYSTIC FIBROSIS IS THERE A LINK WITH GASTRO-OESOPHAGEAL REFLUX JOURNAL OF PAEDIATRIC CHILD HEALTH 34 330-334
bull CECINS NM JENKINS SC PENGELLEY J ET AL (1999) THE ACTIVE CYCLE OF BREATHING TECHNIQUES-TO TIP OR NOT TO TIP RESPIRATORY MEDICINE 93 660-665
bull CONSTANTINI D BRIVIO A BRUSA D ET AL (2001) PEP MASK VERSUS POSTURAL DRAINAGE IN INFANTS A LONG-TERM COMPARATIVE TRIAL PEADIATRIC PULMONOLOGY
bull HOUGH A (2001) PHYSIOTHERAPY IN RESPIRATORY CARE AN EVIDENCE-BASED APPROACH TO RESPIRATORY AND CARDIAC MANAGEMENT CENGAGE LEARNING EMEA
bull INTERNATIONAL PHYSIOTHERAPY GROUP FOR CYSTIC FIBROSIS PHYSIOTHERAPY IN THE TREATMENT OF CYSTIC FIBROSIS (2009) HTTPSWWWECFSEUIPG_CFBOOKLET INTERNATIONAL PHYSIOTHERAPY GROUP ndash THE BLUE BOOKLET
bull KONSTAN MW STERN RC DOERSHUK CF (1994) EFFICACY OF THE FLUTTER DEVICE FOR AIRWAY MUCUS CLEARANCE IN PATIENTS WITH CYSTIC FIBROSIS JOURNAL OF PEDIATRICS 124 (5 (PT 1) 689-693
bull MCILWAINE M BUTTON B AND DWAN K (2015) POSITIVE EXPIRATORY PRESSURE PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 6 ART NO CD003147 DOI 10100214651858CD003147PUB4
bull MESTRINER RG FERNANDES RO STAFFEN LC ET AL (2009) OPTIMUM DESIGN PARAMETERS FOR A THERAPIST-CONSTRUCTED POSITIVE-EXPIRATORY-PRESSURE THERAPY BOTTLE DEVICE RESPIRATORY CARE 54 504-8
bull MORRISON L AND AGNEW J (2014) OSCILLATING DEVICES FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 7 ART NO CD006842 DOI 10100214651858CD006842PUB
bull OERMANN CM SOCKRIDER MM GILES D ET AL (2001) COMPARISON OF HIGH-FREQUENCY CHEST WALL OSCILLATION AND OSCILLATING POSITIVE EXPIRATORY PRESSURE IN THE HOME MANAGEMENT OF CYSTIC FIBROSIS A PILOT STUDY PEDIATRIC PULMONOLOGY 32 (5) 372-7
bull PRASAD SA AND HUSSEY J (1995) PAEDIATRIC RESPIRATORY CARE A GUIDE FOR PHYSIOTHERAPISTS AND HEALTH PROFESSIONALS CHAPMAN amp HALL
bull PRYOR J (1999) PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN ADULTS EUROPEAN RESPIRATORY JOURNAL 14 (6) 1418-1424
bull PRYOR JA amp PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS CHURCHILL LIVINGSTONE
bull PRYOR JA WEBBER BA HODSON ME ET AL (1994) THE FLUTTER VRP1 AS AN ADJUNCT TO CHEST PHYSIOTHERAPY IN CYSTIC FIBROSIS RESPIRATORY MEDICINE 88677-81
bull WEST K WALLEN M FOLLETT J (2010) ACAPELLA VS PEP MASK THERAPY A RANDOMISED TRIAL IN CHILDREN WITH CYSTIC FIBROSIS DURING RESPIRATORY EXACERBATION PHYSIOTHERAPY THEORY PRACTICE 26143-9
bull WILSONLM AGNEW J MORRISON L ET AL (2014) AIRWAY CLEARANCE TECHNIQUES FOR CYSTIC FIBROSIS AN OVERVIEW OF COCHRANE SYSTEMATIC REVIEWS COCHRANE DATABASE OF SYSTEMATIC REVIEWS DOI 10100214651858CD011231
bull VOLSKO TA DIFIORE JM CHATBURN RL (2003) PERFORMANCE COMPARISON OF TWO OSCILLATORY POSITIVE PRESSURE DEVICES ACAPELLA VERSUS FLUTTER RESPIRATORY CARE 48 (2) 124- 130
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SEDDON PC KHAN Y RESPIRATORY PROBLEMS IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT ARCHIVES OF DISEASE IN CHILDHOOD 2003 01 JAN88(1)75-8
bull MARKS JH PULMONARY CARE OF CHILDREN AND ADOLESCENTS WITH DEVELOPMENTAL DISABILITIES PEDIATR CLIN NORTH AM 2008 DECEMBER55(6)1299-314
bull ARENS R MUZUMDAR H SLEEP SLEEP DISORDERED BREATHING AND NOCTURNAL HYPOVENTILATION IN CHILDREN WITH NEUROMUSCULAR DISEASES PAEDIATRIC RESPIRATORY REVIEWS 2010 MAR11(1)24-30
bull FITZGERALD DA FOLLETT J VAN ASPEREN PP ASSESSING AND MANAGING LUNG DISEASE AND SLEEP DISORDERED BREATHING IN CHILDREN WITH CEREBRAL PALSY PAEDIATRIC RESPIRATORY REVIEWS 2009 MARCH10(1)18-24
bull HSIAO KH NIXON GM THE EFFECT OF TREATMENT OF OBSTRUCTIVE SLEEP APNEA ON QUALITY OF LIFE IN CHILDREN WITH CEREBRAL PALSY RES DEV DISABIL 2008 MAR-APR29(2)133-40
bull LUNDBERG A OXYGEN CONSUMPTION IN RELATION TO WORKLOAD IN STUDENTS WITH CEREBRAL PALSY J APPL PHYSIO 197640873-5
bull SULLIVAN PB ROSENBLOOM L FEEDING THE DISABLED CHILD CLINICS IN DEVELOPMENTAL MEDICINE MACKEITH PRESS 1999140
bull MARTIN TR THE RELATIONSHIP BETWEEN MALNUTRITION AND LUNG INFECTIONS CLIN CHEST MED 19878359
bull MOSTAFA SM BHANDARI S RITCHIE G ET AL CONSTIPATION AND ITS IMPLICATIONS IN THE CRITICALLY ILL PATIENT BR J ANAESTH 200391815-9 3
bull GACOUIN A CAMUS C GROS A ET AL CONSTIPATION IN LONGTERM VENTILATED PATIENTS ASSOCIATED FACTORS AND IMPACT ON INTENSIVE CARE UNIT OUTCOMES CRIT CARE MED 2010381933- 8
bull NGUYEN T FRENETTE AJ JOHANSON C ET AL IMPAIRED GASTROINTESTINAL TRANSIT AND ITS ASSOCIATED MORBIDITY IN THE INTENSIVE CARE UNIT J CRIT CARE 201328537
bull ASAI T CONSTIPATION DOES IT INCREASE MORBIDITY AND MORTALITY IN CRITICALLY ILL PATIENTS CRIT CARE MED 2007352861-2
bull UNDERSTANDING THE PHYSIOLOGICAL EFFECTS OF UNTREATED PAIN NURSING TIMES VOL 99 ISSUE 37 PAGE NO 28
bull WINFIELD ET AL NON-PHARMACEUTICAL MANAGEMENT OF RESPIRATORY MORBIDITY IN CHILDREN WITH SEVERE GLOBAL DEVELOPMENTAL DELAY THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014
bull OLOUGHLIN EV SOMERVILLE HM SOMERVILLE ER DEALING WITH MULTISYSTEM DISEASE IN PEOPLE WITH A DEVELOPMENTAL DISABILITY MEDICAL JOURNAL OF AUSTRALIA 2009 JUN 1190(11)616-7
bull MESTROVIC J KARDUM G POLIC B MESTROVIC M MARKIC J SUSTIC A ET AL THE INFLUENCE OF CHRONIC HEALTH CONDITIONS ON SUSCEPTIBILITY TO SEVERE ACUTE ILLNESS OF CHILDREN TREATED IN PICU EUROPEAN JOURNAL OF PEDIATRICS 2006 AUG165(8)526-
9
bull HEALY F PANITCH HB PULMONARY COMPLICATIONS OF PEDIATRIC NEUROLOGICAL DISEASES PEDIATR ANN 2010 APR39(4)216-24
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SRIVASTAVA R JACKSON WD BARNHART DC DYSPHAGIA AND GASTROESOPHAGEAL REFLUX DISEASE DILEMMAS IN DIAGNOSIS AND MANAGEMENT IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT PEDIATR ANN 2010 APR39(4)225-31
bull SULLIVAN PB JUSZCZAK E BACHLET AME LAMBERT B VERNON-ROBERTS A GRANT HW ET AL GASTROSTOMY TUBE FEEDING IN CHILDREN WITH CEREBRAL PALSY A PROSPECTIVE LONGITUDINAL STUDY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 2005
FEBRUARY47(2)77-85
bull SOMERVILLE H TZANNES G WOOD J SHUN A HILL C ARROWSMITH F ET AL GASTROINTESTINAL AND NUTRITIONAL PROBLEMS IN SEVERE DEVELOPMENTAL DISABILITY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 200850(9)712-6
bull TODER DS RESPIRATORY PROBLEMS IN THE ADOLESCENT WITH DEVELOPMENTAL DELAY ADOLESCENT MEDICINE 2000 3 OCTOBER 200011(3)617-31
bull LEVIN K COLON A DIPALMA J FITZPATRICK S USING THE RADIONUCLIDE SALIVAGRAM TO DETECT PULMONARY ASPIRATION AND ESOPHAGEAL DYSMOTILITY CLIN NUCL MED 1993 FEB18(2)110-4
bull SCHROEDER AS KLING T HUSS K BORGGRAEFE I KOERTE IK BLASCHEK A ET AL BOTULINUM TOXIN TYPE A AND B FOR THE REDUCTION OF HYPERSALIVATION IN CHILDREN WITH NEUROLOGICAL DISORDERS A FOCUS ON EFFECTIVENESS AND THERAPY ADHERENCE
NEUROPEDIATRICS 201243(1)27-36
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull GOEMINNE P AND DUPONT L (2010) NON-CYSTIC FIBROSIS BRONCHIECTASIS DIAGNOSIS AND MANAGEMENT IN 21ST CENTURY POSTGRADUATE MEDICAL JOURNAL 86(1018) PP493-501
bull LEE A BUTTON B AND TANNENBAUM E (2017) AIRWAY-CLEARANCE TECHNIQUES IN CHILDREN AND ADOLESCENTS WITH CHRONIC SUPPURATIVE LUNG DISEASE AND BRONCHIECTASIS FRONTIERS IN PEDIATRICS 5
bull MANDAL P SIDHU M KOPE L POLLOCK W STEVENSON L PENTLAND J TURNBULL K MAC QUARRIE S AND HILL A (2012) A PILOT STUDY OF PULMONARY REHABILITATION AND CHEST PHYSIOTHERAPY VERSUS CHEST PHYSIOTHERAPY ALONE IN
BRONCHIECTASIS RESPIRATORY MEDICINE 106(12) PP1647-1654
bull MURRAY M PENTLAND J AND HILL A (2009) A RANDOMISED CROSSOVER TRIAL OF CHEST PHYSIOTHERAPY IN NON-CYSTIC FIBROSIS BRONCHIECTASIS EUROPEAN RESPIRATORY JOURNAL 34(5) PP1086-1092
bull NEWALL C STOCKLEY R AND HILL S (2005) EXERCISE TRAINING AND INSPIRATORY MUSCLE TRAINING IN PATIENTS WITH BRONCHIECTASIS THORAX 60(11) PP943-948
bull ONG H LEE A HILL C HOLLAND A AND DENEHY L (2011) EFFECTS OF PULMONARY REHABILITATION IN BRONCHIECTASIS A RETROSPECTIVE STUDY CHRONIC RESPIRATORY DISEASE 8(1) PP21-30
bull QUINT J MILLETT E JOSHI M NAVARATNAM V THOMAS S HURST J SMEETH L AND BROWN J (2015) CHANGES IN THE INCIDENCE PREVALENCE AND MORTALITY OF BRONCHIECTASIS IN THE UK FROM 2004 TO 2013 A POPULATION-BASED COHORT
STUDY EUROPEAN RESPIRATORY JOURNAL 47(1) PP186-193
bull SNIJDERS D FERNANDEZ DOMINGUEZ B CALGARO S BERTOZZI I ESCRIBANO MONTANER A PERILONGO G AND BARBATO A (2015) MUCOCILIARY CLEARANCE TECHNIQUES FOR TREATING NON-CYSTIC FIBROSIS BRONCHIECTASIS IS THERE
EVIDENCE INTERNATIONAL JOURNAL OF IMMUNOPATHOLOGY AND PHARMACOLOGY 28(2) PP150-159
bull SHORT TERM TREATMENT AIMS TO MINIMISE INFECTION AND PREVENT
REPEATED LUNG DAMAGE
bull NORMALISE RESPIRATORY SYSTEM
bull MAXIMISE VENTILATION amp ENCOURAGE EQUAL FILLING
bull MAXIMISE EXPIRATORY FLOWVELOCITY
bull REMOVAL OF TRACHEOBRONCHIAL SECRETIONS FROM THE LUNGS
bull DECREASE WORK OF BREATHING
bull LONG TERM TREATMENT AIMS TO DELAY THE PROGRESSION OF RESPIRATORY
DISEASE AND MAINTAIN OPTIMAL RESPIRATORY FUNCTION
AIMS OF ACT
AIM OF ACT
bull COMPENSATE FOR IMPAIRED MUCOCILIARY CLEARANCE
bull COMPENSATE FOR INABILITY TO CREATE EXPIRATORY FLOW AND INSP EFFORT
bull IMPROVE VENTILATION BY PREVENTING OBSTRUCTION OF SMALL AIRWAYS
bull SLOW DOWN LUNG DISEASE
POOR AIRWAY CLEARANCE
INCREASED AIRWAY RESISTANCE
INCREASED WOB
HYPOXAEMIA
REPEATED INFECTIONS
LOSS OF RESPIRATORY RESERVE
AIRWAY DAMAGE
RESPIRATORY FAILURE
AIRWAY CLEARANCE TECHNIQUES
bull CHEST PHYSIO
bull DECREASED LUNG VOLUME
bull SECRETION RETENTION
bull INCREASED WOB
bull KETCHUP BOTTLE
bull GLASS
bull PLASTIC
bull SACHET
bull HUMIDIFICATION INHALATION THERAPY
bull MANUAL TECHNIQUES
bull BREATHING TECHNIQUES
bull MAXIMAL INSPIRATORY CAPACITY
bull PHYSIO WITH NIV
bull PEP
bull OSCILLATORY TECHNIQUES
bull HFCWO
bull MIE
bull SUCTION
ACT TECHNIQUES
MANUAL TECHNIQUES
bull PERCUSSION
bull VIBRATIONSHAKING
bull MANUAL ASSISTED COUGH
bull TRACHEAL PRESSURE
bull OVERPRESSURE
bull MANUALASSISTED AD
ACTIVE CYCLE OF BREATHING
Breathing control
3-5 Deep Breaths or TEE
with 3 sec inspiratory
hold
Breathing control
3-5 Deep Breaths or TEE
with 3 sec inspiratory
hold
Breathing control
2-3 FET huffs amp coughs
Clear mucus
Active Cycle
of Breathing
Technique
(ACBT)
AUTOGENIC DRAINAGE
bull JEAN CHEVALLIER 1967 IN BELGIUM
bull OBSERVED CHILDREN SLEEPING
bull LOW LV VrsquoS HIGH LVrsquoS
bull 3 PHASES OF BREATHING
bull LOW
bull MID
bull HIGH
bull MOVING FROM RESIDUAL VOLUME TO TOTAL LUNG CAPACITY
bull AIM TO GENERATE INCREASED EXPIRATORY AIRFLOW PROGRESSIVELY THROUGH EACH GENERATION OF BRONCHI
bull SECRETIONS LOOSEN AND MOVE INTO LARGER AIRWAYS TO AID EXPECTORATION
AD CONTrsquoD
bull METHOD bull DIAGNOSTIC BREATH WHERE ABLE
bull LOW FLOW ON INSPIRATION IE QUIET BREATH IN
bull FASTER EXPIRATORY FLOW
bull SPEED OF EXPIRATORY FLOW bull TRANSPORTS SECRETIONS
bull SHEARS SECRETIONS FROM BRONCHIAL WALL
bull COMBINE WITH TREATMENTS
bull BENEFICIAL IN PATIENTS WITH SIGNIFICANT HYPER-REACTIVITY amp
HAEMOPTYSIS
AD IN NMD
bull PASSIVE AD
bull THERAPIST CONTROLS DEPTH OF LUNG VOLUMES
bull SAME PRINCIPALS
bull OFTEN USED IN CONJUNCTION WITH PEP TO PREVENT SMALL AIRWAY COLLAPSE
bull DEMONSTRATION TO FOLLOW
bull EXHALATION AGAINST A CONSTANT POSITIVE PRESSURE
bull AIDS REMOVAL OF BRONCHIAL SECRETIONS
bull PREVENTING AIRWAY COLLAPSE BY STENTING THE AIRWAYS
bull RECRUITMENT OF PREVIOUSLY OBSTRUCTED AIRWAYS
bull IMPROVE VENTILATION REDUCE ATELECTASIS
bull INCREASING INTRATHORACIC PRESSURE DISTAL TO RETAINED SECRETIONS BY COLLATERAL VENTILATION OR BY INCREASING FRC
bull MAINTAIN PULMONARY FUNCTION
POSITIVE EXPIRATORY PRESSURE (PEP)
bull MASK VALVE RESISTOR amp MANOMETER
bull O2CAN BE CONNECTED TO THE INHALATION SIDE IF REQUIRED
bull SIT IN GOOD POSITION WITH GOOD SEAL AROUND MOUTHPIECEMASK
bull SLOW INHALATION JUST A LITTLE LARGER THAN A NORMAL BREATH IN
(HOLD FOR 3 SECS IF USING MOUTHPIECE)
bull STEADY ACTIVE amp FULL EXHALATION
bull AIM FOR 10-20 CM H2O FOR 3-5 SECS
bull REPEAT 12-15 TIMES FOLLOWED BY FET amp COUGH
bull COMPLETE FOR 15-30 MINS (6-8 CYCLES OR SETS OF ABOVE)
PEP TREATMENT
bull BEFORE OR AT LEAST 1 HR AFTER A FEED
bull START WITH THE SMALLEST HOLERESISTOR THAT BABY CAN TOLERATE
bull USE A MANOMETER
bull HOLD THE BABY IN ARMS OR ON PARENTS LAP SIT ON GYM BALL
bull PLACE THE MASK OVER THE BABYrsquoS MOUTH amp NOSE
bull AIM FOR FEW BREATHS 30-60 SECONDS WHICH CAN BE BUILT UP TO 1-2 MINUTES AS TOLERATED
bull AIM TO REACH PRESSURES BETWEEN 5-15 CM H2O
bull REST FOR 30-60 SECONDS THEN REPEAT FOR ABOUT 5-10 MINUTES
bull COMBINE THIS WITH OTHER TREATMENTS
BABY PEP TREATMENT
OSCILLATING PEP
OSCILLATING PEP
bull DEVICES CAN BE INTRA-THORACIC OR EXTRA-THORACIC
bull INTRA-THORACIC DEVICES ARE PLACED IN THE MOUTH AND PROVIDE RESISTANCE DURING EXHALATION
bull ALTERS EXPIRATORY AIRFLOW
bull VIBRATIONS ON THE AIRWAY SURFACE
bull REDUCES MUCOUS VISCOSITY
bull ACCELERATION OF THE EXPIRATORY FLOW
bull PREVENTS AND TREATS AIRWAY COMPRESSION ATELECTASIS
bull IMPROVES AIRWAY PATENCY amp VENTILATION
bull DECREASES HYPERINFLATION
bull IMPROVES LUNG FUNCTION PARAMETERS
bull INCLUDES EXERCISE
OSCILLATING PEP TREATMENT
bull SIMILAR TO PEP
bull GOOD POSITION
bull PLACE MOUTHPIECE BETWEEN LIPS AND TEETH OR USE MASK
bull SLOW INHALE JUST A LITTLE LARGER THAN A NORMAL BREATH IN
bull HOLD FOR 3 SECONDS
bull STEADY ACTIVE amp FULL EXHALATION
bull ADJUST THE RESISTANCE AS REQUIRED
bull REPEAT 12-15 TIMES FOLLOWED BY FET amp COUGH
bull COMPLETE FOR 5-10 MINS
bull COMBINE WITH OTHER TREATMENTS
ACAPELLA
bull DETACHABLE MOUTHPIECEFACEMASK
bull ONE-WAY INSPIRATORY VALVE
bull EXPIRATORY RESISTANCEFREQUENCY ADJUSTMENT DIAL
bull COUNTERWEIGHTED PLUG amp MAGNET
bull MAINTAINS A RAISED FRC LEVEL
TREATMENT
bull EASY TO USE IN DIFFERENT POSITIONS
bull INHALE amp EXHALE THROUGH THE ACAPELLA
bull ROTATE THE FREQUENCY RESISTANCE DIAL UNTIL MAXIMUM VIBRATIONS ARE FELT WITHIN THE CHEST WALL
AEROBIKA bull COMBINES PEP WITH HIGH FREQUENCY OSCILLATIONS
bull CAN BE USED WITH A MANOMETER
bull NEBULISER CAN BE ENTRAINED INTO THE SYSTEM
bull POSSIBLE INCREASE IN TREATMENT COMPLIANCE BY DECREASING
TREATMENT TIMES
TECHNIQUE AS OSCILLATING PEP
BUBBLE PEP
Suction tubing (~1cm diameter) The end MUST sit at the bottom of the bottle
Plastic bottle Any widthshapediameter must be gt20cm tall 15cm fresh tapsterile water
(depth of water determines the amount of pressure ie cm H20
Washing up bowl
INDICATIONS
bull REDUCED LUNG VOLUME (FVClt50)
bull WEAK COUGH (PCFlt270)
bull SECRETIONS RETENTION
bull ATELECTASIS
bull REDUCED MECHANICAL COMPLIANCE
bull CHILD ABLE TO COMPLY
BENEFITS
bull INCREASE LUNG VOLUME = IMPROVES PCF
bull SECRETION CLEARANCE
bull MAY REVERSE ATELECTASIS
bull IMPROVE MECHANICAL COMPLIANCE = LUNG AND CHEST WALL MOBILITY
bull IMPROVE VOICE STRENGTH
LUNG VOLUME RECRUITMENT
bull LABEL NOT FOR RESUSCITATION
bull BEST IN SITTING
bull SUCTION READY
bull AGREE SIGNAL WITH CHILD WHEN MIC ACHIEVED
bull ASK TO BREATH OUT
bull PLACE MOUTHPIECE +- NOSE CLIP OR MASK
bull ASK TO BREATH IN AND HOLD WHILE GENTLY SQUEEZING BAG
bull WITHOUT LETTING AIR OUT ASK CHILD TO TAKE ANOTHER BREATH IN ON TOP OF THE FIRST BREATH AND SQUEEZE BAG IN TIME WITH BREATH
bull REPEAT UNTIL LUNGS ARE FULL (NORMALLY 3-5 BREATHS) OR SIGNAL
bull REMOVE MASK OR MOUTHPIECE ASK TO HOLD FOR 3-5 SECONDS
bull EXHALE OR IF SECRETIONS ARE PRESENT ENCOURAGE TO HAVE A COUGH OR MAC
bull REPEATED X3-5 X2-4 DAY
LVR TREATMENT
bull AIRWAY CLEARANCE OR THORACIC MOBILITY
bull AMBU RESUS BAG
bull GREEN ldquoPHYSIOrdquo BAG
bull MANUAL TECHNIQUES WITH BAGGING
bull MHI AT HOME
bull MANOMETERS
MHI
PHYSIO WITH NIV
bull PHYSIO SETTINGS
bull SECRETIONS
bull THORACIC MOBILITY
bull ALLOWS REST PERIOD PRE ACT
bull HUMIDIFICATION
bull INFLATABLE VEST CONNECTED BY TUBES TO AN AIR PULSE GENERATOR WHICH RAPIDLY INFLATES AND DEFLATES THE VEST PRODUCING OSCILLATIONS TO THE CHEST WALL
bull RAPID CHEST MOVEMENT MIMICS A COUGH-LIKE EXPIRATORY FLOW THAT SHEARS MUCUS AWAY FROM THE AIRWAY WALLS AND HELPS TO MOVE IT ALONG TO THE CENTRAL AIRWAYS
bull PASSIVE TREATMENT amp NOT POSITION DEPENDANT
bull COMBINATION OF RX
bull CONTRAINDICATIONS
bull HEAD ANDOR NECK INJURY THAT HAS NOT BEEN STABILISED
bull ACTIVE HAEMORRHAGE WITH HEMODYNAMIC INSTABILITY
HFCWO
HFCWO INDICATIONS
bull CHRONIC MUCUS HYPERSECRETION OR RETENTION ASSOCIATED WITH A CHRONIC PULMONARY OR NEUROMUSCULAR CONDITION
bull LRT SECRETIONS AND FREQUENT LRTI REQUIRING HOSPITAL ADMISSION
bull INEFFECTIVE COUGH OR INABILITY TO REMOVE MUCUS BY COUGHING
bull TENACIOUS SECRETIONS THAT ARE NOT EASILY MOBILISED WITH STANDARD CPT
bull MECHANICALLY VENTILATED WITH EVIDENCE OF SECRETION RETENTION
bull ALTERNATIVE AIRWAY CLEARANCE THERAPY PROVEN INEFFECTIVE OR CONTRAINDICATEDDO NOT TOLERATE STANDARD CPT
bull CONSTANT FATIGUE LACK OF STRENGTH OR ABILITY TO PERFORM ACTIVE TREATMENT
bull SYMPTOMATIC
bull POOR COMPLIANCE WITH OTHER AIRWAY CLEARANCE METHODS
bull HIGH BURDEN OF CARE
bull PATIENT UNABLE TO TOLERATE THE INCREASED WORK OF BREATHING bull ACTIVE HAEMOPTYSIS bull UNTREATED PNEUMOTHORAX bull INTRACRANIAL PRESSURE (ICP) gt 20 MMHG bull HAEMODYNAMIC INSTABILITY bull SEVERE CARDIOVASCULAR INSULTDISEASE bull RECENT FACIAL ORAL OR SKULL SURGERY OR TRAUMA bull ACUTE SINUSITIS bull EPISTAXIS bull POST OESOPHAGEAL amp LUNG SURGERY bull KNOWN OR SUSPECTED TYMPANIC MEMBRANE RUPTURE OR OTHER MIDDLE EAR
PATHOLOGY
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
POSSIBLE HAZARDSCOMPLICATIONS
bull INCREASED WORK OF BREATHING THAT MAY LEAD TO HYPOVENTILATION AND
HYPERCARBIA
bull INCREASED INTRACRANIAL PRESSURE
bull CARDIOVASCULAR COMPROMISE
bull NAUSEA
bull MYOCARDIAL ISCHEMIA
bull DECREASED VENOUS RETURN
bull AIR SWALLOWING WITH INCREASED LIKELIHOOD OF VOMITING AND
ASPIRATION
bull CLAUSTROPHOBIA
bull SKIN BREAK DOWN AND DISCOMFORT FROM MASK
bull PULMONARY BAROTRAUMA
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
MI-E
bull USED WITH CHILDREN WHO HAVE DECREASED INSPIRATORY EFFORT DUE TO EITHER SPINAL CORD INJURY OR NMW AND WHO HAVE AN IMPAIRED OR INEFFECTIVE COUGH WITH APPROPRIATE RESPIRATORY SYMPTOMS
bull CONSIDERED WHEN CONVENTIONAL COUGH ASSISTANCE TECHNIQUES BECOME INEFFECTIVE
bull ACCEPTED AS THE CORE STANDARD FOR CHILD WITH NMW
bull MIE WORKS BY
bull INFLATING THE LUNGS WITH GRADUAL POSITIVE AIRWAY PRESSURE ASSISTING INSPIRATION CALLED INSUFFLATION
bull FOLLOWED BY A RAPID SWITCH TO NEGATIVE PRESSURE WHICH SIMULATES THE FLOW CHANGES THAT OCCUR DURING A COUGH THEREBY ENHANCING EXPIRATORY FLOW CALLED EXSUFFLATION AND ASSISTING EXPECTORATION OF SECRETIONS
bull MOVEMENT AND EXERCISE BEST FUNCTIONAL METHOD OF AIRWAY CLEARANCE
bull CPET BETTER CORRELATION THAN LUNG FUNCTION IN SURVIVAL RATES IN PEOPLE WITH
CYSTIC FIBROSIS
bull RUNNINGWALKING BETTER FOR SECRETION CLEARANCE THAN BIKE DURING TO SHEARING
MECHANISM
bull CONSIDER ADDING IN HUFFS (DYER)
bull CONSIDER USE OF AD BELT
EXERCISE
bull APCP SUCTION GUIDELINES
bull TYPESNASOPHARANGEAL OROPHARANGEAL AND TRACHEOSTOMY
bull MAIN VARIABLES SUCTION TYPE AND SIZE DEPTH OF SUCTION
PRESSURE TECHNIQUE
SUCTION
SPUTUM
bull SPUTUM bull 95 WATER bull COLOUR bull VOLUME bull CONSISTENCY bull ODOUR
bull PURPOSE bull HUMIDIFICATION bull WATERPROOFING bull PROTECTION OF EPITHELIUM
HUMIDIFICATION
bull METABOLIC AND VENTILATORY REQUIREMENTS ARE X2-3 OF ADULTS
IMPLICATION
bull HEAT AND MOISTURE LOSSES FROM RESPIRATION WILL INCREASE BY X2-3
bull CONSUME GREATER AMOUNTS OF ENERGY AND WATER
HUMIDIFICATION INHALATION
THERAPY
bull TRACHEOSTOMY HME
bull WET DRY CIRCUIT
bull NEBULISERS INHALERS MUCOLYTICS
bull HUMIDIFIERS WITH NIV
bull OXYGEN
bull SYSTEMIC HYDRATION ENVIRONMENT
NEBULISERS
bull NEBULISER CHAMBER CONVERTS LIQUID INTO
RESPIRABLE PARTICLES
bull MOISTURE DESCENDS THROUGH THE HOLES IN THE SUPERFICIAL GEL LAYER
bull INCREASES THE SOL LAYER SO THE CILIARY BEAT IS OPTIMAL FOR MUCUS TRANSPORT
bull SHORT TERM HUMIDIFICATION
bull DAILY WASHING OF NEBULISER SYSTEM
TIMING OF DRUG AND PHYSIOTHERAPY
BEFORE TREATMENT
bull DNASE (PULMOZYME)
bull SALBUTAMOL
(VENTOLIN BLUE)
bull SALINE NEBS
AFTER TREATMENT
bull SERETIDE (PURPLE)
bull BECLOMETHASONE (BECOTIDE BROWN)
bull COLISTIN (COLOMYCIN PROMIXIN)
bull TOBRAMYCIN
CONCLUSION
bull BE AWARE OF CHILDrsquoS RESPIRATORY FUNCTION
bull CHOSE ACT BEST FOR THEM bull TYPE OF KETCHUP BOTTLE bull LV SECRETION RETENTION WOB
bull EARLY RESPIRATORY REFERRAL
bull RESPIRATORY CARE COMPETENCIES
bull EFFECTIVE SECRETION CLEARANCE AT HOMERESPITESCHOOL
bull USE OF PEAK COUGH FLOWS TO AID CHOICE OF ADJUNCT
0
50
100
150
200
250
300
350
400
0
50
100
150
200
250
300
350
400
Green
Key
Additional info
(please comment) Please refer to BTSACPRC Guideline
Lothian University Hospitals NHS Trust
n PCF
gt270lmin
Breathstack
ing tri-
flow
blowing
REFERENCES bull BTSACPRC GUIDELINE IS PUBLISHED IN THORAX VOL 67 SUPPLEMENT 1
bull AVAILABLE ONLINE AT HTTPTHORAXBMJCOMCONTENTVOL64ISSUESUPPLI
bull HTTPWWWBRIT-THORACICORGUKPHYSIOGUIDE
bull BRITISH THORACIC SOCIETY REPORTS VOL 1 NO 1 2009
bull ADAPTED PRYOR AJ AND PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS3RD ED
bull HOUGH A PHYSIOTHERAPY IN RESPIRATORY CARE LONDON CHAPMAN AND HALL 1993
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1997) POSTURAL DRAINAGE AND GASTRO-OESOPHAGEAL REFLUX IN INFANTS WITH CYSTIC FIBROSIS ARCHIVES OF DISEASE IN CHILDHOOD 76 148-150
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1998) POSTURAL DRAINAGE IN CYSTIC FIBROSIS IS THERE A LINK WITH GASTRO-OESOPHAGEAL REFLUX JOURNAL OF PAEDIATRIC CHILD HEALTH 34 330-334
bull CECINS NM JENKINS SC PENGELLEY J ET AL (1999) THE ACTIVE CYCLE OF BREATHING TECHNIQUES-TO TIP OR NOT TO TIP RESPIRATORY MEDICINE 93 660-665
bull CONSTANTINI D BRIVIO A BRUSA D ET AL (2001) PEP MASK VERSUS POSTURAL DRAINAGE IN INFANTS A LONG-TERM COMPARATIVE TRIAL PEADIATRIC PULMONOLOGY
bull HOUGH A (2001) PHYSIOTHERAPY IN RESPIRATORY CARE AN EVIDENCE-BASED APPROACH TO RESPIRATORY AND CARDIAC MANAGEMENT CENGAGE LEARNING EMEA
bull INTERNATIONAL PHYSIOTHERAPY GROUP FOR CYSTIC FIBROSIS PHYSIOTHERAPY IN THE TREATMENT OF CYSTIC FIBROSIS (2009) HTTPSWWWECFSEUIPG_CFBOOKLET INTERNATIONAL PHYSIOTHERAPY GROUP ndash THE BLUE BOOKLET
bull KONSTAN MW STERN RC DOERSHUK CF (1994) EFFICACY OF THE FLUTTER DEVICE FOR AIRWAY MUCUS CLEARANCE IN PATIENTS WITH CYSTIC FIBROSIS JOURNAL OF PEDIATRICS 124 (5 (PT 1) 689-693
bull MCILWAINE M BUTTON B AND DWAN K (2015) POSITIVE EXPIRATORY PRESSURE PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 6 ART NO CD003147 DOI 10100214651858CD003147PUB4
bull MESTRINER RG FERNANDES RO STAFFEN LC ET AL (2009) OPTIMUM DESIGN PARAMETERS FOR A THERAPIST-CONSTRUCTED POSITIVE-EXPIRATORY-PRESSURE THERAPY BOTTLE DEVICE RESPIRATORY CARE 54 504-8
bull MORRISON L AND AGNEW J (2014) OSCILLATING DEVICES FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 7 ART NO CD006842 DOI 10100214651858CD006842PUB
bull OERMANN CM SOCKRIDER MM GILES D ET AL (2001) COMPARISON OF HIGH-FREQUENCY CHEST WALL OSCILLATION AND OSCILLATING POSITIVE EXPIRATORY PRESSURE IN THE HOME MANAGEMENT OF CYSTIC FIBROSIS A PILOT STUDY PEDIATRIC PULMONOLOGY 32 (5) 372-7
bull PRASAD SA AND HUSSEY J (1995) PAEDIATRIC RESPIRATORY CARE A GUIDE FOR PHYSIOTHERAPISTS AND HEALTH PROFESSIONALS CHAPMAN amp HALL
bull PRYOR J (1999) PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN ADULTS EUROPEAN RESPIRATORY JOURNAL 14 (6) 1418-1424
bull PRYOR JA amp PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS CHURCHILL LIVINGSTONE
bull PRYOR JA WEBBER BA HODSON ME ET AL (1994) THE FLUTTER VRP1 AS AN ADJUNCT TO CHEST PHYSIOTHERAPY IN CYSTIC FIBROSIS RESPIRATORY MEDICINE 88677-81
bull WEST K WALLEN M FOLLETT J (2010) ACAPELLA VS PEP MASK THERAPY A RANDOMISED TRIAL IN CHILDREN WITH CYSTIC FIBROSIS DURING RESPIRATORY EXACERBATION PHYSIOTHERAPY THEORY PRACTICE 26143-9
bull WILSONLM AGNEW J MORRISON L ET AL (2014) AIRWAY CLEARANCE TECHNIQUES FOR CYSTIC FIBROSIS AN OVERVIEW OF COCHRANE SYSTEMATIC REVIEWS COCHRANE DATABASE OF SYSTEMATIC REVIEWS DOI 10100214651858CD011231
bull VOLSKO TA DIFIORE JM CHATBURN RL (2003) PERFORMANCE COMPARISON OF TWO OSCILLATORY POSITIVE PRESSURE DEVICES ACAPELLA VERSUS FLUTTER RESPIRATORY CARE 48 (2) 124- 130
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SEDDON PC KHAN Y RESPIRATORY PROBLEMS IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT ARCHIVES OF DISEASE IN CHILDHOOD 2003 01 JAN88(1)75-8
bull MARKS JH PULMONARY CARE OF CHILDREN AND ADOLESCENTS WITH DEVELOPMENTAL DISABILITIES PEDIATR CLIN NORTH AM 2008 DECEMBER55(6)1299-314
bull ARENS R MUZUMDAR H SLEEP SLEEP DISORDERED BREATHING AND NOCTURNAL HYPOVENTILATION IN CHILDREN WITH NEUROMUSCULAR DISEASES PAEDIATRIC RESPIRATORY REVIEWS 2010 MAR11(1)24-30
bull FITZGERALD DA FOLLETT J VAN ASPEREN PP ASSESSING AND MANAGING LUNG DISEASE AND SLEEP DISORDERED BREATHING IN CHILDREN WITH CEREBRAL PALSY PAEDIATRIC RESPIRATORY REVIEWS 2009 MARCH10(1)18-24
bull HSIAO KH NIXON GM THE EFFECT OF TREATMENT OF OBSTRUCTIVE SLEEP APNEA ON QUALITY OF LIFE IN CHILDREN WITH CEREBRAL PALSY RES DEV DISABIL 2008 MAR-APR29(2)133-40
bull LUNDBERG A OXYGEN CONSUMPTION IN RELATION TO WORKLOAD IN STUDENTS WITH CEREBRAL PALSY J APPL PHYSIO 197640873-5
bull SULLIVAN PB ROSENBLOOM L FEEDING THE DISABLED CHILD CLINICS IN DEVELOPMENTAL MEDICINE MACKEITH PRESS 1999140
bull MARTIN TR THE RELATIONSHIP BETWEEN MALNUTRITION AND LUNG INFECTIONS CLIN CHEST MED 19878359
bull MOSTAFA SM BHANDARI S RITCHIE G ET AL CONSTIPATION AND ITS IMPLICATIONS IN THE CRITICALLY ILL PATIENT BR J ANAESTH 200391815-9 3
bull GACOUIN A CAMUS C GROS A ET AL CONSTIPATION IN LONGTERM VENTILATED PATIENTS ASSOCIATED FACTORS AND IMPACT ON INTENSIVE CARE UNIT OUTCOMES CRIT CARE MED 2010381933- 8
bull NGUYEN T FRENETTE AJ JOHANSON C ET AL IMPAIRED GASTROINTESTINAL TRANSIT AND ITS ASSOCIATED MORBIDITY IN THE INTENSIVE CARE UNIT J CRIT CARE 201328537
bull ASAI T CONSTIPATION DOES IT INCREASE MORBIDITY AND MORTALITY IN CRITICALLY ILL PATIENTS CRIT CARE MED 2007352861-2
bull UNDERSTANDING THE PHYSIOLOGICAL EFFECTS OF UNTREATED PAIN NURSING TIMES VOL 99 ISSUE 37 PAGE NO 28
bull WINFIELD ET AL NON-PHARMACEUTICAL MANAGEMENT OF RESPIRATORY MORBIDITY IN CHILDREN WITH SEVERE GLOBAL DEVELOPMENTAL DELAY THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014
bull OLOUGHLIN EV SOMERVILLE HM SOMERVILLE ER DEALING WITH MULTISYSTEM DISEASE IN PEOPLE WITH A DEVELOPMENTAL DISABILITY MEDICAL JOURNAL OF AUSTRALIA 2009 JUN 1190(11)616-7
bull MESTROVIC J KARDUM G POLIC B MESTROVIC M MARKIC J SUSTIC A ET AL THE INFLUENCE OF CHRONIC HEALTH CONDITIONS ON SUSCEPTIBILITY TO SEVERE ACUTE ILLNESS OF CHILDREN TREATED IN PICU EUROPEAN JOURNAL OF PEDIATRICS 2006 AUG165(8)526-
9
bull HEALY F PANITCH HB PULMONARY COMPLICATIONS OF PEDIATRIC NEUROLOGICAL DISEASES PEDIATR ANN 2010 APR39(4)216-24
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SRIVASTAVA R JACKSON WD BARNHART DC DYSPHAGIA AND GASTROESOPHAGEAL REFLUX DISEASE DILEMMAS IN DIAGNOSIS AND MANAGEMENT IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT PEDIATR ANN 2010 APR39(4)225-31
bull SULLIVAN PB JUSZCZAK E BACHLET AME LAMBERT B VERNON-ROBERTS A GRANT HW ET AL GASTROSTOMY TUBE FEEDING IN CHILDREN WITH CEREBRAL PALSY A PROSPECTIVE LONGITUDINAL STUDY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 2005
FEBRUARY47(2)77-85
bull SOMERVILLE H TZANNES G WOOD J SHUN A HILL C ARROWSMITH F ET AL GASTROINTESTINAL AND NUTRITIONAL PROBLEMS IN SEVERE DEVELOPMENTAL DISABILITY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 200850(9)712-6
bull TODER DS RESPIRATORY PROBLEMS IN THE ADOLESCENT WITH DEVELOPMENTAL DELAY ADOLESCENT MEDICINE 2000 3 OCTOBER 200011(3)617-31
bull LEVIN K COLON A DIPALMA J FITZPATRICK S USING THE RADIONUCLIDE SALIVAGRAM TO DETECT PULMONARY ASPIRATION AND ESOPHAGEAL DYSMOTILITY CLIN NUCL MED 1993 FEB18(2)110-4
bull SCHROEDER AS KLING T HUSS K BORGGRAEFE I KOERTE IK BLASCHEK A ET AL BOTULINUM TOXIN TYPE A AND B FOR THE REDUCTION OF HYPERSALIVATION IN CHILDREN WITH NEUROLOGICAL DISORDERS A FOCUS ON EFFECTIVENESS AND THERAPY ADHERENCE
NEUROPEDIATRICS 201243(1)27-36
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull GOEMINNE P AND DUPONT L (2010) NON-CYSTIC FIBROSIS BRONCHIECTASIS DIAGNOSIS AND MANAGEMENT IN 21ST CENTURY POSTGRADUATE MEDICAL JOURNAL 86(1018) PP493-501
bull LEE A BUTTON B AND TANNENBAUM E (2017) AIRWAY-CLEARANCE TECHNIQUES IN CHILDREN AND ADOLESCENTS WITH CHRONIC SUPPURATIVE LUNG DISEASE AND BRONCHIECTASIS FRONTIERS IN PEDIATRICS 5
bull MANDAL P SIDHU M KOPE L POLLOCK W STEVENSON L PENTLAND J TURNBULL K MAC QUARRIE S AND HILL A (2012) A PILOT STUDY OF PULMONARY REHABILITATION AND CHEST PHYSIOTHERAPY VERSUS CHEST PHYSIOTHERAPY ALONE IN
BRONCHIECTASIS RESPIRATORY MEDICINE 106(12) PP1647-1654
bull MURRAY M PENTLAND J AND HILL A (2009) A RANDOMISED CROSSOVER TRIAL OF CHEST PHYSIOTHERAPY IN NON-CYSTIC FIBROSIS BRONCHIECTASIS EUROPEAN RESPIRATORY JOURNAL 34(5) PP1086-1092
bull NEWALL C STOCKLEY R AND HILL S (2005) EXERCISE TRAINING AND INSPIRATORY MUSCLE TRAINING IN PATIENTS WITH BRONCHIECTASIS THORAX 60(11) PP943-948
bull ONG H LEE A HILL C HOLLAND A AND DENEHY L (2011) EFFECTS OF PULMONARY REHABILITATION IN BRONCHIECTASIS A RETROSPECTIVE STUDY CHRONIC RESPIRATORY DISEASE 8(1) PP21-30
bull QUINT J MILLETT E JOSHI M NAVARATNAM V THOMAS S HURST J SMEETH L AND BROWN J (2015) CHANGES IN THE INCIDENCE PREVALENCE AND MORTALITY OF BRONCHIECTASIS IN THE UK FROM 2004 TO 2013 A POPULATION-BASED COHORT
STUDY EUROPEAN RESPIRATORY JOURNAL 47(1) PP186-193
bull SNIJDERS D FERNANDEZ DOMINGUEZ B CALGARO S BERTOZZI I ESCRIBANO MONTANER A PERILONGO G AND BARBATO A (2015) MUCOCILIARY CLEARANCE TECHNIQUES FOR TREATING NON-CYSTIC FIBROSIS BRONCHIECTASIS IS THERE
EVIDENCE INTERNATIONAL JOURNAL OF IMMUNOPATHOLOGY AND PHARMACOLOGY 28(2) PP150-159
AIM OF ACT
bull COMPENSATE FOR IMPAIRED MUCOCILIARY CLEARANCE
bull COMPENSATE FOR INABILITY TO CREATE EXPIRATORY FLOW AND INSP EFFORT
bull IMPROVE VENTILATION BY PREVENTING OBSTRUCTION OF SMALL AIRWAYS
bull SLOW DOWN LUNG DISEASE
POOR AIRWAY CLEARANCE
INCREASED AIRWAY RESISTANCE
INCREASED WOB
HYPOXAEMIA
REPEATED INFECTIONS
LOSS OF RESPIRATORY RESERVE
AIRWAY DAMAGE
RESPIRATORY FAILURE
AIRWAY CLEARANCE TECHNIQUES
bull CHEST PHYSIO
bull DECREASED LUNG VOLUME
bull SECRETION RETENTION
bull INCREASED WOB
bull KETCHUP BOTTLE
bull GLASS
bull PLASTIC
bull SACHET
bull HUMIDIFICATION INHALATION THERAPY
bull MANUAL TECHNIQUES
bull BREATHING TECHNIQUES
bull MAXIMAL INSPIRATORY CAPACITY
bull PHYSIO WITH NIV
bull PEP
bull OSCILLATORY TECHNIQUES
bull HFCWO
bull MIE
bull SUCTION
ACT TECHNIQUES
MANUAL TECHNIQUES
bull PERCUSSION
bull VIBRATIONSHAKING
bull MANUAL ASSISTED COUGH
bull TRACHEAL PRESSURE
bull OVERPRESSURE
bull MANUALASSISTED AD
ACTIVE CYCLE OF BREATHING
Breathing control
3-5 Deep Breaths or TEE
with 3 sec inspiratory
hold
Breathing control
3-5 Deep Breaths or TEE
with 3 sec inspiratory
hold
Breathing control
2-3 FET huffs amp coughs
Clear mucus
Active Cycle
of Breathing
Technique
(ACBT)
AUTOGENIC DRAINAGE
bull JEAN CHEVALLIER 1967 IN BELGIUM
bull OBSERVED CHILDREN SLEEPING
bull LOW LV VrsquoS HIGH LVrsquoS
bull 3 PHASES OF BREATHING
bull LOW
bull MID
bull HIGH
bull MOVING FROM RESIDUAL VOLUME TO TOTAL LUNG CAPACITY
bull AIM TO GENERATE INCREASED EXPIRATORY AIRFLOW PROGRESSIVELY THROUGH EACH GENERATION OF BRONCHI
bull SECRETIONS LOOSEN AND MOVE INTO LARGER AIRWAYS TO AID EXPECTORATION
AD CONTrsquoD
bull METHOD bull DIAGNOSTIC BREATH WHERE ABLE
bull LOW FLOW ON INSPIRATION IE QUIET BREATH IN
bull FASTER EXPIRATORY FLOW
bull SPEED OF EXPIRATORY FLOW bull TRANSPORTS SECRETIONS
bull SHEARS SECRETIONS FROM BRONCHIAL WALL
bull COMBINE WITH TREATMENTS
bull BENEFICIAL IN PATIENTS WITH SIGNIFICANT HYPER-REACTIVITY amp
HAEMOPTYSIS
AD IN NMD
bull PASSIVE AD
bull THERAPIST CONTROLS DEPTH OF LUNG VOLUMES
bull SAME PRINCIPALS
bull OFTEN USED IN CONJUNCTION WITH PEP TO PREVENT SMALL AIRWAY COLLAPSE
bull DEMONSTRATION TO FOLLOW
bull EXHALATION AGAINST A CONSTANT POSITIVE PRESSURE
bull AIDS REMOVAL OF BRONCHIAL SECRETIONS
bull PREVENTING AIRWAY COLLAPSE BY STENTING THE AIRWAYS
bull RECRUITMENT OF PREVIOUSLY OBSTRUCTED AIRWAYS
bull IMPROVE VENTILATION REDUCE ATELECTASIS
bull INCREASING INTRATHORACIC PRESSURE DISTAL TO RETAINED SECRETIONS BY COLLATERAL VENTILATION OR BY INCREASING FRC
bull MAINTAIN PULMONARY FUNCTION
POSITIVE EXPIRATORY PRESSURE (PEP)
bull MASK VALVE RESISTOR amp MANOMETER
bull O2CAN BE CONNECTED TO THE INHALATION SIDE IF REQUIRED
bull SIT IN GOOD POSITION WITH GOOD SEAL AROUND MOUTHPIECEMASK
bull SLOW INHALATION JUST A LITTLE LARGER THAN A NORMAL BREATH IN
(HOLD FOR 3 SECS IF USING MOUTHPIECE)
bull STEADY ACTIVE amp FULL EXHALATION
bull AIM FOR 10-20 CM H2O FOR 3-5 SECS
bull REPEAT 12-15 TIMES FOLLOWED BY FET amp COUGH
bull COMPLETE FOR 15-30 MINS (6-8 CYCLES OR SETS OF ABOVE)
PEP TREATMENT
bull BEFORE OR AT LEAST 1 HR AFTER A FEED
bull START WITH THE SMALLEST HOLERESISTOR THAT BABY CAN TOLERATE
bull USE A MANOMETER
bull HOLD THE BABY IN ARMS OR ON PARENTS LAP SIT ON GYM BALL
bull PLACE THE MASK OVER THE BABYrsquoS MOUTH amp NOSE
bull AIM FOR FEW BREATHS 30-60 SECONDS WHICH CAN BE BUILT UP TO 1-2 MINUTES AS TOLERATED
bull AIM TO REACH PRESSURES BETWEEN 5-15 CM H2O
bull REST FOR 30-60 SECONDS THEN REPEAT FOR ABOUT 5-10 MINUTES
bull COMBINE THIS WITH OTHER TREATMENTS
BABY PEP TREATMENT
OSCILLATING PEP
OSCILLATING PEP
bull DEVICES CAN BE INTRA-THORACIC OR EXTRA-THORACIC
bull INTRA-THORACIC DEVICES ARE PLACED IN THE MOUTH AND PROVIDE RESISTANCE DURING EXHALATION
bull ALTERS EXPIRATORY AIRFLOW
bull VIBRATIONS ON THE AIRWAY SURFACE
bull REDUCES MUCOUS VISCOSITY
bull ACCELERATION OF THE EXPIRATORY FLOW
bull PREVENTS AND TREATS AIRWAY COMPRESSION ATELECTASIS
bull IMPROVES AIRWAY PATENCY amp VENTILATION
bull DECREASES HYPERINFLATION
bull IMPROVES LUNG FUNCTION PARAMETERS
bull INCLUDES EXERCISE
OSCILLATING PEP TREATMENT
bull SIMILAR TO PEP
bull GOOD POSITION
bull PLACE MOUTHPIECE BETWEEN LIPS AND TEETH OR USE MASK
bull SLOW INHALE JUST A LITTLE LARGER THAN A NORMAL BREATH IN
bull HOLD FOR 3 SECONDS
bull STEADY ACTIVE amp FULL EXHALATION
bull ADJUST THE RESISTANCE AS REQUIRED
bull REPEAT 12-15 TIMES FOLLOWED BY FET amp COUGH
bull COMPLETE FOR 5-10 MINS
bull COMBINE WITH OTHER TREATMENTS
ACAPELLA
bull DETACHABLE MOUTHPIECEFACEMASK
bull ONE-WAY INSPIRATORY VALVE
bull EXPIRATORY RESISTANCEFREQUENCY ADJUSTMENT DIAL
bull COUNTERWEIGHTED PLUG amp MAGNET
bull MAINTAINS A RAISED FRC LEVEL
TREATMENT
bull EASY TO USE IN DIFFERENT POSITIONS
bull INHALE amp EXHALE THROUGH THE ACAPELLA
bull ROTATE THE FREQUENCY RESISTANCE DIAL UNTIL MAXIMUM VIBRATIONS ARE FELT WITHIN THE CHEST WALL
AEROBIKA bull COMBINES PEP WITH HIGH FREQUENCY OSCILLATIONS
bull CAN BE USED WITH A MANOMETER
bull NEBULISER CAN BE ENTRAINED INTO THE SYSTEM
bull POSSIBLE INCREASE IN TREATMENT COMPLIANCE BY DECREASING
TREATMENT TIMES
TECHNIQUE AS OSCILLATING PEP
BUBBLE PEP
Suction tubing (~1cm diameter) The end MUST sit at the bottom of the bottle
Plastic bottle Any widthshapediameter must be gt20cm tall 15cm fresh tapsterile water
(depth of water determines the amount of pressure ie cm H20
Washing up bowl
INDICATIONS
bull REDUCED LUNG VOLUME (FVClt50)
bull WEAK COUGH (PCFlt270)
bull SECRETIONS RETENTION
bull ATELECTASIS
bull REDUCED MECHANICAL COMPLIANCE
bull CHILD ABLE TO COMPLY
BENEFITS
bull INCREASE LUNG VOLUME = IMPROVES PCF
bull SECRETION CLEARANCE
bull MAY REVERSE ATELECTASIS
bull IMPROVE MECHANICAL COMPLIANCE = LUNG AND CHEST WALL MOBILITY
bull IMPROVE VOICE STRENGTH
LUNG VOLUME RECRUITMENT
bull LABEL NOT FOR RESUSCITATION
bull BEST IN SITTING
bull SUCTION READY
bull AGREE SIGNAL WITH CHILD WHEN MIC ACHIEVED
bull ASK TO BREATH OUT
bull PLACE MOUTHPIECE +- NOSE CLIP OR MASK
bull ASK TO BREATH IN AND HOLD WHILE GENTLY SQUEEZING BAG
bull WITHOUT LETTING AIR OUT ASK CHILD TO TAKE ANOTHER BREATH IN ON TOP OF THE FIRST BREATH AND SQUEEZE BAG IN TIME WITH BREATH
bull REPEAT UNTIL LUNGS ARE FULL (NORMALLY 3-5 BREATHS) OR SIGNAL
bull REMOVE MASK OR MOUTHPIECE ASK TO HOLD FOR 3-5 SECONDS
bull EXHALE OR IF SECRETIONS ARE PRESENT ENCOURAGE TO HAVE A COUGH OR MAC
bull REPEATED X3-5 X2-4 DAY
LVR TREATMENT
bull AIRWAY CLEARANCE OR THORACIC MOBILITY
bull AMBU RESUS BAG
bull GREEN ldquoPHYSIOrdquo BAG
bull MANUAL TECHNIQUES WITH BAGGING
bull MHI AT HOME
bull MANOMETERS
MHI
PHYSIO WITH NIV
bull PHYSIO SETTINGS
bull SECRETIONS
bull THORACIC MOBILITY
bull ALLOWS REST PERIOD PRE ACT
bull HUMIDIFICATION
bull INFLATABLE VEST CONNECTED BY TUBES TO AN AIR PULSE GENERATOR WHICH RAPIDLY INFLATES AND DEFLATES THE VEST PRODUCING OSCILLATIONS TO THE CHEST WALL
bull RAPID CHEST MOVEMENT MIMICS A COUGH-LIKE EXPIRATORY FLOW THAT SHEARS MUCUS AWAY FROM THE AIRWAY WALLS AND HELPS TO MOVE IT ALONG TO THE CENTRAL AIRWAYS
bull PASSIVE TREATMENT amp NOT POSITION DEPENDANT
bull COMBINATION OF RX
bull CONTRAINDICATIONS
bull HEAD ANDOR NECK INJURY THAT HAS NOT BEEN STABILISED
bull ACTIVE HAEMORRHAGE WITH HEMODYNAMIC INSTABILITY
HFCWO
HFCWO INDICATIONS
bull CHRONIC MUCUS HYPERSECRETION OR RETENTION ASSOCIATED WITH A CHRONIC PULMONARY OR NEUROMUSCULAR CONDITION
bull LRT SECRETIONS AND FREQUENT LRTI REQUIRING HOSPITAL ADMISSION
bull INEFFECTIVE COUGH OR INABILITY TO REMOVE MUCUS BY COUGHING
bull TENACIOUS SECRETIONS THAT ARE NOT EASILY MOBILISED WITH STANDARD CPT
bull MECHANICALLY VENTILATED WITH EVIDENCE OF SECRETION RETENTION
bull ALTERNATIVE AIRWAY CLEARANCE THERAPY PROVEN INEFFECTIVE OR CONTRAINDICATEDDO NOT TOLERATE STANDARD CPT
bull CONSTANT FATIGUE LACK OF STRENGTH OR ABILITY TO PERFORM ACTIVE TREATMENT
bull SYMPTOMATIC
bull POOR COMPLIANCE WITH OTHER AIRWAY CLEARANCE METHODS
bull HIGH BURDEN OF CARE
bull PATIENT UNABLE TO TOLERATE THE INCREASED WORK OF BREATHING bull ACTIVE HAEMOPTYSIS bull UNTREATED PNEUMOTHORAX bull INTRACRANIAL PRESSURE (ICP) gt 20 MMHG bull HAEMODYNAMIC INSTABILITY bull SEVERE CARDIOVASCULAR INSULTDISEASE bull RECENT FACIAL ORAL OR SKULL SURGERY OR TRAUMA bull ACUTE SINUSITIS bull EPISTAXIS bull POST OESOPHAGEAL amp LUNG SURGERY bull KNOWN OR SUSPECTED TYMPANIC MEMBRANE RUPTURE OR OTHER MIDDLE EAR
PATHOLOGY
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
POSSIBLE HAZARDSCOMPLICATIONS
bull INCREASED WORK OF BREATHING THAT MAY LEAD TO HYPOVENTILATION AND
HYPERCARBIA
bull INCREASED INTRACRANIAL PRESSURE
bull CARDIOVASCULAR COMPROMISE
bull NAUSEA
bull MYOCARDIAL ISCHEMIA
bull DECREASED VENOUS RETURN
bull AIR SWALLOWING WITH INCREASED LIKELIHOOD OF VOMITING AND
ASPIRATION
bull CLAUSTROPHOBIA
bull SKIN BREAK DOWN AND DISCOMFORT FROM MASK
bull PULMONARY BAROTRAUMA
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
MI-E
bull USED WITH CHILDREN WHO HAVE DECREASED INSPIRATORY EFFORT DUE TO EITHER SPINAL CORD INJURY OR NMW AND WHO HAVE AN IMPAIRED OR INEFFECTIVE COUGH WITH APPROPRIATE RESPIRATORY SYMPTOMS
bull CONSIDERED WHEN CONVENTIONAL COUGH ASSISTANCE TECHNIQUES BECOME INEFFECTIVE
bull ACCEPTED AS THE CORE STANDARD FOR CHILD WITH NMW
bull MIE WORKS BY
bull INFLATING THE LUNGS WITH GRADUAL POSITIVE AIRWAY PRESSURE ASSISTING INSPIRATION CALLED INSUFFLATION
bull FOLLOWED BY A RAPID SWITCH TO NEGATIVE PRESSURE WHICH SIMULATES THE FLOW CHANGES THAT OCCUR DURING A COUGH THEREBY ENHANCING EXPIRATORY FLOW CALLED EXSUFFLATION AND ASSISTING EXPECTORATION OF SECRETIONS
bull MOVEMENT AND EXERCISE BEST FUNCTIONAL METHOD OF AIRWAY CLEARANCE
bull CPET BETTER CORRELATION THAN LUNG FUNCTION IN SURVIVAL RATES IN PEOPLE WITH
CYSTIC FIBROSIS
bull RUNNINGWALKING BETTER FOR SECRETION CLEARANCE THAN BIKE DURING TO SHEARING
MECHANISM
bull CONSIDER ADDING IN HUFFS (DYER)
bull CONSIDER USE OF AD BELT
EXERCISE
bull APCP SUCTION GUIDELINES
bull TYPESNASOPHARANGEAL OROPHARANGEAL AND TRACHEOSTOMY
bull MAIN VARIABLES SUCTION TYPE AND SIZE DEPTH OF SUCTION
PRESSURE TECHNIQUE
SUCTION
SPUTUM
bull SPUTUM bull 95 WATER bull COLOUR bull VOLUME bull CONSISTENCY bull ODOUR
bull PURPOSE bull HUMIDIFICATION bull WATERPROOFING bull PROTECTION OF EPITHELIUM
HUMIDIFICATION
bull METABOLIC AND VENTILATORY REQUIREMENTS ARE X2-3 OF ADULTS
IMPLICATION
bull HEAT AND MOISTURE LOSSES FROM RESPIRATION WILL INCREASE BY X2-3
bull CONSUME GREATER AMOUNTS OF ENERGY AND WATER
HUMIDIFICATION INHALATION
THERAPY
bull TRACHEOSTOMY HME
bull WET DRY CIRCUIT
bull NEBULISERS INHALERS MUCOLYTICS
bull HUMIDIFIERS WITH NIV
bull OXYGEN
bull SYSTEMIC HYDRATION ENVIRONMENT
NEBULISERS
bull NEBULISER CHAMBER CONVERTS LIQUID INTO
RESPIRABLE PARTICLES
bull MOISTURE DESCENDS THROUGH THE HOLES IN THE SUPERFICIAL GEL LAYER
bull INCREASES THE SOL LAYER SO THE CILIARY BEAT IS OPTIMAL FOR MUCUS TRANSPORT
bull SHORT TERM HUMIDIFICATION
bull DAILY WASHING OF NEBULISER SYSTEM
TIMING OF DRUG AND PHYSIOTHERAPY
BEFORE TREATMENT
bull DNASE (PULMOZYME)
bull SALBUTAMOL
(VENTOLIN BLUE)
bull SALINE NEBS
AFTER TREATMENT
bull SERETIDE (PURPLE)
bull BECLOMETHASONE (BECOTIDE BROWN)
bull COLISTIN (COLOMYCIN PROMIXIN)
bull TOBRAMYCIN
CONCLUSION
bull BE AWARE OF CHILDrsquoS RESPIRATORY FUNCTION
bull CHOSE ACT BEST FOR THEM bull TYPE OF KETCHUP BOTTLE bull LV SECRETION RETENTION WOB
bull EARLY RESPIRATORY REFERRAL
bull RESPIRATORY CARE COMPETENCIES
bull EFFECTIVE SECRETION CLEARANCE AT HOMERESPITESCHOOL
bull USE OF PEAK COUGH FLOWS TO AID CHOICE OF ADJUNCT
0
50
100
150
200
250
300
350
400
0
50
100
150
200
250
300
350
400
Green
Key
Additional info
(please comment) Please refer to BTSACPRC Guideline
Lothian University Hospitals NHS Trust
n PCF
gt270lmin
Breathstack
ing tri-
flow
blowing
REFERENCES bull BTSACPRC GUIDELINE IS PUBLISHED IN THORAX VOL 67 SUPPLEMENT 1
bull AVAILABLE ONLINE AT HTTPTHORAXBMJCOMCONTENTVOL64ISSUESUPPLI
bull HTTPWWWBRIT-THORACICORGUKPHYSIOGUIDE
bull BRITISH THORACIC SOCIETY REPORTS VOL 1 NO 1 2009
bull ADAPTED PRYOR AJ AND PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS3RD ED
bull HOUGH A PHYSIOTHERAPY IN RESPIRATORY CARE LONDON CHAPMAN AND HALL 1993
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1997) POSTURAL DRAINAGE AND GASTRO-OESOPHAGEAL REFLUX IN INFANTS WITH CYSTIC FIBROSIS ARCHIVES OF DISEASE IN CHILDHOOD 76 148-150
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1998) POSTURAL DRAINAGE IN CYSTIC FIBROSIS IS THERE A LINK WITH GASTRO-OESOPHAGEAL REFLUX JOURNAL OF PAEDIATRIC CHILD HEALTH 34 330-334
bull CECINS NM JENKINS SC PENGELLEY J ET AL (1999) THE ACTIVE CYCLE OF BREATHING TECHNIQUES-TO TIP OR NOT TO TIP RESPIRATORY MEDICINE 93 660-665
bull CONSTANTINI D BRIVIO A BRUSA D ET AL (2001) PEP MASK VERSUS POSTURAL DRAINAGE IN INFANTS A LONG-TERM COMPARATIVE TRIAL PEADIATRIC PULMONOLOGY
bull HOUGH A (2001) PHYSIOTHERAPY IN RESPIRATORY CARE AN EVIDENCE-BASED APPROACH TO RESPIRATORY AND CARDIAC MANAGEMENT CENGAGE LEARNING EMEA
bull INTERNATIONAL PHYSIOTHERAPY GROUP FOR CYSTIC FIBROSIS PHYSIOTHERAPY IN THE TREATMENT OF CYSTIC FIBROSIS (2009) HTTPSWWWECFSEUIPG_CFBOOKLET INTERNATIONAL PHYSIOTHERAPY GROUP ndash THE BLUE BOOKLET
bull KONSTAN MW STERN RC DOERSHUK CF (1994) EFFICACY OF THE FLUTTER DEVICE FOR AIRWAY MUCUS CLEARANCE IN PATIENTS WITH CYSTIC FIBROSIS JOURNAL OF PEDIATRICS 124 (5 (PT 1) 689-693
bull MCILWAINE M BUTTON B AND DWAN K (2015) POSITIVE EXPIRATORY PRESSURE PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 6 ART NO CD003147 DOI 10100214651858CD003147PUB4
bull MESTRINER RG FERNANDES RO STAFFEN LC ET AL (2009) OPTIMUM DESIGN PARAMETERS FOR A THERAPIST-CONSTRUCTED POSITIVE-EXPIRATORY-PRESSURE THERAPY BOTTLE DEVICE RESPIRATORY CARE 54 504-8
bull MORRISON L AND AGNEW J (2014) OSCILLATING DEVICES FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 7 ART NO CD006842 DOI 10100214651858CD006842PUB
bull OERMANN CM SOCKRIDER MM GILES D ET AL (2001) COMPARISON OF HIGH-FREQUENCY CHEST WALL OSCILLATION AND OSCILLATING POSITIVE EXPIRATORY PRESSURE IN THE HOME MANAGEMENT OF CYSTIC FIBROSIS A PILOT STUDY PEDIATRIC PULMONOLOGY 32 (5) 372-7
bull PRASAD SA AND HUSSEY J (1995) PAEDIATRIC RESPIRATORY CARE A GUIDE FOR PHYSIOTHERAPISTS AND HEALTH PROFESSIONALS CHAPMAN amp HALL
bull PRYOR J (1999) PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN ADULTS EUROPEAN RESPIRATORY JOURNAL 14 (6) 1418-1424
bull PRYOR JA amp PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS CHURCHILL LIVINGSTONE
bull PRYOR JA WEBBER BA HODSON ME ET AL (1994) THE FLUTTER VRP1 AS AN ADJUNCT TO CHEST PHYSIOTHERAPY IN CYSTIC FIBROSIS RESPIRATORY MEDICINE 88677-81
bull WEST K WALLEN M FOLLETT J (2010) ACAPELLA VS PEP MASK THERAPY A RANDOMISED TRIAL IN CHILDREN WITH CYSTIC FIBROSIS DURING RESPIRATORY EXACERBATION PHYSIOTHERAPY THEORY PRACTICE 26143-9
bull WILSONLM AGNEW J MORRISON L ET AL (2014) AIRWAY CLEARANCE TECHNIQUES FOR CYSTIC FIBROSIS AN OVERVIEW OF COCHRANE SYSTEMATIC REVIEWS COCHRANE DATABASE OF SYSTEMATIC REVIEWS DOI 10100214651858CD011231
bull VOLSKO TA DIFIORE JM CHATBURN RL (2003) PERFORMANCE COMPARISON OF TWO OSCILLATORY POSITIVE PRESSURE DEVICES ACAPELLA VERSUS FLUTTER RESPIRATORY CARE 48 (2) 124- 130
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SEDDON PC KHAN Y RESPIRATORY PROBLEMS IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT ARCHIVES OF DISEASE IN CHILDHOOD 2003 01 JAN88(1)75-8
bull MARKS JH PULMONARY CARE OF CHILDREN AND ADOLESCENTS WITH DEVELOPMENTAL DISABILITIES PEDIATR CLIN NORTH AM 2008 DECEMBER55(6)1299-314
bull ARENS R MUZUMDAR H SLEEP SLEEP DISORDERED BREATHING AND NOCTURNAL HYPOVENTILATION IN CHILDREN WITH NEUROMUSCULAR DISEASES PAEDIATRIC RESPIRATORY REVIEWS 2010 MAR11(1)24-30
bull FITZGERALD DA FOLLETT J VAN ASPEREN PP ASSESSING AND MANAGING LUNG DISEASE AND SLEEP DISORDERED BREATHING IN CHILDREN WITH CEREBRAL PALSY PAEDIATRIC RESPIRATORY REVIEWS 2009 MARCH10(1)18-24
bull HSIAO KH NIXON GM THE EFFECT OF TREATMENT OF OBSTRUCTIVE SLEEP APNEA ON QUALITY OF LIFE IN CHILDREN WITH CEREBRAL PALSY RES DEV DISABIL 2008 MAR-APR29(2)133-40
bull LUNDBERG A OXYGEN CONSUMPTION IN RELATION TO WORKLOAD IN STUDENTS WITH CEREBRAL PALSY J APPL PHYSIO 197640873-5
bull SULLIVAN PB ROSENBLOOM L FEEDING THE DISABLED CHILD CLINICS IN DEVELOPMENTAL MEDICINE MACKEITH PRESS 1999140
bull MARTIN TR THE RELATIONSHIP BETWEEN MALNUTRITION AND LUNG INFECTIONS CLIN CHEST MED 19878359
bull MOSTAFA SM BHANDARI S RITCHIE G ET AL CONSTIPATION AND ITS IMPLICATIONS IN THE CRITICALLY ILL PATIENT BR J ANAESTH 200391815-9 3
bull GACOUIN A CAMUS C GROS A ET AL CONSTIPATION IN LONGTERM VENTILATED PATIENTS ASSOCIATED FACTORS AND IMPACT ON INTENSIVE CARE UNIT OUTCOMES CRIT CARE MED 2010381933- 8
bull NGUYEN T FRENETTE AJ JOHANSON C ET AL IMPAIRED GASTROINTESTINAL TRANSIT AND ITS ASSOCIATED MORBIDITY IN THE INTENSIVE CARE UNIT J CRIT CARE 201328537
bull ASAI T CONSTIPATION DOES IT INCREASE MORBIDITY AND MORTALITY IN CRITICALLY ILL PATIENTS CRIT CARE MED 2007352861-2
bull UNDERSTANDING THE PHYSIOLOGICAL EFFECTS OF UNTREATED PAIN NURSING TIMES VOL 99 ISSUE 37 PAGE NO 28
bull WINFIELD ET AL NON-PHARMACEUTICAL MANAGEMENT OF RESPIRATORY MORBIDITY IN CHILDREN WITH SEVERE GLOBAL DEVELOPMENTAL DELAY THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014
bull OLOUGHLIN EV SOMERVILLE HM SOMERVILLE ER DEALING WITH MULTISYSTEM DISEASE IN PEOPLE WITH A DEVELOPMENTAL DISABILITY MEDICAL JOURNAL OF AUSTRALIA 2009 JUN 1190(11)616-7
bull MESTROVIC J KARDUM G POLIC B MESTROVIC M MARKIC J SUSTIC A ET AL THE INFLUENCE OF CHRONIC HEALTH CONDITIONS ON SUSCEPTIBILITY TO SEVERE ACUTE ILLNESS OF CHILDREN TREATED IN PICU EUROPEAN JOURNAL OF PEDIATRICS 2006 AUG165(8)526-
9
bull HEALY F PANITCH HB PULMONARY COMPLICATIONS OF PEDIATRIC NEUROLOGICAL DISEASES PEDIATR ANN 2010 APR39(4)216-24
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SRIVASTAVA R JACKSON WD BARNHART DC DYSPHAGIA AND GASTROESOPHAGEAL REFLUX DISEASE DILEMMAS IN DIAGNOSIS AND MANAGEMENT IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT PEDIATR ANN 2010 APR39(4)225-31
bull SULLIVAN PB JUSZCZAK E BACHLET AME LAMBERT B VERNON-ROBERTS A GRANT HW ET AL GASTROSTOMY TUBE FEEDING IN CHILDREN WITH CEREBRAL PALSY A PROSPECTIVE LONGITUDINAL STUDY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 2005
FEBRUARY47(2)77-85
bull SOMERVILLE H TZANNES G WOOD J SHUN A HILL C ARROWSMITH F ET AL GASTROINTESTINAL AND NUTRITIONAL PROBLEMS IN SEVERE DEVELOPMENTAL DISABILITY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 200850(9)712-6
bull TODER DS RESPIRATORY PROBLEMS IN THE ADOLESCENT WITH DEVELOPMENTAL DELAY ADOLESCENT MEDICINE 2000 3 OCTOBER 200011(3)617-31
bull LEVIN K COLON A DIPALMA J FITZPATRICK S USING THE RADIONUCLIDE SALIVAGRAM TO DETECT PULMONARY ASPIRATION AND ESOPHAGEAL DYSMOTILITY CLIN NUCL MED 1993 FEB18(2)110-4
bull SCHROEDER AS KLING T HUSS K BORGGRAEFE I KOERTE IK BLASCHEK A ET AL BOTULINUM TOXIN TYPE A AND B FOR THE REDUCTION OF HYPERSALIVATION IN CHILDREN WITH NEUROLOGICAL DISORDERS A FOCUS ON EFFECTIVENESS AND THERAPY ADHERENCE
NEUROPEDIATRICS 201243(1)27-36
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull GOEMINNE P AND DUPONT L (2010) NON-CYSTIC FIBROSIS BRONCHIECTASIS DIAGNOSIS AND MANAGEMENT IN 21ST CENTURY POSTGRADUATE MEDICAL JOURNAL 86(1018) PP493-501
bull LEE A BUTTON B AND TANNENBAUM E (2017) AIRWAY-CLEARANCE TECHNIQUES IN CHILDREN AND ADOLESCENTS WITH CHRONIC SUPPURATIVE LUNG DISEASE AND BRONCHIECTASIS FRONTIERS IN PEDIATRICS 5
bull MANDAL P SIDHU M KOPE L POLLOCK W STEVENSON L PENTLAND J TURNBULL K MAC QUARRIE S AND HILL A (2012) A PILOT STUDY OF PULMONARY REHABILITATION AND CHEST PHYSIOTHERAPY VERSUS CHEST PHYSIOTHERAPY ALONE IN
BRONCHIECTASIS RESPIRATORY MEDICINE 106(12) PP1647-1654
bull MURRAY M PENTLAND J AND HILL A (2009) A RANDOMISED CROSSOVER TRIAL OF CHEST PHYSIOTHERAPY IN NON-CYSTIC FIBROSIS BRONCHIECTASIS EUROPEAN RESPIRATORY JOURNAL 34(5) PP1086-1092
bull NEWALL C STOCKLEY R AND HILL S (2005) EXERCISE TRAINING AND INSPIRATORY MUSCLE TRAINING IN PATIENTS WITH BRONCHIECTASIS THORAX 60(11) PP943-948
bull ONG H LEE A HILL C HOLLAND A AND DENEHY L (2011) EFFECTS OF PULMONARY REHABILITATION IN BRONCHIECTASIS A RETROSPECTIVE STUDY CHRONIC RESPIRATORY DISEASE 8(1) PP21-30
bull QUINT J MILLETT E JOSHI M NAVARATNAM V THOMAS S HURST J SMEETH L AND BROWN J (2015) CHANGES IN THE INCIDENCE PREVALENCE AND MORTALITY OF BRONCHIECTASIS IN THE UK FROM 2004 TO 2013 A POPULATION-BASED COHORT
STUDY EUROPEAN RESPIRATORY JOURNAL 47(1) PP186-193
bull SNIJDERS D FERNANDEZ DOMINGUEZ B CALGARO S BERTOZZI I ESCRIBANO MONTANER A PERILONGO G AND BARBATO A (2015) MUCOCILIARY CLEARANCE TECHNIQUES FOR TREATING NON-CYSTIC FIBROSIS BRONCHIECTASIS IS THERE
EVIDENCE INTERNATIONAL JOURNAL OF IMMUNOPATHOLOGY AND PHARMACOLOGY 28(2) PP150-159
POOR AIRWAY CLEARANCE
INCREASED AIRWAY RESISTANCE
INCREASED WOB
HYPOXAEMIA
REPEATED INFECTIONS
LOSS OF RESPIRATORY RESERVE
AIRWAY DAMAGE
RESPIRATORY FAILURE
AIRWAY CLEARANCE TECHNIQUES
bull CHEST PHYSIO
bull DECREASED LUNG VOLUME
bull SECRETION RETENTION
bull INCREASED WOB
bull KETCHUP BOTTLE
bull GLASS
bull PLASTIC
bull SACHET
bull HUMIDIFICATION INHALATION THERAPY
bull MANUAL TECHNIQUES
bull BREATHING TECHNIQUES
bull MAXIMAL INSPIRATORY CAPACITY
bull PHYSIO WITH NIV
bull PEP
bull OSCILLATORY TECHNIQUES
bull HFCWO
bull MIE
bull SUCTION
ACT TECHNIQUES
MANUAL TECHNIQUES
bull PERCUSSION
bull VIBRATIONSHAKING
bull MANUAL ASSISTED COUGH
bull TRACHEAL PRESSURE
bull OVERPRESSURE
bull MANUALASSISTED AD
ACTIVE CYCLE OF BREATHING
Breathing control
3-5 Deep Breaths or TEE
with 3 sec inspiratory
hold
Breathing control
3-5 Deep Breaths or TEE
with 3 sec inspiratory
hold
Breathing control
2-3 FET huffs amp coughs
Clear mucus
Active Cycle
of Breathing
Technique
(ACBT)
AUTOGENIC DRAINAGE
bull JEAN CHEVALLIER 1967 IN BELGIUM
bull OBSERVED CHILDREN SLEEPING
bull LOW LV VrsquoS HIGH LVrsquoS
bull 3 PHASES OF BREATHING
bull LOW
bull MID
bull HIGH
bull MOVING FROM RESIDUAL VOLUME TO TOTAL LUNG CAPACITY
bull AIM TO GENERATE INCREASED EXPIRATORY AIRFLOW PROGRESSIVELY THROUGH EACH GENERATION OF BRONCHI
bull SECRETIONS LOOSEN AND MOVE INTO LARGER AIRWAYS TO AID EXPECTORATION
AD CONTrsquoD
bull METHOD bull DIAGNOSTIC BREATH WHERE ABLE
bull LOW FLOW ON INSPIRATION IE QUIET BREATH IN
bull FASTER EXPIRATORY FLOW
bull SPEED OF EXPIRATORY FLOW bull TRANSPORTS SECRETIONS
bull SHEARS SECRETIONS FROM BRONCHIAL WALL
bull COMBINE WITH TREATMENTS
bull BENEFICIAL IN PATIENTS WITH SIGNIFICANT HYPER-REACTIVITY amp
HAEMOPTYSIS
AD IN NMD
bull PASSIVE AD
bull THERAPIST CONTROLS DEPTH OF LUNG VOLUMES
bull SAME PRINCIPALS
bull OFTEN USED IN CONJUNCTION WITH PEP TO PREVENT SMALL AIRWAY COLLAPSE
bull DEMONSTRATION TO FOLLOW
bull EXHALATION AGAINST A CONSTANT POSITIVE PRESSURE
bull AIDS REMOVAL OF BRONCHIAL SECRETIONS
bull PREVENTING AIRWAY COLLAPSE BY STENTING THE AIRWAYS
bull RECRUITMENT OF PREVIOUSLY OBSTRUCTED AIRWAYS
bull IMPROVE VENTILATION REDUCE ATELECTASIS
bull INCREASING INTRATHORACIC PRESSURE DISTAL TO RETAINED SECRETIONS BY COLLATERAL VENTILATION OR BY INCREASING FRC
bull MAINTAIN PULMONARY FUNCTION
POSITIVE EXPIRATORY PRESSURE (PEP)
bull MASK VALVE RESISTOR amp MANOMETER
bull O2CAN BE CONNECTED TO THE INHALATION SIDE IF REQUIRED
bull SIT IN GOOD POSITION WITH GOOD SEAL AROUND MOUTHPIECEMASK
bull SLOW INHALATION JUST A LITTLE LARGER THAN A NORMAL BREATH IN
(HOLD FOR 3 SECS IF USING MOUTHPIECE)
bull STEADY ACTIVE amp FULL EXHALATION
bull AIM FOR 10-20 CM H2O FOR 3-5 SECS
bull REPEAT 12-15 TIMES FOLLOWED BY FET amp COUGH
bull COMPLETE FOR 15-30 MINS (6-8 CYCLES OR SETS OF ABOVE)
PEP TREATMENT
bull BEFORE OR AT LEAST 1 HR AFTER A FEED
bull START WITH THE SMALLEST HOLERESISTOR THAT BABY CAN TOLERATE
bull USE A MANOMETER
bull HOLD THE BABY IN ARMS OR ON PARENTS LAP SIT ON GYM BALL
bull PLACE THE MASK OVER THE BABYrsquoS MOUTH amp NOSE
bull AIM FOR FEW BREATHS 30-60 SECONDS WHICH CAN BE BUILT UP TO 1-2 MINUTES AS TOLERATED
bull AIM TO REACH PRESSURES BETWEEN 5-15 CM H2O
bull REST FOR 30-60 SECONDS THEN REPEAT FOR ABOUT 5-10 MINUTES
bull COMBINE THIS WITH OTHER TREATMENTS
BABY PEP TREATMENT
OSCILLATING PEP
OSCILLATING PEP
bull DEVICES CAN BE INTRA-THORACIC OR EXTRA-THORACIC
bull INTRA-THORACIC DEVICES ARE PLACED IN THE MOUTH AND PROVIDE RESISTANCE DURING EXHALATION
bull ALTERS EXPIRATORY AIRFLOW
bull VIBRATIONS ON THE AIRWAY SURFACE
bull REDUCES MUCOUS VISCOSITY
bull ACCELERATION OF THE EXPIRATORY FLOW
bull PREVENTS AND TREATS AIRWAY COMPRESSION ATELECTASIS
bull IMPROVES AIRWAY PATENCY amp VENTILATION
bull DECREASES HYPERINFLATION
bull IMPROVES LUNG FUNCTION PARAMETERS
bull INCLUDES EXERCISE
OSCILLATING PEP TREATMENT
bull SIMILAR TO PEP
bull GOOD POSITION
bull PLACE MOUTHPIECE BETWEEN LIPS AND TEETH OR USE MASK
bull SLOW INHALE JUST A LITTLE LARGER THAN A NORMAL BREATH IN
bull HOLD FOR 3 SECONDS
bull STEADY ACTIVE amp FULL EXHALATION
bull ADJUST THE RESISTANCE AS REQUIRED
bull REPEAT 12-15 TIMES FOLLOWED BY FET amp COUGH
bull COMPLETE FOR 5-10 MINS
bull COMBINE WITH OTHER TREATMENTS
ACAPELLA
bull DETACHABLE MOUTHPIECEFACEMASK
bull ONE-WAY INSPIRATORY VALVE
bull EXPIRATORY RESISTANCEFREQUENCY ADJUSTMENT DIAL
bull COUNTERWEIGHTED PLUG amp MAGNET
bull MAINTAINS A RAISED FRC LEVEL
TREATMENT
bull EASY TO USE IN DIFFERENT POSITIONS
bull INHALE amp EXHALE THROUGH THE ACAPELLA
bull ROTATE THE FREQUENCY RESISTANCE DIAL UNTIL MAXIMUM VIBRATIONS ARE FELT WITHIN THE CHEST WALL
AEROBIKA bull COMBINES PEP WITH HIGH FREQUENCY OSCILLATIONS
bull CAN BE USED WITH A MANOMETER
bull NEBULISER CAN BE ENTRAINED INTO THE SYSTEM
bull POSSIBLE INCREASE IN TREATMENT COMPLIANCE BY DECREASING
TREATMENT TIMES
TECHNIQUE AS OSCILLATING PEP
BUBBLE PEP
Suction tubing (~1cm diameter) The end MUST sit at the bottom of the bottle
Plastic bottle Any widthshapediameter must be gt20cm tall 15cm fresh tapsterile water
(depth of water determines the amount of pressure ie cm H20
Washing up bowl
INDICATIONS
bull REDUCED LUNG VOLUME (FVClt50)
bull WEAK COUGH (PCFlt270)
bull SECRETIONS RETENTION
bull ATELECTASIS
bull REDUCED MECHANICAL COMPLIANCE
bull CHILD ABLE TO COMPLY
BENEFITS
bull INCREASE LUNG VOLUME = IMPROVES PCF
bull SECRETION CLEARANCE
bull MAY REVERSE ATELECTASIS
bull IMPROVE MECHANICAL COMPLIANCE = LUNG AND CHEST WALL MOBILITY
bull IMPROVE VOICE STRENGTH
LUNG VOLUME RECRUITMENT
bull LABEL NOT FOR RESUSCITATION
bull BEST IN SITTING
bull SUCTION READY
bull AGREE SIGNAL WITH CHILD WHEN MIC ACHIEVED
bull ASK TO BREATH OUT
bull PLACE MOUTHPIECE +- NOSE CLIP OR MASK
bull ASK TO BREATH IN AND HOLD WHILE GENTLY SQUEEZING BAG
bull WITHOUT LETTING AIR OUT ASK CHILD TO TAKE ANOTHER BREATH IN ON TOP OF THE FIRST BREATH AND SQUEEZE BAG IN TIME WITH BREATH
bull REPEAT UNTIL LUNGS ARE FULL (NORMALLY 3-5 BREATHS) OR SIGNAL
bull REMOVE MASK OR MOUTHPIECE ASK TO HOLD FOR 3-5 SECONDS
bull EXHALE OR IF SECRETIONS ARE PRESENT ENCOURAGE TO HAVE A COUGH OR MAC
bull REPEATED X3-5 X2-4 DAY
LVR TREATMENT
bull AIRWAY CLEARANCE OR THORACIC MOBILITY
bull AMBU RESUS BAG
bull GREEN ldquoPHYSIOrdquo BAG
bull MANUAL TECHNIQUES WITH BAGGING
bull MHI AT HOME
bull MANOMETERS
MHI
PHYSIO WITH NIV
bull PHYSIO SETTINGS
bull SECRETIONS
bull THORACIC MOBILITY
bull ALLOWS REST PERIOD PRE ACT
bull HUMIDIFICATION
bull INFLATABLE VEST CONNECTED BY TUBES TO AN AIR PULSE GENERATOR WHICH RAPIDLY INFLATES AND DEFLATES THE VEST PRODUCING OSCILLATIONS TO THE CHEST WALL
bull RAPID CHEST MOVEMENT MIMICS A COUGH-LIKE EXPIRATORY FLOW THAT SHEARS MUCUS AWAY FROM THE AIRWAY WALLS AND HELPS TO MOVE IT ALONG TO THE CENTRAL AIRWAYS
bull PASSIVE TREATMENT amp NOT POSITION DEPENDANT
bull COMBINATION OF RX
bull CONTRAINDICATIONS
bull HEAD ANDOR NECK INJURY THAT HAS NOT BEEN STABILISED
bull ACTIVE HAEMORRHAGE WITH HEMODYNAMIC INSTABILITY
HFCWO
HFCWO INDICATIONS
bull CHRONIC MUCUS HYPERSECRETION OR RETENTION ASSOCIATED WITH A CHRONIC PULMONARY OR NEUROMUSCULAR CONDITION
bull LRT SECRETIONS AND FREQUENT LRTI REQUIRING HOSPITAL ADMISSION
bull INEFFECTIVE COUGH OR INABILITY TO REMOVE MUCUS BY COUGHING
bull TENACIOUS SECRETIONS THAT ARE NOT EASILY MOBILISED WITH STANDARD CPT
bull MECHANICALLY VENTILATED WITH EVIDENCE OF SECRETION RETENTION
bull ALTERNATIVE AIRWAY CLEARANCE THERAPY PROVEN INEFFECTIVE OR CONTRAINDICATEDDO NOT TOLERATE STANDARD CPT
bull CONSTANT FATIGUE LACK OF STRENGTH OR ABILITY TO PERFORM ACTIVE TREATMENT
bull SYMPTOMATIC
bull POOR COMPLIANCE WITH OTHER AIRWAY CLEARANCE METHODS
bull HIGH BURDEN OF CARE
bull PATIENT UNABLE TO TOLERATE THE INCREASED WORK OF BREATHING bull ACTIVE HAEMOPTYSIS bull UNTREATED PNEUMOTHORAX bull INTRACRANIAL PRESSURE (ICP) gt 20 MMHG bull HAEMODYNAMIC INSTABILITY bull SEVERE CARDIOVASCULAR INSULTDISEASE bull RECENT FACIAL ORAL OR SKULL SURGERY OR TRAUMA bull ACUTE SINUSITIS bull EPISTAXIS bull POST OESOPHAGEAL amp LUNG SURGERY bull KNOWN OR SUSPECTED TYMPANIC MEMBRANE RUPTURE OR OTHER MIDDLE EAR
PATHOLOGY
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
POSSIBLE HAZARDSCOMPLICATIONS
bull INCREASED WORK OF BREATHING THAT MAY LEAD TO HYPOVENTILATION AND
HYPERCARBIA
bull INCREASED INTRACRANIAL PRESSURE
bull CARDIOVASCULAR COMPROMISE
bull NAUSEA
bull MYOCARDIAL ISCHEMIA
bull DECREASED VENOUS RETURN
bull AIR SWALLOWING WITH INCREASED LIKELIHOOD OF VOMITING AND
ASPIRATION
bull CLAUSTROPHOBIA
bull SKIN BREAK DOWN AND DISCOMFORT FROM MASK
bull PULMONARY BAROTRAUMA
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
MI-E
bull USED WITH CHILDREN WHO HAVE DECREASED INSPIRATORY EFFORT DUE TO EITHER SPINAL CORD INJURY OR NMW AND WHO HAVE AN IMPAIRED OR INEFFECTIVE COUGH WITH APPROPRIATE RESPIRATORY SYMPTOMS
bull CONSIDERED WHEN CONVENTIONAL COUGH ASSISTANCE TECHNIQUES BECOME INEFFECTIVE
bull ACCEPTED AS THE CORE STANDARD FOR CHILD WITH NMW
bull MIE WORKS BY
bull INFLATING THE LUNGS WITH GRADUAL POSITIVE AIRWAY PRESSURE ASSISTING INSPIRATION CALLED INSUFFLATION
bull FOLLOWED BY A RAPID SWITCH TO NEGATIVE PRESSURE WHICH SIMULATES THE FLOW CHANGES THAT OCCUR DURING A COUGH THEREBY ENHANCING EXPIRATORY FLOW CALLED EXSUFFLATION AND ASSISTING EXPECTORATION OF SECRETIONS
bull MOVEMENT AND EXERCISE BEST FUNCTIONAL METHOD OF AIRWAY CLEARANCE
bull CPET BETTER CORRELATION THAN LUNG FUNCTION IN SURVIVAL RATES IN PEOPLE WITH
CYSTIC FIBROSIS
bull RUNNINGWALKING BETTER FOR SECRETION CLEARANCE THAN BIKE DURING TO SHEARING
MECHANISM
bull CONSIDER ADDING IN HUFFS (DYER)
bull CONSIDER USE OF AD BELT
EXERCISE
bull APCP SUCTION GUIDELINES
bull TYPESNASOPHARANGEAL OROPHARANGEAL AND TRACHEOSTOMY
bull MAIN VARIABLES SUCTION TYPE AND SIZE DEPTH OF SUCTION
PRESSURE TECHNIQUE
SUCTION
SPUTUM
bull SPUTUM bull 95 WATER bull COLOUR bull VOLUME bull CONSISTENCY bull ODOUR
bull PURPOSE bull HUMIDIFICATION bull WATERPROOFING bull PROTECTION OF EPITHELIUM
HUMIDIFICATION
bull METABOLIC AND VENTILATORY REQUIREMENTS ARE X2-3 OF ADULTS
IMPLICATION
bull HEAT AND MOISTURE LOSSES FROM RESPIRATION WILL INCREASE BY X2-3
bull CONSUME GREATER AMOUNTS OF ENERGY AND WATER
HUMIDIFICATION INHALATION
THERAPY
bull TRACHEOSTOMY HME
bull WET DRY CIRCUIT
bull NEBULISERS INHALERS MUCOLYTICS
bull HUMIDIFIERS WITH NIV
bull OXYGEN
bull SYSTEMIC HYDRATION ENVIRONMENT
NEBULISERS
bull NEBULISER CHAMBER CONVERTS LIQUID INTO
RESPIRABLE PARTICLES
bull MOISTURE DESCENDS THROUGH THE HOLES IN THE SUPERFICIAL GEL LAYER
bull INCREASES THE SOL LAYER SO THE CILIARY BEAT IS OPTIMAL FOR MUCUS TRANSPORT
bull SHORT TERM HUMIDIFICATION
bull DAILY WASHING OF NEBULISER SYSTEM
TIMING OF DRUG AND PHYSIOTHERAPY
BEFORE TREATMENT
bull DNASE (PULMOZYME)
bull SALBUTAMOL
(VENTOLIN BLUE)
bull SALINE NEBS
AFTER TREATMENT
bull SERETIDE (PURPLE)
bull BECLOMETHASONE (BECOTIDE BROWN)
bull COLISTIN (COLOMYCIN PROMIXIN)
bull TOBRAMYCIN
CONCLUSION
bull BE AWARE OF CHILDrsquoS RESPIRATORY FUNCTION
bull CHOSE ACT BEST FOR THEM bull TYPE OF KETCHUP BOTTLE bull LV SECRETION RETENTION WOB
bull EARLY RESPIRATORY REFERRAL
bull RESPIRATORY CARE COMPETENCIES
bull EFFECTIVE SECRETION CLEARANCE AT HOMERESPITESCHOOL
bull USE OF PEAK COUGH FLOWS TO AID CHOICE OF ADJUNCT
0
50
100
150
200
250
300
350
400
0
50
100
150
200
250
300
350
400
Green
Key
Additional info
(please comment) Please refer to BTSACPRC Guideline
Lothian University Hospitals NHS Trust
n PCF
gt270lmin
Breathstack
ing tri-
flow
blowing
REFERENCES bull BTSACPRC GUIDELINE IS PUBLISHED IN THORAX VOL 67 SUPPLEMENT 1
bull AVAILABLE ONLINE AT HTTPTHORAXBMJCOMCONTENTVOL64ISSUESUPPLI
bull HTTPWWWBRIT-THORACICORGUKPHYSIOGUIDE
bull BRITISH THORACIC SOCIETY REPORTS VOL 1 NO 1 2009
bull ADAPTED PRYOR AJ AND PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS3RD ED
bull HOUGH A PHYSIOTHERAPY IN RESPIRATORY CARE LONDON CHAPMAN AND HALL 1993
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1997) POSTURAL DRAINAGE AND GASTRO-OESOPHAGEAL REFLUX IN INFANTS WITH CYSTIC FIBROSIS ARCHIVES OF DISEASE IN CHILDHOOD 76 148-150
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1998) POSTURAL DRAINAGE IN CYSTIC FIBROSIS IS THERE A LINK WITH GASTRO-OESOPHAGEAL REFLUX JOURNAL OF PAEDIATRIC CHILD HEALTH 34 330-334
bull CECINS NM JENKINS SC PENGELLEY J ET AL (1999) THE ACTIVE CYCLE OF BREATHING TECHNIQUES-TO TIP OR NOT TO TIP RESPIRATORY MEDICINE 93 660-665
bull CONSTANTINI D BRIVIO A BRUSA D ET AL (2001) PEP MASK VERSUS POSTURAL DRAINAGE IN INFANTS A LONG-TERM COMPARATIVE TRIAL PEADIATRIC PULMONOLOGY
bull HOUGH A (2001) PHYSIOTHERAPY IN RESPIRATORY CARE AN EVIDENCE-BASED APPROACH TO RESPIRATORY AND CARDIAC MANAGEMENT CENGAGE LEARNING EMEA
bull INTERNATIONAL PHYSIOTHERAPY GROUP FOR CYSTIC FIBROSIS PHYSIOTHERAPY IN THE TREATMENT OF CYSTIC FIBROSIS (2009) HTTPSWWWECFSEUIPG_CFBOOKLET INTERNATIONAL PHYSIOTHERAPY GROUP ndash THE BLUE BOOKLET
bull KONSTAN MW STERN RC DOERSHUK CF (1994) EFFICACY OF THE FLUTTER DEVICE FOR AIRWAY MUCUS CLEARANCE IN PATIENTS WITH CYSTIC FIBROSIS JOURNAL OF PEDIATRICS 124 (5 (PT 1) 689-693
bull MCILWAINE M BUTTON B AND DWAN K (2015) POSITIVE EXPIRATORY PRESSURE PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 6 ART NO CD003147 DOI 10100214651858CD003147PUB4
bull MESTRINER RG FERNANDES RO STAFFEN LC ET AL (2009) OPTIMUM DESIGN PARAMETERS FOR A THERAPIST-CONSTRUCTED POSITIVE-EXPIRATORY-PRESSURE THERAPY BOTTLE DEVICE RESPIRATORY CARE 54 504-8
bull MORRISON L AND AGNEW J (2014) OSCILLATING DEVICES FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 7 ART NO CD006842 DOI 10100214651858CD006842PUB
bull OERMANN CM SOCKRIDER MM GILES D ET AL (2001) COMPARISON OF HIGH-FREQUENCY CHEST WALL OSCILLATION AND OSCILLATING POSITIVE EXPIRATORY PRESSURE IN THE HOME MANAGEMENT OF CYSTIC FIBROSIS A PILOT STUDY PEDIATRIC PULMONOLOGY 32 (5) 372-7
bull PRASAD SA AND HUSSEY J (1995) PAEDIATRIC RESPIRATORY CARE A GUIDE FOR PHYSIOTHERAPISTS AND HEALTH PROFESSIONALS CHAPMAN amp HALL
bull PRYOR J (1999) PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN ADULTS EUROPEAN RESPIRATORY JOURNAL 14 (6) 1418-1424
bull PRYOR JA amp PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS CHURCHILL LIVINGSTONE
bull PRYOR JA WEBBER BA HODSON ME ET AL (1994) THE FLUTTER VRP1 AS AN ADJUNCT TO CHEST PHYSIOTHERAPY IN CYSTIC FIBROSIS RESPIRATORY MEDICINE 88677-81
bull WEST K WALLEN M FOLLETT J (2010) ACAPELLA VS PEP MASK THERAPY A RANDOMISED TRIAL IN CHILDREN WITH CYSTIC FIBROSIS DURING RESPIRATORY EXACERBATION PHYSIOTHERAPY THEORY PRACTICE 26143-9
bull WILSONLM AGNEW J MORRISON L ET AL (2014) AIRWAY CLEARANCE TECHNIQUES FOR CYSTIC FIBROSIS AN OVERVIEW OF COCHRANE SYSTEMATIC REVIEWS COCHRANE DATABASE OF SYSTEMATIC REVIEWS DOI 10100214651858CD011231
bull VOLSKO TA DIFIORE JM CHATBURN RL (2003) PERFORMANCE COMPARISON OF TWO OSCILLATORY POSITIVE PRESSURE DEVICES ACAPELLA VERSUS FLUTTER RESPIRATORY CARE 48 (2) 124- 130
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SEDDON PC KHAN Y RESPIRATORY PROBLEMS IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT ARCHIVES OF DISEASE IN CHILDHOOD 2003 01 JAN88(1)75-8
bull MARKS JH PULMONARY CARE OF CHILDREN AND ADOLESCENTS WITH DEVELOPMENTAL DISABILITIES PEDIATR CLIN NORTH AM 2008 DECEMBER55(6)1299-314
bull ARENS R MUZUMDAR H SLEEP SLEEP DISORDERED BREATHING AND NOCTURNAL HYPOVENTILATION IN CHILDREN WITH NEUROMUSCULAR DISEASES PAEDIATRIC RESPIRATORY REVIEWS 2010 MAR11(1)24-30
bull FITZGERALD DA FOLLETT J VAN ASPEREN PP ASSESSING AND MANAGING LUNG DISEASE AND SLEEP DISORDERED BREATHING IN CHILDREN WITH CEREBRAL PALSY PAEDIATRIC RESPIRATORY REVIEWS 2009 MARCH10(1)18-24
bull HSIAO KH NIXON GM THE EFFECT OF TREATMENT OF OBSTRUCTIVE SLEEP APNEA ON QUALITY OF LIFE IN CHILDREN WITH CEREBRAL PALSY RES DEV DISABIL 2008 MAR-APR29(2)133-40
bull LUNDBERG A OXYGEN CONSUMPTION IN RELATION TO WORKLOAD IN STUDENTS WITH CEREBRAL PALSY J APPL PHYSIO 197640873-5
bull SULLIVAN PB ROSENBLOOM L FEEDING THE DISABLED CHILD CLINICS IN DEVELOPMENTAL MEDICINE MACKEITH PRESS 1999140
bull MARTIN TR THE RELATIONSHIP BETWEEN MALNUTRITION AND LUNG INFECTIONS CLIN CHEST MED 19878359
bull MOSTAFA SM BHANDARI S RITCHIE G ET AL CONSTIPATION AND ITS IMPLICATIONS IN THE CRITICALLY ILL PATIENT BR J ANAESTH 200391815-9 3
bull GACOUIN A CAMUS C GROS A ET AL CONSTIPATION IN LONGTERM VENTILATED PATIENTS ASSOCIATED FACTORS AND IMPACT ON INTENSIVE CARE UNIT OUTCOMES CRIT CARE MED 2010381933- 8
bull NGUYEN T FRENETTE AJ JOHANSON C ET AL IMPAIRED GASTROINTESTINAL TRANSIT AND ITS ASSOCIATED MORBIDITY IN THE INTENSIVE CARE UNIT J CRIT CARE 201328537
bull ASAI T CONSTIPATION DOES IT INCREASE MORBIDITY AND MORTALITY IN CRITICALLY ILL PATIENTS CRIT CARE MED 2007352861-2
bull UNDERSTANDING THE PHYSIOLOGICAL EFFECTS OF UNTREATED PAIN NURSING TIMES VOL 99 ISSUE 37 PAGE NO 28
bull WINFIELD ET AL NON-PHARMACEUTICAL MANAGEMENT OF RESPIRATORY MORBIDITY IN CHILDREN WITH SEVERE GLOBAL DEVELOPMENTAL DELAY THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014
bull OLOUGHLIN EV SOMERVILLE HM SOMERVILLE ER DEALING WITH MULTISYSTEM DISEASE IN PEOPLE WITH A DEVELOPMENTAL DISABILITY MEDICAL JOURNAL OF AUSTRALIA 2009 JUN 1190(11)616-7
bull MESTROVIC J KARDUM G POLIC B MESTROVIC M MARKIC J SUSTIC A ET AL THE INFLUENCE OF CHRONIC HEALTH CONDITIONS ON SUSCEPTIBILITY TO SEVERE ACUTE ILLNESS OF CHILDREN TREATED IN PICU EUROPEAN JOURNAL OF PEDIATRICS 2006 AUG165(8)526-
9
bull HEALY F PANITCH HB PULMONARY COMPLICATIONS OF PEDIATRIC NEUROLOGICAL DISEASES PEDIATR ANN 2010 APR39(4)216-24
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SRIVASTAVA R JACKSON WD BARNHART DC DYSPHAGIA AND GASTROESOPHAGEAL REFLUX DISEASE DILEMMAS IN DIAGNOSIS AND MANAGEMENT IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT PEDIATR ANN 2010 APR39(4)225-31
bull SULLIVAN PB JUSZCZAK E BACHLET AME LAMBERT B VERNON-ROBERTS A GRANT HW ET AL GASTROSTOMY TUBE FEEDING IN CHILDREN WITH CEREBRAL PALSY A PROSPECTIVE LONGITUDINAL STUDY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 2005
FEBRUARY47(2)77-85
bull SOMERVILLE H TZANNES G WOOD J SHUN A HILL C ARROWSMITH F ET AL GASTROINTESTINAL AND NUTRITIONAL PROBLEMS IN SEVERE DEVELOPMENTAL DISABILITY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 200850(9)712-6
bull TODER DS RESPIRATORY PROBLEMS IN THE ADOLESCENT WITH DEVELOPMENTAL DELAY ADOLESCENT MEDICINE 2000 3 OCTOBER 200011(3)617-31
bull LEVIN K COLON A DIPALMA J FITZPATRICK S USING THE RADIONUCLIDE SALIVAGRAM TO DETECT PULMONARY ASPIRATION AND ESOPHAGEAL DYSMOTILITY CLIN NUCL MED 1993 FEB18(2)110-4
bull SCHROEDER AS KLING T HUSS K BORGGRAEFE I KOERTE IK BLASCHEK A ET AL BOTULINUM TOXIN TYPE A AND B FOR THE REDUCTION OF HYPERSALIVATION IN CHILDREN WITH NEUROLOGICAL DISORDERS A FOCUS ON EFFECTIVENESS AND THERAPY ADHERENCE
NEUROPEDIATRICS 201243(1)27-36
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull GOEMINNE P AND DUPONT L (2010) NON-CYSTIC FIBROSIS BRONCHIECTASIS DIAGNOSIS AND MANAGEMENT IN 21ST CENTURY POSTGRADUATE MEDICAL JOURNAL 86(1018) PP493-501
bull LEE A BUTTON B AND TANNENBAUM E (2017) AIRWAY-CLEARANCE TECHNIQUES IN CHILDREN AND ADOLESCENTS WITH CHRONIC SUPPURATIVE LUNG DISEASE AND BRONCHIECTASIS FRONTIERS IN PEDIATRICS 5
bull MANDAL P SIDHU M KOPE L POLLOCK W STEVENSON L PENTLAND J TURNBULL K MAC QUARRIE S AND HILL A (2012) A PILOT STUDY OF PULMONARY REHABILITATION AND CHEST PHYSIOTHERAPY VERSUS CHEST PHYSIOTHERAPY ALONE IN
BRONCHIECTASIS RESPIRATORY MEDICINE 106(12) PP1647-1654
bull MURRAY M PENTLAND J AND HILL A (2009) A RANDOMISED CROSSOVER TRIAL OF CHEST PHYSIOTHERAPY IN NON-CYSTIC FIBROSIS BRONCHIECTASIS EUROPEAN RESPIRATORY JOURNAL 34(5) PP1086-1092
bull NEWALL C STOCKLEY R AND HILL S (2005) EXERCISE TRAINING AND INSPIRATORY MUSCLE TRAINING IN PATIENTS WITH BRONCHIECTASIS THORAX 60(11) PP943-948
bull ONG H LEE A HILL C HOLLAND A AND DENEHY L (2011) EFFECTS OF PULMONARY REHABILITATION IN BRONCHIECTASIS A RETROSPECTIVE STUDY CHRONIC RESPIRATORY DISEASE 8(1) PP21-30
bull QUINT J MILLETT E JOSHI M NAVARATNAM V THOMAS S HURST J SMEETH L AND BROWN J (2015) CHANGES IN THE INCIDENCE PREVALENCE AND MORTALITY OF BRONCHIECTASIS IN THE UK FROM 2004 TO 2013 A POPULATION-BASED COHORT
STUDY EUROPEAN RESPIRATORY JOURNAL 47(1) PP186-193
bull SNIJDERS D FERNANDEZ DOMINGUEZ B CALGARO S BERTOZZI I ESCRIBANO MONTANER A PERILONGO G AND BARBATO A (2015) MUCOCILIARY CLEARANCE TECHNIQUES FOR TREATING NON-CYSTIC FIBROSIS BRONCHIECTASIS IS THERE
EVIDENCE INTERNATIONAL JOURNAL OF IMMUNOPATHOLOGY AND PHARMACOLOGY 28(2) PP150-159
AIRWAY CLEARANCE TECHNIQUES
bull CHEST PHYSIO
bull DECREASED LUNG VOLUME
bull SECRETION RETENTION
bull INCREASED WOB
bull KETCHUP BOTTLE
bull GLASS
bull PLASTIC
bull SACHET
bull HUMIDIFICATION INHALATION THERAPY
bull MANUAL TECHNIQUES
bull BREATHING TECHNIQUES
bull MAXIMAL INSPIRATORY CAPACITY
bull PHYSIO WITH NIV
bull PEP
bull OSCILLATORY TECHNIQUES
bull HFCWO
bull MIE
bull SUCTION
ACT TECHNIQUES
MANUAL TECHNIQUES
bull PERCUSSION
bull VIBRATIONSHAKING
bull MANUAL ASSISTED COUGH
bull TRACHEAL PRESSURE
bull OVERPRESSURE
bull MANUALASSISTED AD
ACTIVE CYCLE OF BREATHING
Breathing control
3-5 Deep Breaths or TEE
with 3 sec inspiratory
hold
Breathing control
3-5 Deep Breaths or TEE
with 3 sec inspiratory
hold
Breathing control
2-3 FET huffs amp coughs
Clear mucus
Active Cycle
of Breathing
Technique
(ACBT)
AUTOGENIC DRAINAGE
bull JEAN CHEVALLIER 1967 IN BELGIUM
bull OBSERVED CHILDREN SLEEPING
bull LOW LV VrsquoS HIGH LVrsquoS
bull 3 PHASES OF BREATHING
bull LOW
bull MID
bull HIGH
bull MOVING FROM RESIDUAL VOLUME TO TOTAL LUNG CAPACITY
bull AIM TO GENERATE INCREASED EXPIRATORY AIRFLOW PROGRESSIVELY THROUGH EACH GENERATION OF BRONCHI
bull SECRETIONS LOOSEN AND MOVE INTO LARGER AIRWAYS TO AID EXPECTORATION
AD CONTrsquoD
bull METHOD bull DIAGNOSTIC BREATH WHERE ABLE
bull LOW FLOW ON INSPIRATION IE QUIET BREATH IN
bull FASTER EXPIRATORY FLOW
bull SPEED OF EXPIRATORY FLOW bull TRANSPORTS SECRETIONS
bull SHEARS SECRETIONS FROM BRONCHIAL WALL
bull COMBINE WITH TREATMENTS
bull BENEFICIAL IN PATIENTS WITH SIGNIFICANT HYPER-REACTIVITY amp
HAEMOPTYSIS
AD IN NMD
bull PASSIVE AD
bull THERAPIST CONTROLS DEPTH OF LUNG VOLUMES
bull SAME PRINCIPALS
bull OFTEN USED IN CONJUNCTION WITH PEP TO PREVENT SMALL AIRWAY COLLAPSE
bull DEMONSTRATION TO FOLLOW
bull EXHALATION AGAINST A CONSTANT POSITIVE PRESSURE
bull AIDS REMOVAL OF BRONCHIAL SECRETIONS
bull PREVENTING AIRWAY COLLAPSE BY STENTING THE AIRWAYS
bull RECRUITMENT OF PREVIOUSLY OBSTRUCTED AIRWAYS
bull IMPROVE VENTILATION REDUCE ATELECTASIS
bull INCREASING INTRATHORACIC PRESSURE DISTAL TO RETAINED SECRETIONS BY COLLATERAL VENTILATION OR BY INCREASING FRC
bull MAINTAIN PULMONARY FUNCTION
POSITIVE EXPIRATORY PRESSURE (PEP)
bull MASK VALVE RESISTOR amp MANOMETER
bull O2CAN BE CONNECTED TO THE INHALATION SIDE IF REQUIRED
bull SIT IN GOOD POSITION WITH GOOD SEAL AROUND MOUTHPIECEMASK
bull SLOW INHALATION JUST A LITTLE LARGER THAN A NORMAL BREATH IN
(HOLD FOR 3 SECS IF USING MOUTHPIECE)
bull STEADY ACTIVE amp FULL EXHALATION
bull AIM FOR 10-20 CM H2O FOR 3-5 SECS
bull REPEAT 12-15 TIMES FOLLOWED BY FET amp COUGH
bull COMPLETE FOR 15-30 MINS (6-8 CYCLES OR SETS OF ABOVE)
PEP TREATMENT
bull BEFORE OR AT LEAST 1 HR AFTER A FEED
bull START WITH THE SMALLEST HOLERESISTOR THAT BABY CAN TOLERATE
bull USE A MANOMETER
bull HOLD THE BABY IN ARMS OR ON PARENTS LAP SIT ON GYM BALL
bull PLACE THE MASK OVER THE BABYrsquoS MOUTH amp NOSE
bull AIM FOR FEW BREATHS 30-60 SECONDS WHICH CAN BE BUILT UP TO 1-2 MINUTES AS TOLERATED
bull AIM TO REACH PRESSURES BETWEEN 5-15 CM H2O
bull REST FOR 30-60 SECONDS THEN REPEAT FOR ABOUT 5-10 MINUTES
bull COMBINE THIS WITH OTHER TREATMENTS
BABY PEP TREATMENT
OSCILLATING PEP
OSCILLATING PEP
bull DEVICES CAN BE INTRA-THORACIC OR EXTRA-THORACIC
bull INTRA-THORACIC DEVICES ARE PLACED IN THE MOUTH AND PROVIDE RESISTANCE DURING EXHALATION
bull ALTERS EXPIRATORY AIRFLOW
bull VIBRATIONS ON THE AIRWAY SURFACE
bull REDUCES MUCOUS VISCOSITY
bull ACCELERATION OF THE EXPIRATORY FLOW
bull PREVENTS AND TREATS AIRWAY COMPRESSION ATELECTASIS
bull IMPROVES AIRWAY PATENCY amp VENTILATION
bull DECREASES HYPERINFLATION
bull IMPROVES LUNG FUNCTION PARAMETERS
bull INCLUDES EXERCISE
OSCILLATING PEP TREATMENT
bull SIMILAR TO PEP
bull GOOD POSITION
bull PLACE MOUTHPIECE BETWEEN LIPS AND TEETH OR USE MASK
bull SLOW INHALE JUST A LITTLE LARGER THAN A NORMAL BREATH IN
bull HOLD FOR 3 SECONDS
bull STEADY ACTIVE amp FULL EXHALATION
bull ADJUST THE RESISTANCE AS REQUIRED
bull REPEAT 12-15 TIMES FOLLOWED BY FET amp COUGH
bull COMPLETE FOR 5-10 MINS
bull COMBINE WITH OTHER TREATMENTS
ACAPELLA
bull DETACHABLE MOUTHPIECEFACEMASK
bull ONE-WAY INSPIRATORY VALVE
bull EXPIRATORY RESISTANCEFREQUENCY ADJUSTMENT DIAL
bull COUNTERWEIGHTED PLUG amp MAGNET
bull MAINTAINS A RAISED FRC LEVEL
TREATMENT
bull EASY TO USE IN DIFFERENT POSITIONS
bull INHALE amp EXHALE THROUGH THE ACAPELLA
bull ROTATE THE FREQUENCY RESISTANCE DIAL UNTIL MAXIMUM VIBRATIONS ARE FELT WITHIN THE CHEST WALL
AEROBIKA bull COMBINES PEP WITH HIGH FREQUENCY OSCILLATIONS
bull CAN BE USED WITH A MANOMETER
bull NEBULISER CAN BE ENTRAINED INTO THE SYSTEM
bull POSSIBLE INCREASE IN TREATMENT COMPLIANCE BY DECREASING
TREATMENT TIMES
TECHNIQUE AS OSCILLATING PEP
BUBBLE PEP
Suction tubing (~1cm diameter) The end MUST sit at the bottom of the bottle
Plastic bottle Any widthshapediameter must be gt20cm tall 15cm fresh tapsterile water
(depth of water determines the amount of pressure ie cm H20
Washing up bowl
INDICATIONS
bull REDUCED LUNG VOLUME (FVClt50)
bull WEAK COUGH (PCFlt270)
bull SECRETIONS RETENTION
bull ATELECTASIS
bull REDUCED MECHANICAL COMPLIANCE
bull CHILD ABLE TO COMPLY
BENEFITS
bull INCREASE LUNG VOLUME = IMPROVES PCF
bull SECRETION CLEARANCE
bull MAY REVERSE ATELECTASIS
bull IMPROVE MECHANICAL COMPLIANCE = LUNG AND CHEST WALL MOBILITY
bull IMPROVE VOICE STRENGTH
LUNG VOLUME RECRUITMENT
bull LABEL NOT FOR RESUSCITATION
bull BEST IN SITTING
bull SUCTION READY
bull AGREE SIGNAL WITH CHILD WHEN MIC ACHIEVED
bull ASK TO BREATH OUT
bull PLACE MOUTHPIECE +- NOSE CLIP OR MASK
bull ASK TO BREATH IN AND HOLD WHILE GENTLY SQUEEZING BAG
bull WITHOUT LETTING AIR OUT ASK CHILD TO TAKE ANOTHER BREATH IN ON TOP OF THE FIRST BREATH AND SQUEEZE BAG IN TIME WITH BREATH
bull REPEAT UNTIL LUNGS ARE FULL (NORMALLY 3-5 BREATHS) OR SIGNAL
bull REMOVE MASK OR MOUTHPIECE ASK TO HOLD FOR 3-5 SECONDS
bull EXHALE OR IF SECRETIONS ARE PRESENT ENCOURAGE TO HAVE A COUGH OR MAC
bull REPEATED X3-5 X2-4 DAY
LVR TREATMENT
bull AIRWAY CLEARANCE OR THORACIC MOBILITY
bull AMBU RESUS BAG
bull GREEN ldquoPHYSIOrdquo BAG
bull MANUAL TECHNIQUES WITH BAGGING
bull MHI AT HOME
bull MANOMETERS
MHI
PHYSIO WITH NIV
bull PHYSIO SETTINGS
bull SECRETIONS
bull THORACIC MOBILITY
bull ALLOWS REST PERIOD PRE ACT
bull HUMIDIFICATION
bull INFLATABLE VEST CONNECTED BY TUBES TO AN AIR PULSE GENERATOR WHICH RAPIDLY INFLATES AND DEFLATES THE VEST PRODUCING OSCILLATIONS TO THE CHEST WALL
bull RAPID CHEST MOVEMENT MIMICS A COUGH-LIKE EXPIRATORY FLOW THAT SHEARS MUCUS AWAY FROM THE AIRWAY WALLS AND HELPS TO MOVE IT ALONG TO THE CENTRAL AIRWAYS
bull PASSIVE TREATMENT amp NOT POSITION DEPENDANT
bull COMBINATION OF RX
bull CONTRAINDICATIONS
bull HEAD ANDOR NECK INJURY THAT HAS NOT BEEN STABILISED
bull ACTIVE HAEMORRHAGE WITH HEMODYNAMIC INSTABILITY
HFCWO
HFCWO INDICATIONS
bull CHRONIC MUCUS HYPERSECRETION OR RETENTION ASSOCIATED WITH A CHRONIC PULMONARY OR NEUROMUSCULAR CONDITION
bull LRT SECRETIONS AND FREQUENT LRTI REQUIRING HOSPITAL ADMISSION
bull INEFFECTIVE COUGH OR INABILITY TO REMOVE MUCUS BY COUGHING
bull TENACIOUS SECRETIONS THAT ARE NOT EASILY MOBILISED WITH STANDARD CPT
bull MECHANICALLY VENTILATED WITH EVIDENCE OF SECRETION RETENTION
bull ALTERNATIVE AIRWAY CLEARANCE THERAPY PROVEN INEFFECTIVE OR CONTRAINDICATEDDO NOT TOLERATE STANDARD CPT
bull CONSTANT FATIGUE LACK OF STRENGTH OR ABILITY TO PERFORM ACTIVE TREATMENT
bull SYMPTOMATIC
bull POOR COMPLIANCE WITH OTHER AIRWAY CLEARANCE METHODS
bull HIGH BURDEN OF CARE
bull PATIENT UNABLE TO TOLERATE THE INCREASED WORK OF BREATHING bull ACTIVE HAEMOPTYSIS bull UNTREATED PNEUMOTHORAX bull INTRACRANIAL PRESSURE (ICP) gt 20 MMHG bull HAEMODYNAMIC INSTABILITY bull SEVERE CARDIOVASCULAR INSULTDISEASE bull RECENT FACIAL ORAL OR SKULL SURGERY OR TRAUMA bull ACUTE SINUSITIS bull EPISTAXIS bull POST OESOPHAGEAL amp LUNG SURGERY bull KNOWN OR SUSPECTED TYMPANIC MEMBRANE RUPTURE OR OTHER MIDDLE EAR
PATHOLOGY
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
POSSIBLE HAZARDSCOMPLICATIONS
bull INCREASED WORK OF BREATHING THAT MAY LEAD TO HYPOVENTILATION AND
HYPERCARBIA
bull INCREASED INTRACRANIAL PRESSURE
bull CARDIOVASCULAR COMPROMISE
bull NAUSEA
bull MYOCARDIAL ISCHEMIA
bull DECREASED VENOUS RETURN
bull AIR SWALLOWING WITH INCREASED LIKELIHOOD OF VOMITING AND
ASPIRATION
bull CLAUSTROPHOBIA
bull SKIN BREAK DOWN AND DISCOMFORT FROM MASK
bull PULMONARY BAROTRAUMA
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
MI-E
bull USED WITH CHILDREN WHO HAVE DECREASED INSPIRATORY EFFORT DUE TO EITHER SPINAL CORD INJURY OR NMW AND WHO HAVE AN IMPAIRED OR INEFFECTIVE COUGH WITH APPROPRIATE RESPIRATORY SYMPTOMS
bull CONSIDERED WHEN CONVENTIONAL COUGH ASSISTANCE TECHNIQUES BECOME INEFFECTIVE
bull ACCEPTED AS THE CORE STANDARD FOR CHILD WITH NMW
bull MIE WORKS BY
bull INFLATING THE LUNGS WITH GRADUAL POSITIVE AIRWAY PRESSURE ASSISTING INSPIRATION CALLED INSUFFLATION
bull FOLLOWED BY A RAPID SWITCH TO NEGATIVE PRESSURE WHICH SIMULATES THE FLOW CHANGES THAT OCCUR DURING A COUGH THEREBY ENHANCING EXPIRATORY FLOW CALLED EXSUFFLATION AND ASSISTING EXPECTORATION OF SECRETIONS
bull MOVEMENT AND EXERCISE BEST FUNCTIONAL METHOD OF AIRWAY CLEARANCE
bull CPET BETTER CORRELATION THAN LUNG FUNCTION IN SURVIVAL RATES IN PEOPLE WITH
CYSTIC FIBROSIS
bull RUNNINGWALKING BETTER FOR SECRETION CLEARANCE THAN BIKE DURING TO SHEARING
MECHANISM
bull CONSIDER ADDING IN HUFFS (DYER)
bull CONSIDER USE OF AD BELT
EXERCISE
bull APCP SUCTION GUIDELINES
bull TYPESNASOPHARANGEAL OROPHARANGEAL AND TRACHEOSTOMY
bull MAIN VARIABLES SUCTION TYPE AND SIZE DEPTH OF SUCTION
PRESSURE TECHNIQUE
SUCTION
SPUTUM
bull SPUTUM bull 95 WATER bull COLOUR bull VOLUME bull CONSISTENCY bull ODOUR
bull PURPOSE bull HUMIDIFICATION bull WATERPROOFING bull PROTECTION OF EPITHELIUM
HUMIDIFICATION
bull METABOLIC AND VENTILATORY REQUIREMENTS ARE X2-3 OF ADULTS
IMPLICATION
bull HEAT AND MOISTURE LOSSES FROM RESPIRATION WILL INCREASE BY X2-3
bull CONSUME GREATER AMOUNTS OF ENERGY AND WATER
HUMIDIFICATION INHALATION
THERAPY
bull TRACHEOSTOMY HME
bull WET DRY CIRCUIT
bull NEBULISERS INHALERS MUCOLYTICS
bull HUMIDIFIERS WITH NIV
bull OXYGEN
bull SYSTEMIC HYDRATION ENVIRONMENT
NEBULISERS
bull NEBULISER CHAMBER CONVERTS LIQUID INTO
RESPIRABLE PARTICLES
bull MOISTURE DESCENDS THROUGH THE HOLES IN THE SUPERFICIAL GEL LAYER
bull INCREASES THE SOL LAYER SO THE CILIARY BEAT IS OPTIMAL FOR MUCUS TRANSPORT
bull SHORT TERM HUMIDIFICATION
bull DAILY WASHING OF NEBULISER SYSTEM
TIMING OF DRUG AND PHYSIOTHERAPY
BEFORE TREATMENT
bull DNASE (PULMOZYME)
bull SALBUTAMOL
(VENTOLIN BLUE)
bull SALINE NEBS
AFTER TREATMENT
bull SERETIDE (PURPLE)
bull BECLOMETHASONE (BECOTIDE BROWN)
bull COLISTIN (COLOMYCIN PROMIXIN)
bull TOBRAMYCIN
CONCLUSION
bull BE AWARE OF CHILDrsquoS RESPIRATORY FUNCTION
bull CHOSE ACT BEST FOR THEM bull TYPE OF KETCHUP BOTTLE bull LV SECRETION RETENTION WOB
bull EARLY RESPIRATORY REFERRAL
bull RESPIRATORY CARE COMPETENCIES
bull EFFECTIVE SECRETION CLEARANCE AT HOMERESPITESCHOOL
bull USE OF PEAK COUGH FLOWS TO AID CHOICE OF ADJUNCT
0
50
100
150
200
250
300
350
400
0
50
100
150
200
250
300
350
400
Green
Key
Additional info
(please comment) Please refer to BTSACPRC Guideline
Lothian University Hospitals NHS Trust
n PCF
gt270lmin
Breathstack
ing tri-
flow
blowing
REFERENCES bull BTSACPRC GUIDELINE IS PUBLISHED IN THORAX VOL 67 SUPPLEMENT 1
bull AVAILABLE ONLINE AT HTTPTHORAXBMJCOMCONTENTVOL64ISSUESUPPLI
bull HTTPWWWBRIT-THORACICORGUKPHYSIOGUIDE
bull BRITISH THORACIC SOCIETY REPORTS VOL 1 NO 1 2009
bull ADAPTED PRYOR AJ AND PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS3RD ED
bull HOUGH A PHYSIOTHERAPY IN RESPIRATORY CARE LONDON CHAPMAN AND HALL 1993
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1997) POSTURAL DRAINAGE AND GASTRO-OESOPHAGEAL REFLUX IN INFANTS WITH CYSTIC FIBROSIS ARCHIVES OF DISEASE IN CHILDHOOD 76 148-150
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1998) POSTURAL DRAINAGE IN CYSTIC FIBROSIS IS THERE A LINK WITH GASTRO-OESOPHAGEAL REFLUX JOURNAL OF PAEDIATRIC CHILD HEALTH 34 330-334
bull CECINS NM JENKINS SC PENGELLEY J ET AL (1999) THE ACTIVE CYCLE OF BREATHING TECHNIQUES-TO TIP OR NOT TO TIP RESPIRATORY MEDICINE 93 660-665
bull CONSTANTINI D BRIVIO A BRUSA D ET AL (2001) PEP MASK VERSUS POSTURAL DRAINAGE IN INFANTS A LONG-TERM COMPARATIVE TRIAL PEADIATRIC PULMONOLOGY
bull HOUGH A (2001) PHYSIOTHERAPY IN RESPIRATORY CARE AN EVIDENCE-BASED APPROACH TO RESPIRATORY AND CARDIAC MANAGEMENT CENGAGE LEARNING EMEA
bull INTERNATIONAL PHYSIOTHERAPY GROUP FOR CYSTIC FIBROSIS PHYSIOTHERAPY IN THE TREATMENT OF CYSTIC FIBROSIS (2009) HTTPSWWWECFSEUIPG_CFBOOKLET INTERNATIONAL PHYSIOTHERAPY GROUP ndash THE BLUE BOOKLET
bull KONSTAN MW STERN RC DOERSHUK CF (1994) EFFICACY OF THE FLUTTER DEVICE FOR AIRWAY MUCUS CLEARANCE IN PATIENTS WITH CYSTIC FIBROSIS JOURNAL OF PEDIATRICS 124 (5 (PT 1) 689-693
bull MCILWAINE M BUTTON B AND DWAN K (2015) POSITIVE EXPIRATORY PRESSURE PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 6 ART NO CD003147 DOI 10100214651858CD003147PUB4
bull MESTRINER RG FERNANDES RO STAFFEN LC ET AL (2009) OPTIMUM DESIGN PARAMETERS FOR A THERAPIST-CONSTRUCTED POSITIVE-EXPIRATORY-PRESSURE THERAPY BOTTLE DEVICE RESPIRATORY CARE 54 504-8
bull MORRISON L AND AGNEW J (2014) OSCILLATING DEVICES FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 7 ART NO CD006842 DOI 10100214651858CD006842PUB
bull OERMANN CM SOCKRIDER MM GILES D ET AL (2001) COMPARISON OF HIGH-FREQUENCY CHEST WALL OSCILLATION AND OSCILLATING POSITIVE EXPIRATORY PRESSURE IN THE HOME MANAGEMENT OF CYSTIC FIBROSIS A PILOT STUDY PEDIATRIC PULMONOLOGY 32 (5) 372-7
bull PRASAD SA AND HUSSEY J (1995) PAEDIATRIC RESPIRATORY CARE A GUIDE FOR PHYSIOTHERAPISTS AND HEALTH PROFESSIONALS CHAPMAN amp HALL
bull PRYOR J (1999) PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN ADULTS EUROPEAN RESPIRATORY JOURNAL 14 (6) 1418-1424
bull PRYOR JA amp PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS CHURCHILL LIVINGSTONE
bull PRYOR JA WEBBER BA HODSON ME ET AL (1994) THE FLUTTER VRP1 AS AN ADJUNCT TO CHEST PHYSIOTHERAPY IN CYSTIC FIBROSIS RESPIRATORY MEDICINE 88677-81
bull WEST K WALLEN M FOLLETT J (2010) ACAPELLA VS PEP MASK THERAPY A RANDOMISED TRIAL IN CHILDREN WITH CYSTIC FIBROSIS DURING RESPIRATORY EXACERBATION PHYSIOTHERAPY THEORY PRACTICE 26143-9
bull WILSONLM AGNEW J MORRISON L ET AL (2014) AIRWAY CLEARANCE TECHNIQUES FOR CYSTIC FIBROSIS AN OVERVIEW OF COCHRANE SYSTEMATIC REVIEWS COCHRANE DATABASE OF SYSTEMATIC REVIEWS DOI 10100214651858CD011231
bull VOLSKO TA DIFIORE JM CHATBURN RL (2003) PERFORMANCE COMPARISON OF TWO OSCILLATORY POSITIVE PRESSURE DEVICES ACAPELLA VERSUS FLUTTER RESPIRATORY CARE 48 (2) 124- 130
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SEDDON PC KHAN Y RESPIRATORY PROBLEMS IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT ARCHIVES OF DISEASE IN CHILDHOOD 2003 01 JAN88(1)75-8
bull MARKS JH PULMONARY CARE OF CHILDREN AND ADOLESCENTS WITH DEVELOPMENTAL DISABILITIES PEDIATR CLIN NORTH AM 2008 DECEMBER55(6)1299-314
bull ARENS R MUZUMDAR H SLEEP SLEEP DISORDERED BREATHING AND NOCTURNAL HYPOVENTILATION IN CHILDREN WITH NEUROMUSCULAR DISEASES PAEDIATRIC RESPIRATORY REVIEWS 2010 MAR11(1)24-30
bull FITZGERALD DA FOLLETT J VAN ASPEREN PP ASSESSING AND MANAGING LUNG DISEASE AND SLEEP DISORDERED BREATHING IN CHILDREN WITH CEREBRAL PALSY PAEDIATRIC RESPIRATORY REVIEWS 2009 MARCH10(1)18-24
bull HSIAO KH NIXON GM THE EFFECT OF TREATMENT OF OBSTRUCTIVE SLEEP APNEA ON QUALITY OF LIFE IN CHILDREN WITH CEREBRAL PALSY RES DEV DISABIL 2008 MAR-APR29(2)133-40
bull LUNDBERG A OXYGEN CONSUMPTION IN RELATION TO WORKLOAD IN STUDENTS WITH CEREBRAL PALSY J APPL PHYSIO 197640873-5
bull SULLIVAN PB ROSENBLOOM L FEEDING THE DISABLED CHILD CLINICS IN DEVELOPMENTAL MEDICINE MACKEITH PRESS 1999140
bull MARTIN TR THE RELATIONSHIP BETWEEN MALNUTRITION AND LUNG INFECTIONS CLIN CHEST MED 19878359
bull MOSTAFA SM BHANDARI S RITCHIE G ET AL CONSTIPATION AND ITS IMPLICATIONS IN THE CRITICALLY ILL PATIENT BR J ANAESTH 200391815-9 3
bull GACOUIN A CAMUS C GROS A ET AL CONSTIPATION IN LONGTERM VENTILATED PATIENTS ASSOCIATED FACTORS AND IMPACT ON INTENSIVE CARE UNIT OUTCOMES CRIT CARE MED 2010381933- 8
bull NGUYEN T FRENETTE AJ JOHANSON C ET AL IMPAIRED GASTROINTESTINAL TRANSIT AND ITS ASSOCIATED MORBIDITY IN THE INTENSIVE CARE UNIT J CRIT CARE 201328537
bull ASAI T CONSTIPATION DOES IT INCREASE MORBIDITY AND MORTALITY IN CRITICALLY ILL PATIENTS CRIT CARE MED 2007352861-2
bull UNDERSTANDING THE PHYSIOLOGICAL EFFECTS OF UNTREATED PAIN NURSING TIMES VOL 99 ISSUE 37 PAGE NO 28
bull WINFIELD ET AL NON-PHARMACEUTICAL MANAGEMENT OF RESPIRATORY MORBIDITY IN CHILDREN WITH SEVERE GLOBAL DEVELOPMENTAL DELAY THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014
bull OLOUGHLIN EV SOMERVILLE HM SOMERVILLE ER DEALING WITH MULTISYSTEM DISEASE IN PEOPLE WITH A DEVELOPMENTAL DISABILITY MEDICAL JOURNAL OF AUSTRALIA 2009 JUN 1190(11)616-7
bull MESTROVIC J KARDUM G POLIC B MESTROVIC M MARKIC J SUSTIC A ET AL THE INFLUENCE OF CHRONIC HEALTH CONDITIONS ON SUSCEPTIBILITY TO SEVERE ACUTE ILLNESS OF CHILDREN TREATED IN PICU EUROPEAN JOURNAL OF PEDIATRICS 2006 AUG165(8)526-
9
bull HEALY F PANITCH HB PULMONARY COMPLICATIONS OF PEDIATRIC NEUROLOGICAL DISEASES PEDIATR ANN 2010 APR39(4)216-24
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SRIVASTAVA R JACKSON WD BARNHART DC DYSPHAGIA AND GASTROESOPHAGEAL REFLUX DISEASE DILEMMAS IN DIAGNOSIS AND MANAGEMENT IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT PEDIATR ANN 2010 APR39(4)225-31
bull SULLIVAN PB JUSZCZAK E BACHLET AME LAMBERT B VERNON-ROBERTS A GRANT HW ET AL GASTROSTOMY TUBE FEEDING IN CHILDREN WITH CEREBRAL PALSY A PROSPECTIVE LONGITUDINAL STUDY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 2005
FEBRUARY47(2)77-85
bull SOMERVILLE H TZANNES G WOOD J SHUN A HILL C ARROWSMITH F ET AL GASTROINTESTINAL AND NUTRITIONAL PROBLEMS IN SEVERE DEVELOPMENTAL DISABILITY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 200850(9)712-6
bull TODER DS RESPIRATORY PROBLEMS IN THE ADOLESCENT WITH DEVELOPMENTAL DELAY ADOLESCENT MEDICINE 2000 3 OCTOBER 200011(3)617-31
bull LEVIN K COLON A DIPALMA J FITZPATRICK S USING THE RADIONUCLIDE SALIVAGRAM TO DETECT PULMONARY ASPIRATION AND ESOPHAGEAL DYSMOTILITY CLIN NUCL MED 1993 FEB18(2)110-4
bull SCHROEDER AS KLING T HUSS K BORGGRAEFE I KOERTE IK BLASCHEK A ET AL BOTULINUM TOXIN TYPE A AND B FOR THE REDUCTION OF HYPERSALIVATION IN CHILDREN WITH NEUROLOGICAL DISORDERS A FOCUS ON EFFECTIVENESS AND THERAPY ADHERENCE
NEUROPEDIATRICS 201243(1)27-36
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull GOEMINNE P AND DUPONT L (2010) NON-CYSTIC FIBROSIS BRONCHIECTASIS DIAGNOSIS AND MANAGEMENT IN 21ST CENTURY POSTGRADUATE MEDICAL JOURNAL 86(1018) PP493-501
bull LEE A BUTTON B AND TANNENBAUM E (2017) AIRWAY-CLEARANCE TECHNIQUES IN CHILDREN AND ADOLESCENTS WITH CHRONIC SUPPURATIVE LUNG DISEASE AND BRONCHIECTASIS FRONTIERS IN PEDIATRICS 5
bull MANDAL P SIDHU M KOPE L POLLOCK W STEVENSON L PENTLAND J TURNBULL K MAC QUARRIE S AND HILL A (2012) A PILOT STUDY OF PULMONARY REHABILITATION AND CHEST PHYSIOTHERAPY VERSUS CHEST PHYSIOTHERAPY ALONE IN
BRONCHIECTASIS RESPIRATORY MEDICINE 106(12) PP1647-1654
bull MURRAY M PENTLAND J AND HILL A (2009) A RANDOMISED CROSSOVER TRIAL OF CHEST PHYSIOTHERAPY IN NON-CYSTIC FIBROSIS BRONCHIECTASIS EUROPEAN RESPIRATORY JOURNAL 34(5) PP1086-1092
bull NEWALL C STOCKLEY R AND HILL S (2005) EXERCISE TRAINING AND INSPIRATORY MUSCLE TRAINING IN PATIENTS WITH BRONCHIECTASIS THORAX 60(11) PP943-948
bull ONG H LEE A HILL C HOLLAND A AND DENEHY L (2011) EFFECTS OF PULMONARY REHABILITATION IN BRONCHIECTASIS A RETROSPECTIVE STUDY CHRONIC RESPIRATORY DISEASE 8(1) PP21-30
bull QUINT J MILLETT E JOSHI M NAVARATNAM V THOMAS S HURST J SMEETH L AND BROWN J (2015) CHANGES IN THE INCIDENCE PREVALENCE AND MORTALITY OF BRONCHIECTASIS IN THE UK FROM 2004 TO 2013 A POPULATION-BASED COHORT
STUDY EUROPEAN RESPIRATORY JOURNAL 47(1) PP186-193
bull SNIJDERS D FERNANDEZ DOMINGUEZ B CALGARO S BERTOZZI I ESCRIBANO MONTANER A PERILONGO G AND BARBATO A (2015) MUCOCILIARY CLEARANCE TECHNIQUES FOR TREATING NON-CYSTIC FIBROSIS BRONCHIECTASIS IS THERE
EVIDENCE INTERNATIONAL JOURNAL OF IMMUNOPATHOLOGY AND PHARMACOLOGY 28(2) PP150-159
bull HUMIDIFICATION INHALATION THERAPY
bull MANUAL TECHNIQUES
bull BREATHING TECHNIQUES
bull MAXIMAL INSPIRATORY CAPACITY
bull PHYSIO WITH NIV
bull PEP
bull OSCILLATORY TECHNIQUES
bull HFCWO
bull MIE
bull SUCTION
ACT TECHNIQUES
MANUAL TECHNIQUES
bull PERCUSSION
bull VIBRATIONSHAKING
bull MANUAL ASSISTED COUGH
bull TRACHEAL PRESSURE
bull OVERPRESSURE
bull MANUALASSISTED AD
ACTIVE CYCLE OF BREATHING
Breathing control
3-5 Deep Breaths or TEE
with 3 sec inspiratory
hold
Breathing control
3-5 Deep Breaths or TEE
with 3 sec inspiratory
hold
Breathing control
2-3 FET huffs amp coughs
Clear mucus
Active Cycle
of Breathing
Technique
(ACBT)
AUTOGENIC DRAINAGE
bull JEAN CHEVALLIER 1967 IN BELGIUM
bull OBSERVED CHILDREN SLEEPING
bull LOW LV VrsquoS HIGH LVrsquoS
bull 3 PHASES OF BREATHING
bull LOW
bull MID
bull HIGH
bull MOVING FROM RESIDUAL VOLUME TO TOTAL LUNG CAPACITY
bull AIM TO GENERATE INCREASED EXPIRATORY AIRFLOW PROGRESSIVELY THROUGH EACH GENERATION OF BRONCHI
bull SECRETIONS LOOSEN AND MOVE INTO LARGER AIRWAYS TO AID EXPECTORATION
AD CONTrsquoD
bull METHOD bull DIAGNOSTIC BREATH WHERE ABLE
bull LOW FLOW ON INSPIRATION IE QUIET BREATH IN
bull FASTER EXPIRATORY FLOW
bull SPEED OF EXPIRATORY FLOW bull TRANSPORTS SECRETIONS
bull SHEARS SECRETIONS FROM BRONCHIAL WALL
bull COMBINE WITH TREATMENTS
bull BENEFICIAL IN PATIENTS WITH SIGNIFICANT HYPER-REACTIVITY amp
HAEMOPTYSIS
AD IN NMD
bull PASSIVE AD
bull THERAPIST CONTROLS DEPTH OF LUNG VOLUMES
bull SAME PRINCIPALS
bull OFTEN USED IN CONJUNCTION WITH PEP TO PREVENT SMALL AIRWAY COLLAPSE
bull DEMONSTRATION TO FOLLOW
bull EXHALATION AGAINST A CONSTANT POSITIVE PRESSURE
bull AIDS REMOVAL OF BRONCHIAL SECRETIONS
bull PREVENTING AIRWAY COLLAPSE BY STENTING THE AIRWAYS
bull RECRUITMENT OF PREVIOUSLY OBSTRUCTED AIRWAYS
bull IMPROVE VENTILATION REDUCE ATELECTASIS
bull INCREASING INTRATHORACIC PRESSURE DISTAL TO RETAINED SECRETIONS BY COLLATERAL VENTILATION OR BY INCREASING FRC
bull MAINTAIN PULMONARY FUNCTION
POSITIVE EXPIRATORY PRESSURE (PEP)
bull MASK VALVE RESISTOR amp MANOMETER
bull O2CAN BE CONNECTED TO THE INHALATION SIDE IF REQUIRED
bull SIT IN GOOD POSITION WITH GOOD SEAL AROUND MOUTHPIECEMASK
bull SLOW INHALATION JUST A LITTLE LARGER THAN A NORMAL BREATH IN
(HOLD FOR 3 SECS IF USING MOUTHPIECE)
bull STEADY ACTIVE amp FULL EXHALATION
bull AIM FOR 10-20 CM H2O FOR 3-5 SECS
bull REPEAT 12-15 TIMES FOLLOWED BY FET amp COUGH
bull COMPLETE FOR 15-30 MINS (6-8 CYCLES OR SETS OF ABOVE)
PEP TREATMENT
bull BEFORE OR AT LEAST 1 HR AFTER A FEED
bull START WITH THE SMALLEST HOLERESISTOR THAT BABY CAN TOLERATE
bull USE A MANOMETER
bull HOLD THE BABY IN ARMS OR ON PARENTS LAP SIT ON GYM BALL
bull PLACE THE MASK OVER THE BABYrsquoS MOUTH amp NOSE
bull AIM FOR FEW BREATHS 30-60 SECONDS WHICH CAN BE BUILT UP TO 1-2 MINUTES AS TOLERATED
bull AIM TO REACH PRESSURES BETWEEN 5-15 CM H2O
bull REST FOR 30-60 SECONDS THEN REPEAT FOR ABOUT 5-10 MINUTES
bull COMBINE THIS WITH OTHER TREATMENTS
BABY PEP TREATMENT
OSCILLATING PEP
OSCILLATING PEP
bull DEVICES CAN BE INTRA-THORACIC OR EXTRA-THORACIC
bull INTRA-THORACIC DEVICES ARE PLACED IN THE MOUTH AND PROVIDE RESISTANCE DURING EXHALATION
bull ALTERS EXPIRATORY AIRFLOW
bull VIBRATIONS ON THE AIRWAY SURFACE
bull REDUCES MUCOUS VISCOSITY
bull ACCELERATION OF THE EXPIRATORY FLOW
bull PREVENTS AND TREATS AIRWAY COMPRESSION ATELECTASIS
bull IMPROVES AIRWAY PATENCY amp VENTILATION
bull DECREASES HYPERINFLATION
bull IMPROVES LUNG FUNCTION PARAMETERS
bull INCLUDES EXERCISE
OSCILLATING PEP TREATMENT
bull SIMILAR TO PEP
bull GOOD POSITION
bull PLACE MOUTHPIECE BETWEEN LIPS AND TEETH OR USE MASK
bull SLOW INHALE JUST A LITTLE LARGER THAN A NORMAL BREATH IN
bull HOLD FOR 3 SECONDS
bull STEADY ACTIVE amp FULL EXHALATION
bull ADJUST THE RESISTANCE AS REQUIRED
bull REPEAT 12-15 TIMES FOLLOWED BY FET amp COUGH
bull COMPLETE FOR 5-10 MINS
bull COMBINE WITH OTHER TREATMENTS
ACAPELLA
bull DETACHABLE MOUTHPIECEFACEMASK
bull ONE-WAY INSPIRATORY VALVE
bull EXPIRATORY RESISTANCEFREQUENCY ADJUSTMENT DIAL
bull COUNTERWEIGHTED PLUG amp MAGNET
bull MAINTAINS A RAISED FRC LEVEL
TREATMENT
bull EASY TO USE IN DIFFERENT POSITIONS
bull INHALE amp EXHALE THROUGH THE ACAPELLA
bull ROTATE THE FREQUENCY RESISTANCE DIAL UNTIL MAXIMUM VIBRATIONS ARE FELT WITHIN THE CHEST WALL
AEROBIKA bull COMBINES PEP WITH HIGH FREQUENCY OSCILLATIONS
bull CAN BE USED WITH A MANOMETER
bull NEBULISER CAN BE ENTRAINED INTO THE SYSTEM
bull POSSIBLE INCREASE IN TREATMENT COMPLIANCE BY DECREASING
TREATMENT TIMES
TECHNIQUE AS OSCILLATING PEP
BUBBLE PEP
Suction tubing (~1cm diameter) The end MUST sit at the bottom of the bottle
Plastic bottle Any widthshapediameter must be gt20cm tall 15cm fresh tapsterile water
(depth of water determines the amount of pressure ie cm H20
Washing up bowl
INDICATIONS
bull REDUCED LUNG VOLUME (FVClt50)
bull WEAK COUGH (PCFlt270)
bull SECRETIONS RETENTION
bull ATELECTASIS
bull REDUCED MECHANICAL COMPLIANCE
bull CHILD ABLE TO COMPLY
BENEFITS
bull INCREASE LUNG VOLUME = IMPROVES PCF
bull SECRETION CLEARANCE
bull MAY REVERSE ATELECTASIS
bull IMPROVE MECHANICAL COMPLIANCE = LUNG AND CHEST WALL MOBILITY
bull IMPROVE VOICE STRENGTH
LUNG VOLUME RECRUITMENT
bull LABEL NOT FOR RESUSCITATION
bull BEST IN SITTING
bull SUCTION READY
bull AGREE SIGNAL WITH CHILD WHEN MIC ACHIEVED
bull ASK TO BREATH OUT
bull PLACE MOUTHPIECE +- NOSE CLIP OR MASK
bull ASK TO BREATH IN AND HOLD WHILE GENTLY SQUEEZING BAG
bull WITHOUT LETTING AIR OUT ASK CHILD TO TAKE ANOTHER BREATH IN ON TOP OF THE FIRST BREATH AND SQUEEZE BAG IN TIME WITH BREATH
bull REPEAT UNTIL LUNGS ARE FULL (NORMALLY 3-5 BREATHS) OR SIGNAL
bull REMOVE MASK OR MOUTHPIECE ASK TO HOLD FOR 3-5 SECONDS
bull EXHALE OR IF SECRETIONS ARE PRESENT ENCOURAGE TO HAVE A COUGH OR MAC
bull REPEATED X3-5 X2-4 DAY
LVR TREATMENT
bull AIRWAY CLEARANCE OR THORACIC MOBILITY
bull AMBU RESUS BAG
bull GREEN ldquoPHYSIOrdquo BAG
bull MANUAL TECHNIQUES WITH BAGGING
bull MHI AT HOME
bull MANOMETERS
MHI
PHYSIO WITH NIV
bull PHYSIO SETTINGS
bull SECRETIONS
bull THORACIC MOBILITY
bull ALLOWS REST PERIOD PRE ACT
bull HUMIDIFICATION
bull INFLATABLE VEST CONNECTED BY TUBES TO AN AIR PULSE GENERATOR WHICH RAPIDLY INFLATES AND DEFLATES THE VEST PRODUCING OSCILLATIONS TO THE CHEST WALL
bull RAPID CHEST MOVEMENT MIMICS A COUGH-LIKE EXPIRATORY FLOW THAT SHEARS MUCUS AWAY FROM THE AIRWAY WALLS AND HELPS TO MOVE IT ALONG TO THE CENTRAL AIRWAYS
bull PASSIVE TREATMENT amp NOT POSITION DEPENDANT
bull COMBINATION OF RX
bull CONTRAINDICATIONS
bull HEAD ANDOR NECK INJURY THAT HAS NOT BEEN STABILISED
bull ACTIVE HAEMORRHAGE WITH HEMODYNAMIC INSTABILITY
HFCWO
HFCWO INDICATIONS
bull CHRONIC MUCUS HYPERSECRETION OR RETENTION ASSOCIATED WITH A CHRONIC PULMONARY OR NEUROMUSCULAR CONDITION
bull LRT SECRETIONS AND FREQUENT LRTI REQUIRING HOSPITAL ADMISSION
bull INEFFECTIVE COUGH OR INABILITY TO REMOVE MUCUS BY COUGHING
bull TENACIOUS SECRETIONS THAT ARE NOT EASILY MOBILISED WITH STANDARD CPT
bull MECHANICALLY VENTILATED WITH EVIDENCE OF SECRETION RETENTION
bull ALTERNATIVE AIRWAY CLEARANCE THERAPY PROVEN INEFFECTIVE OR CONTRAINDICATEDDO NOT TOLERATE STANDARD CPT
bull CONSTANT FATIGUE LACK OF STRENGTH OR ABILITY TO PERFORM ACTIVE TREATMENT
bull SYMPTOMATIC
bull POOR COMPLIANCE WITH OTHER AIRWAY CLEARANCE METHODS
bull HIGH BURDEN OF CARE
bull PATIENT UNABLE TO TOLERATE THE INCREASED WORK OF BREATHING bull ACTIVE HAEMOPTYSIS bull UNTREATED PNEUMOTHORAX bull INTRACRANIAL PRESSURE (ICP) gt 20 MMHG bull HAEMODYNAMIC INSTABILITY bull SEVERE CARDIOVASCULAR INSULTDISEASE bull RECENT FACIAL ORAL OR SKULL SURGERY OR TRAUMA bull ACUTE SINUSITIS bull EPISTAXIS bull POST OESOPHAGEAL amp LUNG SURGERY bull KNOWN OR SUSPECTED TYMPANIC MEMBRANE RUPTURE OR OTHER MIDDLE EAR
PATHOLOGY
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
POSSIBLE HAZARDSCOMPLICATIONS
bull INCREASED WORK OF BREATHING THAT MAY LEAD TO HYPOVENTILATION AND
HYPERCARBIA
bull INCREASED INTRACRANIAL PRESSURE
bull CARDIOVASCULAR COMPROMISE
bull NAUSEA
bull MYOCARDIAL ISCHEMIA
bull DECREASED VENOUS RETURN
bull AIR SWALLOWING WITH INCREASED LIKELIHOOD OF VOMITING AND
ASPIRATION
bull CLAUSTROPHOBIA
bull SKIN BREAK DOWN AND DISCOMFORT FROM MASK
bull PULMONARY BAROTRAUMA
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
MI-E
bull USED WITH CHILDREN WHO HAVE DECREASED INSPIRATORY EFFORT DUE TO EITHER SPINAL CORD INJURY OR NMW AND WHO HAVE AN IMPAIRED OR INEFFECTIVE COUGH WITH APPROPRIATE RESPIRATORY SYMPTOMS
bull CONSIDERED WHEN CONVENTIONAL COUGH ASSISTANCE TECHNIQUES BECOME INEFFECTIVE
bull ACCEPTED AS THE CORE STANDARD FOR CHILD WITH NMW
bull MIE WORKS BY
bull INFLATING THE LUNGS WITH GRADUAL POSITIVE AIRWAY PRESSURE ASSISTING INSPIRATION CALLED INSUFFLATION
bull FOLLOWED BY A RAPID SWITCH TO NEGATIVE PRESSURE WHICH SIMULATES THE FLOW CHANGES THAT OCCUR DURING A COUGH THEREBY ENHANCING EXPIRATORY FLOW CALLED EXSUFFLATION AND ASSISTING EXPECTORATION OF SECRETIONS
bull MOVEMENT AND EXERCISE BEST FUNCTIONAL METHOD OF AIRWAY CLEARANCE
bull CPET BETTER CORRELATION THAN LUNG FUNCTION IN SURVIVAL RATES IN PEOPLE WITH
CYSTIC FIBROSIS
bull RUNNINGWALKING BETTER FOR SECRETION CLEARANCE THAN BIKE DURING TO SHEARING
MECHANISM
bull CONSIDER ADDING IN HUFFS (DYER)
bull CONSIDER USE OF AD BELT
EXERCISE
bull APCP SUCTION GUIDELINES
bull TYPESNASOPHARANGEAL OROPHARANGEAL AND TRACHEOSTOMY
bull MAIN VARIABLES SUCTION TYPE AND SIZE DEPTH OF SUCTION
PRESSURE TECHNIQUE
SUCTION
SPUTUM
bull SPUTUM bull 95 WATER bull COLOUR bull VOLUME bull CONSISTENCY bull ODOUR
bull PURPOSE bull HUMIDIFICATION bull WATERPROOFING bull PROTECTION OF EPITHELIUM
HUMIDIFICATION
bull METABOLIC AND VENTILATORY REQUIREMENTS ARE X2-3 OF ADULTS
IMPLICATION
bull HEAT AND MOISTURE LOSSES FROM RESPIRATION WILL INCREASE BY X2-3
bull CONSUME GREATER AMOUNTS OF ENERGY AND WATER
HUMIDIFICATION INHALATION
THERAPY
bull TRACHEOSTOMY HME
bull WET DRY CIRCUIT
bull NEBULISERS INHALERS MUCOLYTICS
bull HUMIDIFIERS WITH NIV
bull OXYGEN
bull SYSTEMIC HYDRATION ENVIRONMENT
NEBULISERS
bull NEBULISER CHAMBER CONVERTS LIQUID INTO
RESPIRABLE PARTICLES
bull MOISTURE DESCENDS THROUGH THE HOLES IN THE SUPERFICIAL GEL LAYER
bull INCREASES THE SOL LAYER SO THE CILIARY BEAT IS OPTIMAL FOR MUCUS TRANSPORT
bull SHORT TERM HUMIDIFICATION
bull DAILY WASHING OF NEBULISER SYSTEM
TIMING OF DRUG AND PHYSIOTHERAPY
BEFORE TREATMENT
bull DNASE (PULMOZYME)
bull SALBUTAMOL
(VENTOLIN BLUE)
bull SALINE NEBS
AFTER TREATMENT
bull SERETIDE (PURPLE)
bull BECLOMETHASONE (BECOTIDE BROWN)
bull COLISTIN (COLOMYCIN PROMIXIN)
bull TOBRAMYCIN
CONCLUSION
bull BE AWARE OF CHILDrsquoS RESPIRATORY FUNCTION
bull CHOSE ACT BEST FOR THEM bull TYPE OF KETCHUP BOTTLE bull LV SECRETION RETENTION WOB
bull EARLY RESPIRATORY REFERRAL
bull RESPIRATORY CARE COMPETENCIES
bull EFFECTIVE SECRETION CLEARANCE AT HOMERESPITESCHOOL
bull USE OF PEAK COUGH FLOWS TO AID CHOICE OF ADJUNCT
0
50
100
150
200
250
300
350
400
0
50
100
150
200
250
300
350
400
Green
Key
Additional info
(please comment) Please refer to BTSACPRC Guideline
Lothian University Hospitals NHS Trust
n PCF
gt270lmin
Breathstack
ing tri-
flow
blowing
REFERENCES bull BTSACPRC GUIDELINE IS PUBLISHED IN THORAX VOL 67 SUPPLEMENT 1
bull AVAILABLE ONLINE AT HTTPTHORAXBMJCOMCONTENTVOL64ISSUESUPPLI
bull HTTPWWWBRIT-THORACICORGUKPHYSIOGUIDE
bull BRITISH THORACIC SOCIETY REPORTS VOL 1 NO 1 2009
bull ADAPTED PRYOR AJ AND PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS3RD ED
bull HOUGH A PHYSIOTHERAPY IN RESPIRATORY CARE LONDON CHAPMAN AND HALL 1993
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1997) POSTURAL DRAINAGE AND GASTRO-OESOPHAGEAL REFLUX IN INFANTS WITH CYSTIC FIBROSIS ARCHIVES OF DISEASE IN CHILDHOOD 76 148-150
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1998) POSTURAL DRAINAGE IN CYSTIC FIBROSIS IS THERE A LINK WITH GASTRO-OESOPHAGEAL REFLUX JOURNAL OF PAEDIATRIC CHILD HEALTH 34 330-334
bull CECINS NM JENKINS SC PENGELLEY J ET AL (1999) THE ACTIVE CYCLE OF BREATHING TECHNIQUES-TO TIP OR NOT TO TIP RESPIRATORY MEDICINE 93 660-665
bull CONSTANTINI D BRIVIO A BRUSA D ET AL (2001) PEP MASK VERSUS POSTURAL DRAINAGE IN INFANTS A LONG-TERM COMPARATIVE TRIAL PEADIATRIC PULMONOLOGY
bull HOUGH A (2001) PHYSIOTHERAPY IN RESPIRATORY CARE AN EVIDENCE-BASED APPROACH TO RESPIRATORY AND CARDIAC MANAGEMENT CENGAGE LEARNING EMEA
bull INTERNATIONAL PHYSIOTHERAPY GROUP FOR CYSTIC FIBROSIS PHYSIOTHERAPY IN THE TREATMENT OF CYSTIC FIBROSIS (2009) HTTPSWWWECFSEUIPG_CFBOOKLET INTERNATIONAL PHYSIOTHERAPY GROUP ndash THE BLUE BOOKLET
bull KONSTAN MW STERN RC DOERSHUK CF (1994) EFFICACY OF THE FLUTTER DEVICE FOR AIRWAY MUCUS CLEARANCE IN PATIENTS WITH CYSTIC FIBROSIS JOURNAL OF PEDIATRICS 124 (5 (PT 1) 689-693
bull MCILWAINE M BUTTON B AND DWAN K (2015) POSITIVE EXPIRATORY PRESSURE PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 6 ART NO CD003147 DOI 10100214651858CD003147PUB4
bull MESTRINER RG FERNANDES RO STAFFEN LC ET AL (2009) OPTIMUM DESIGN PARAMETERS FOR A THERAPIST-CONSTRUCTED POSITIVE-EXPIRATORY-PRESSURE THERAPY BOTTLE DEVICE RESPIRATORY CARE 54 504-8
bull MORRISON L AND AGNEW J (2014) OSCILLATING DEVICES FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 7 ART NO CD006842 DOI 10100214651858CD006842PUB
bull OERMANN CM SOCKRIDER MM GILES D ET AL (2001) COMPARISON OF HIGH-FREQUENCY CHEST WALL OSCILLATION AND OSCILLATING POSITIVE EXPIRATORY PRESSURE IN THE HOME MANAGEMENT OF CYSTIC FIBROSIS A PILOT STUDY PEDIATRIC PULMONOLOGY 32 (5) 372-7
bull PRASAD SA AND HUSSEY J (1995) PAEDIATRIC RESPIRATORY CARE A GUIDE FOR PHYSIOTHERAPISTS AND HEALTH PROFESSIONALS CHAPMAN amp HALL
bull PRYOR J (1999) PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN ADULTS EUROPEAN RESPIRATORY JOURNAL 14 (6) 1418-1424
bull PRYOR JA amp PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS CHURCHILL LIVINGSTONE
bull PRYOR JA WEBBER BA HODSON ME ET AL (1994) THE FLUTTER VRP1 AS AN ADJUNCT TO CHEST PHYSIOTHERAPY IN CYSTIC FIBROSIS RESPIRATORY MEDICINE 88677-81
bull WEST K WALLEN M FOLLETT J (2010) ACAPELLA VS PEP MASK THERAPY A RANDOMISED TRIAL IN CHILDREN WITH CYSTIC FIBROSIS DURING RESPIRATORY EXACERBATION PHYSIOTHERAPY THEORY PRACTICE 26143-9
bull WILSONLM AGNEW J MORRISON L ET AL (2014) AIRWAY CLEARANCE TECHNIQUES FOR CYSTIC FIBROSIS AN OVERVIEW OF COCHRANE SYSTEMATIC REVIEWS COCHRANE DATABASE OF SYSTEMATIC REVIEWS DOI 10100214651858CD011231
bull VOLSKO TA DIFIORE JM CHATBURN RL (2003) PERFORMANCE COMPARISON OF TWO OSCILLATORY POSITIVE PRESSURE DEVICES ACAPELLA VERSUS FLUTTER RESPIRATORY CARE 48 (2) 124- 130
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SEDDON PC KHAN Y RESPIRATORY PROBLEMS IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT ARCHIVES OF DISEASE IN CHILDHOOD 2003 01 JAN88(1)75-8
bull MARKS JH PULMONARY CARE OF CHILDREN AND ADOLESCENTS WITH DEVELOPMENTAL DISABILITIES PEDIATR CLIN NORTH AM 2008 DECEMBER55(6)1299-314
bull ARENS R MUZUMDAR H SLEEP SLEEP DISORDERED BREATHING AND NOCTURNAL HYPOVENTILATION IN CHILDREN WITH NEUROMUSCULAR DISEASES PAEDIATRIC RESPIRATORY REVIEWS 2010 MAR11(1)24-30
bull FITZGERALD DA FOLLETT J VAN ASPEREN PP ASSESSING AND MANAGING LUNG DISEASE AND SLEEP DISORDERED BREATHING IN CHILDREN WITH CEREBRAL PALSY PAEDIATRIC RESPIRATORY REVIEWS 2009 MARCH10(1)18-24
bull HSIAO KH NIXON GM THE EFFECT OF TREATMENT OF OBSTRUCTIVE SLEEP APNEA ON QUALITY OF LIFE IN CHILDREN WITH CEREBRAL PALSY RES DEV DISABIL 2008 MAR-APR29(2)133-40
bull LUNDBERG A OXYGEN CONSUMPTION IN RELATION TO WORKLOAD IN STUDENTS WITH CEREBRAL PALSY J APPL PHYSIO 197640873-5
bull SULLIVAN PB ROSENBLOOM L FEEDING THE DISABLED CHILD CLINICS IN DEVELOPMENTAL MEDICINE MACKEITH PRESS 1999140
bull MARTIN TR THE RELATIONSHIP BETWEEN MALNUTRITION AND LUNG INFECTIONS CLIN CHEST MED 19878359
bull MOSTAFA SM BHANDARI S RITCHIE G ET AL CONSTIPATION AND ITS IMPLICATIONS IN THE CRITICALLY ILL PATIENT BR J ANAESTH 200391815-9 3
bull GACOUIN A CAMUS C GROS A ET AL CONSTIPATION IN LONGTERM VENTILATED PATIENTS ASSOCIATED FACTORS AND IMPACT ON INTENSIVE CARE UNIT OUTCOMES CRIT CARE MED 2010381933- 8
bull NGUYEN T FRENETTE AJ JOHANSON C ET AL IMPAIRED GASTROINTESTINAL TRANSIT AND ITS ASSOCIATED MORBIDITY IN THE INTENSIVE CARE UNIT J CRIT CARE 201328537
bull ASAI T CONSTIPATION DOES IT INCREASE MORBIDITY AND MORTALITY IN CRITICALLY ILL PATIENTS CRIT CARE MED 2007352861-2
bull UNDERSTANDING THE PHYSIOLOGICAL EFFECTS OF UNTREATED PAIN NURSING TIMES VOL 99 ISSUE 37 PAGE NO 28
bull WINFIELD ET AL NON-PHARMACEUTICAL MANAGEMENT OF RESPIRATORY MORBIDITY IN CHILDREN WITH SEVERE GLOBAL DEVELOPMENTAL DELAY THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014
bull OLOUGHLIN EV SOMERVILLE HM SOMERVILLE ER DEALING WITH MULTISYSTEM DISEASE IN PEOPLE WITH A DEVELOPMENTAL DISABILITY MEDICAL JOURNAL OF AUSTRALIA 2009 JUN 1190(11)616-7
bull MESTROVIC J KARDUM G POLIC B MESTROVIC M MARKIC J SUSTIC A ET AL THE INFLUENCE OF CHRONIC HEALTH CONDITIONS ON SUSCEPTIBILITY TO SEVERE ACUTE ILLNESS OF CHILDREN TREATED IN PICU EUROPEAN JOURNAL OF PEDIATRICS 2006 AUG165(8)526-
9
bull HEALY F PANITCH HB PULMONARY COMPLICATIONS OF PEDIATRIC NEUROLOGICAL DISEASES PEDIATR ANN 2010 APR39(4)216-24
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SRIVASTAVA R JACKSON WD BARNHART DC DYSPHAGIA AND GASTROESOPHAGEAL REFLUX DISEASE DILEMMAS IN DIAGNOSIS AND MANAGEMENT IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT PEDIATR ANN 2010 APR39(4)225-31
bull SULLIVAN PB JUSZCZAK E BACHLET AME LAMBERT B VERNON-ROBERTS A GRANT HW ET AL GASTROSTOMY TUBE FEEDING IN CHILDREN WITH CEREBRAL PALSY A PROSPECTIVE LONGITUDINAL STUDY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 2005
FEBRUARY47(2)77-85
bull SOMERVILLE H TZANNES G WOOD J SHUN A HILL C ARROWSMITH F ET AL GASTROINTESTINAL AND NUTRITIONAL PROBLEMS IN SEVERE DEVELOPMENTAL DISABILITY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 200850(9)712-6
bull TODER DS RESPIRATORY PROBLEMS IN THE ADOLESCENT WITH DEVELOPMENTAL DELAY ADOLESCENT MEDICINE 2000 3 OCTOBER 200011(3)617-31
bull LEVIN K COLON A DIPALMA J FITZPATRICK S USING THE RADIONUCLIDE SALIVAGRAM TO DETECT PULMONARY ASPIRATION AND ESOPHAGEAL DYSMOTILITY CLIN NUCL MED 1993 FEB18(2)110-4
bull SCHROEDER AS KLING T HUSS K BORGGRAEFE I KOERTE IK BLASCHEK A ET AL BOTULINUM TOXIN TYPE A AND B FOR THE REDUCTION OF HYPERSALIVATION IN CHILDREN WITH NEUROLOGICAL DISORDERS A FOCUS ON EFFECTIVENESS AND THERAPY ADHERENCE
NEUROPEDIATRICS 201243(1)27-36
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull GOEMINNE P AND DUPONT L (2010) NON-CYSTIC FIBROSIS BRONCHIECTASIS DIAGNOSIS AND MANAGEMENT IN 21ST CENTURY POSTGRADUATE MEDICAL JOURNAL 86(1018) PP493-501
bull LEE A BUTTON B AND TANNENBAUM E (2017) AIRWAY-CLEARANCE TECHNIQUES IN CHILDREN AND ADOLESCENTS WITH CHRONIC SUPPURATIVE LUNG DISEASE AND BRONCHIECTASIS FRONTIERS IN PEDIATRICS 5
bull MANDAL P SIDHU M KOPE L POLLOCK W STEVENSON L PENTLAND J TURNBULL K MAC QUARRIE S AND HILL A (2012) A PILOT STUDY OF PULMONARY REHABILITATION AND CHEST PHYSIOTHERAPY VERSUS CHEST PHYSIOTHERAPY ALONE IN
BRONCHIECTASIS RESPIRATORY MEDICINE 106(12) PP1647-1654
bull MURRAY M PENTLAND J AND HILL A (2009) A RANDOMISED CROSSOVER TRIAL OF CHEST PHYSIOTHERAPY IN NON-CYSTIC FIBROSIS BRONCHIECTASIS EUROPEAN RESPIRATORY JOURNAL 34(5) PP1086-1092
bull NEWALL C STOCKLEY R AND HILL S (2005) EXERCISE TRAINING AND INSPIRATORY MUSCLE TRAINING IN PATIENTS WITH BRONCHIECTASIS THORAX 60(11) PP943-948
bull ONG H LEE A HILL C HOLLAND A AND DENEHY L (2011) EFFECTS OF PULMONARY REHABILITATION IN BRONCHIECTASIS A RETROSPECTIVE STUDY CHRONIC RESPIRATORY DISEASE 8(1) PP21-30
bull QUINT J MILLETT E JOSHI M NAVARATNAM V THOMAS S HURST J SMEETH L AND BROWN J (2015) CHANGES IN THE INCIDENCE PREVALENCE AND MORTALITY OF BRONCHIECTASIS IN THE UK FROM 2004 TO 2013 A POPULATION-BASED COHORT
STUDY EUROPEAN RESPIRATORY JOURNAL 47(1) PP186-193
bull SNIJDERS D FERNANDEZ DOMINGUEZ B CALGARO S BERTOZZI I ESCRIBANO MONTANER A PERILONGO G AND BARBATO A (2015) MUCOCILIARY CLEARANCE TECHNIQUES FOR TREATING NON-CYSTIC FIBROSIS BRONCHIECTASIS IS THERE
EVIDENCE INTERNATIONAL JOURNAL OF IMMUNOPATHOLOGY AND PHARMACOLOGY 28(2) PP150-159
MANUAL TECHNIQUES
bull PERCUSSION
bull VIBRATIONSHAKING
bull MANUAL ASSISTED COUGH
bull TRACHEAL PRESSURE
bull OVERPRESSURE
bull MANUALASSISTED AD
ACTIVE CYCLE OF BREATHING
Breathing control
3-5 Deep Breaths or TEE
with 3 sec inspiratory
hold
Breathing control
3-5 Deep Breaths or TEE
with 3 sec inspiratory
hold
Breathing control
2-3 FET huffs amp coughs
Clear mucus
Active Cycle
of Breathing
Technique
(ACBT)
AUTOGENIC DRAINAGE
bull JEAN CHEVALLIER 1967 IN BELGIUM
bull OBSERVED CHILDREN SLEEPING
bull LOW LV VrsquoS HIGH LVrsquoS
bull 3 PHASES OF BREATHING
bull LOW
bull MID
bull HIGH
bull MOVING FROM RESIDUAL VOLUME TO TOTAL LUNG CAPACITY
bull AIM TO GENERATE INCREASED EXPIRATORY AIRFLOW PROGRESSIVELY THROUGH EACH GENERATION OF BRONCHI
bull SECRETIONS LOOSEN AND MOVE INTO LARGER AIRWAYS TO AID EXPECTORATION
AD CONTrsquoD
bull METHOD bull DIAGNOSTIC BREATH WHERE ABLE
bull LOW FLOW ON INSPIRATION IE QUIET BREATH IN
bull FASTER EXPIRATORY FLOW
bull SPEED OF EXPIRATORY FLOW bull TRANSPORTS SECRETIONS
bull SHEARS SECRETIONS FROM BRONCHIAL WALL
bull COMBINE WITH TREATMENTS
bull BENEFICIAL IN PATIENTS WITH SIGNIFICANT HYPER-REACTIVITY amp
HAEMOPTYSIS
AD IN NMD
bull PASSIVE AD
bull THERAPIST CONTROLS DEPTH OF LUNG VOLUMES
bull SAME PRINCIPALS
bull OFTEN USED IN CONJUNCTION WITH PEP TO PREVENT SMALL AIRWAY COLLAPSE
bull DEMONSTRATION TO FOLLOW
bull EXHALATION AGAINST A CONSTANT POSITIVE PRESSURE
bull AIDS REMOVAL OF BRONCHIAL SECRETIONS
bull PREVENTING AIRWAY COLLAPSE BY STENTING THE AIRWAYS
bull RECRUITMENT OF PREVIOUSLY OBSTRUCTED AIRWAYS
bull IMPROVE VENTILATION REDUCE ATELECTASIS
bull INCREASING INTRATHORACIC PRESSURE DISTAL TO RETAINED SECRETIONS BY COLLATERAL VENTILATION OR BY INCREASING FRC
bull MAINTAIN PULMONARY FUNCTION
POSITIVE EXPIRATORY PRESSURE (PEP)
bull MASK VALVE RESISTOR amp MANOMETER
bull O2CAN BE CONNECTED TO THE INHALATION SIDE IF REQUIRED
bull SIT IN GOOD POSITION WITH GOOD SEAL AROUND MOUTHPIECEMASK
bull SLOW INHALATION JUST A LITTLE LARGER THAN A NORMAL BREATH IN
(HOLD FOR 3 SECS IF USING MOUTHPIECE)
bull STEADY ACTIVE amp FULL EXHALATION
bull AIM FOR 10-20 CM H2O FOR 3-5 SECS
bull REPEAT 12-15 TIMES FOLLOWED BY FET amp COUGH
bull COMPLETE FOR 15-30 MINS (6-8 CYCLES OR SETS OF ABOVE)
PEP TREATMENT
bull BEFORE OR AT LEAST 1 HR AFTER A FEED
bull START WITH THE SMALLEST HOLERESISTOR THAT BABY CAN TOLERATE
bull USE A MANOMETER
bull HOLD THE BABY IN ARMS OR ON PARENTS LAP SIT ON GYM BALL
bull PLACE THE MASK OVER THE BABYrsquoS MOUTH amp NOSE
bull AIM FOR FEW BREATHS 30-60 SECONDS WHICH CAN BE BUILT UP TO 1-2 MINUTES AS TOLERATED
bull AIM TO REACH PRESSURES BETWEEN 5-15 CM H2O
bull REST FOR 30-60 SECONDS THEN REPEAT FOR ABOUT 5-10 MINUTES
bull COMBINE THIS WITH OTHER TREATMENTS
BABY PEP TREATMENT
OSCILLATING PEP
OSCILLATING PEP
bull DEVICES CAN BE INTRA-THORACIC OR EXTRA-THORACIC
bull INTRA-THORACIC DEVICES ARE PLACED IN THE MOUTH AND PROVIDE RESISTANCE DURING EXHALATION
bull ALTERS EXPIRATORY AIRFLOW
bull VIBRATIONS ON THE AIRWAY SURFACE
bull REDUCES MUCOUS VISCOSITY
bull ACCELERATION OF THE EXPIRATORY FLOW
bull PREVENTS AND TREATS AIRWAY COMPRESSION ATELECTASIS
bull IMPROVES AIRWAY PATENCY amp VENTILATION
bull DECREASES HYPERINFLATION
bull IMPROVES LUNG FUNCTION PARAMETERS
bull INCLUDES EXERCISE
OSCILLATING PEP TREATMENT
bull SIMILAR TO PEP
bull GOOD POSITION
bull PLACE MOUTHPIECE BETWEEN LIPS AND TEETH OR USE MASK
bull SLOW INHALE JUST A LITTLE LARGER THAN A NORMAL BREATH IN
bull HOLD FOR 3 SECONDS
bull STEADY ACTIVE amp FULL EXHALATION
bull ADJUST THE RESISTANCE AS REQUIRED
bull REPEAT 12-15 TIMES FOLLOWED BY FET amp COUGH
bull COMPLETE FOR 5-10 MINS
bull COMBINE WITH OTHER TREATMENTS
ACAPELLA
bull DETACHABLE MOUTHPIECEFACEMASK
bull ONE-WAY INSPIRATORY VALVE
bull EXPIRATORY RESISTANCEFREQUENCY ADJUSTMENT DIAL
bull COUNTERWEIGHTED PLUG amp MAGNET
bull MAINTAINS A RAISED FRC LEVEL
TREATMENT
bull EASY TO USE IN DIFFERENT POSITIONS
bull INHALE amp EXHALE THROUGH THE ACAPELLA
bull ROTATE THE FREQUENCY RESISTANCE DIAL UNTIL MAXIMUM VIBRATIONS ARE FELT WITHIN THE CHEST WALL
AEROBIKA bull COMBINES PEP WITH HIGH FREQUENCY OSCILLATIONS
bull CAN BE USED WITH A MANOMETER
bull NEBULISER CAN BE ENTRAINED INTO THE SYSTEM
bull POSSIBLE INCREASE IN TREATMENT COMPLIANCE BY DECREASING
TREATMENT TIMES
TECHNIQUE AS OSCILLATING PEP
BUBBLE PEP
Suction tubing (~1cm diameter) The end MUST sit at the bottom of the bottle
Plastic bottle Any widthshapediameter must be gt20cm tall 15cm fresh tapsterile water
(depth of water determines the amount of pressure ie cm H20
Washing up bowl
INDICATIONS
bull REDUCED LUNG VOLUME (FVClt50)
bull WEAK COUGH (PCFlt270)
bull SECRETIONS RETENTION
bull ATELECTASIS
bull REDUCED MECHANICAL COMPLIANCE
bull CHILD ABLE TO COMPLY
BENEFITS
bull INCREASE LUNG VOLUME = IMPROVES PCF
bull SECRETION CLEARANCE
bull MAY REVERSE ATELECTASIS
bull IMPROVE MECHANICAL COMPLIANCE = LUNG AND CHEST WALL MOBILITY
bull IMPROVE VOICE STRENGTH
LUNG VOLUME RECRUITMENT
bull LABEL NOT FOR RESUSCITATION
bull BEST IN SITTING
bull SUCTION READY
bull AGREE SIGNAL WITH CHILD WHEN MIC ACHIEVED
bull ASK TO BREATH OUT
bull PLACE MOUTHPIECE +- NOSE CLIP OR MASK
bull ASK TO BREATH IN AND HOLD WHILE GENTLY SQUEEZING BAG
bull WITHOUT LETTING AIR OUT ASK CHILD TO TAKE ANOTHER BREATH IN ON TOP OF THE FIRST BREATH AND SQUEEZE BAG IN TIME WITH BREATH
bull REPEAT UNTIL LUNGS ARE FULL (NORMALLY 3-5 BREATHS) OR SIGNAL
bull REMOVE MASK OR MOUTHPIECE ASK TO HOLD FOR 3-5 SECONDS
bull EXHALE OR IF SECRETIONS ARE PRESENT ENCOURAGE TO HAVE A COUGH OR MAC
bull REPEATED X3-5 X2-4 DAY
LVR TREATMENT
bull AIRWAY CLEARANCE OR THORACIC MOBILITY
bull AMBU RESUS BAG
bull GREEN ldquoPHYSIOrdquo BAG
bull MANUAL TECHNIQUES WITH BAGGING
bull MHI AT HOME
bull MANOMETERS
MHI
PHYSIO WITH NIV
bull PHYSIO SETTINGS
bull SECRETIONS
bull THORACIC MOBILITY
bull ALLOWS REST PERIOD PRE ACT
bull HUMIDIFICATION
bull INFLATABLE VEST CONNECTED BY TUBES TO AN AIR PULSE GENERATOR WHICH RAPIDLY INFLATES AND DEFLATES THE VEST PRODUCING OSCILLATIONS TO THE CHEST WALL
bull RAPID CHEST MOVEMENT MIMICS A COUGH-LIKE EXPIRATORY FLOW THAT SHEARS MUCUS AWAY FROM THE AIRWAY WALLS AND HELPS TO MOVE IT ALONG TO THE CENTRAL AIRWAYS
bull PASSIVE TREATMENT amp NOT POSITION DEPENDANT
bull COMBINATION OF RX
bull CONTRAINDICATIONS
bull HEAD ANDOR NECK INJURY THAT HAS NOT BEEN STABILISED
bull ACTIVE HAEMORRHAGE WITH HEMODYNAMIC INSTABILITY
HFCWO
HFCWO INDICATIONS
bull CHRONIC MUCUS HYPERSECRETION OR RETENTION ASSOCIATED WITH A CHRONIC PULMONARY OR NEUROMUSCULAR CONDITION
bull LRT SECRETIONS AND FREQUENT LRTI REQUIRING HOSPITAL ADMISSION
bull INEFFECTIVE COUGH OR INABILITY TO REMOVE MUCUS BY COUGHING
bull TENACIOUS SECRETIONS THAT ARE NOT EASILY MOBILISED WITH STANDARD CPT
bull MECHANICALLY VENTILATED WITH EVIDENCE OF SECRETION RETENTION
bull ALTERNATIVE AIRWAY CLEARANCE THERAPY PROVEN INEFFECTIVE OR CONTRAINDICATEDDO NOT TOLERATE STANDARD CPT
bull CONSTANT FATIGUE LACK OF STRENGTH OR ABILITY TO PERFORM ACTIVE TREATMENT
bull SYMPTOMATIC
bull POOR COMPLIANCE WITH OTHER AIRWAY CLEARANCE METHODS
bull HIGH BURDEN OF CARE
bull PATIENT UNABLE TO TOLERATE THE INCREASED WORK OF BREATHING bull ACTIVE HAEMOPTYSIS bull UNTREATED PNEUMOTHORAX bull INTRACRANIAL PRESSURE (ICP) gt 20 MMHG bull HAEMODYNAMIC INSTABILITY bull SEVERE CARDIOVASCULAR INSULTDISEASE bull RECENT FACIAL ORAL OR SKULL SURGERY OR TRAUMA bull ACUTE SINUSITIS bull EPISTAXIS bull POST OESOPHAGEAL amp LUNG SURGERY bull KNOWN OR SUSPECTED TYMPANIC MEMBRANE RUPTURE OR OTHER MIDDLE EAR
PATHOLOGY
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
POSSIBLE HAZARDSCOMPLICATIONS
bull INCREASED WORK OF BREATHING THAT MAY LEAD TO HYPOVENTILATION AND
HYPERCARBIA
bull INCREASED INTRACRANIAL PRESSURE
bull CARDIOVASCULAR COMPROMISE
bull NAUSEA
bull MYOCARDIAL ISCHEMIA
bull DECREASED VENOUS RETURN
bull AIR SWALLOWING WITH INCREASED LIKELIHOOD OF VOMITING AND
ASPIRATION
bull CLAUSTROPHOBIA
bull SKIN BREAK DOWN AND DISCOMFORT FROM MASK
bull PULMONARY BAROTRAUMA
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
MI-E
bull USED WITH CHILDREN WHO HAVE DECREASED INSPIRATORY EFFORT DUE TO EITHER SPINAL CORD INJURY OR NMW AND WHO HAVE AN IMPAIRED OR INEFFECTIVE COUGH WITH APPROPRIATE RESPIRATORY SYMPTOMS
bull CONSIDERED WHEN CONVENTIONAL COUGH ASSISTANCE TECHNIQUES BECOME INEFFECTIVE
bull ACCEPTED AS THE CORE STANDARD FOR CHILD WITH NMW
bull MIE WORKS BY
bull INFLATING THE LUNGS WITH GRADUAL POSITIVE AIRWAY PRESSURE ASSISTING INSPIRATION CALLED INSUFFLATION
bull FOLLOWED BY A RAPID SWITCH TO NEGATIVE PRESSURE WHICH SIMULATES THE FLOW CHANGES THAT OCCUR DURING A COUGH THEREBY ENHANCING EXPIRATORY FLOW CALLED EXSUFFLATION AND ASSISTING EXPECTORATION OF SECRETIONS
bull MOVEMENT AND EXERCISE BEST FUNCTIONAL METHOD OF AIRWAY CLEARANCE
bull CPET BETTER CORRELATION THAN LUNG FUNCTION IN SURVIVAL RATES IN PEOPLE WITH
CYSTIC FIBROSIS
bull RUNNINGWALKING BETTER FOR SECRETION CLEARANCE THAN BIKE DURING TO SHEARING
MECHANISM
bull CONSIDER ADDING IN HUFFS (DYER)
bull CONSIDER USE OF AD BELT
EXERCISE
bull APCP SUCTION GUIDELINES
bull TYPESNASOPHARANGEAL OROPHARANGEAL AND TRACHEOSTOMY
bull MAIN VARIABLES SUCTION TYPE AND SIZE DEPTH OF SUCTION
PRESSURE TECHNIQUE
SUCTION
SPUTUM
bull SPUTUM bull 95 WATER bull COLOUR bull VOLUME bull CONSISTENCY bull ODOUR
bull PURPOSE bull HUMIDIFICATION bull WATERPROOFING bull PROTECTION OF EPITHELIUM
HUMIDIFICATION
bull METABOLIC AND VENTILATORY REQUIREMENTS ARE X2-3 OF ADULTS
IMPLICATION
bull HEAT AND MOISTURE LOSSES FROM RESPIRATION WILL INCREASE BY X2-3
bull CONSUME GREATER AMOUNTS OF ENERGY AND WATER
HUMIDIFICATION INHALATION
THERAPY
bull TRACHEOSTOMY HME
bull WET DRY CIRCUIT
bull NEBULISERS INHALERS MUCOLYTICS
bull HUMIDIFIERS WITH NIV
bull OXYGEN
bull SYSTEMIC HYDRATION ENVIRONMENT
NEBULISERS
bull NEBULISER CHAMBER CONVERTS LIQUID INTO
RESPIRABLE PARTICLES
bull MOISTURE DESCENDS THROUGH THE HOLES IN THE SUPERFICIAL GEL LAYER
bull INCREASES THE SOL LAYER SO THE CILIARY BEAT IS OPTIMAL FOR MUCUS TRANSPORT
bull SHORT TERM HUMIDIFICATION
bull DAILY WASHING OF NEBULISER SYSTEM
TIMING OF DRUG AND PHYSIOTHERAPY
BEFORE TREATMENT
bull DNASE (PULMOZYME)
bull SALBUTAMOL
(VENTOLIN BLUE)
bull SALINE NEBS
AFTER TREATMENT
bull SERETIDE (PURPLE)
bull BECLOMETHASONE (BECOTIDE BROWN)
bull COLISTIN (COLOMYCIN PROMIXIN)
bull TOBRAMYCIN
CONCLUSION
bull BE AWARE OF CHILDrsquoS RESPIRATORY FUNCTION
bull CHOSE ACT BEST FOR THEM bull TYPE OF KETCHUP BOTTLE bull LV SECRETION RETENTION WOB
bull EARLY RESPIRATORY REFERRAL
bull RESPIRATORY CARE COMPETENCIES
bull EFFECTIVE SECRETION CLEARANCE AT HOMERESPITESCHOOL
bull USE OF PEAK COUGH FLOWS TO AID CHOICE OF ADJUNCT
0
50
100
150
200
250
300
350
400
0
50
100
150
200
250
300
350
400
Green
Key
Additional info
(please comment) Please refer to BTSACPRC Guideline
Lothian University Hospitals NHS Trust
n PCF
gt270lmin
Breathstack
ing tri-
flow
blowing
REFERENCES bull BTSACPRC GUIDELINE IS PUBLISHED IN THORAX VOL 67 SUPPLEMENT 1
bull AVAILABLE ONLINE AT HTTPTHORAXBMJCOMCONTENTVOL64ISSUESUPPLI
bull HTTPWWWBRIT-THORACICORGUKPHYSIOGUIDE
bull BRITISH THORACIC SOCIETY REPORTS VOL 1 NO 1 2009
bull ADAPTED PRYOR AJ AND PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS3RD ED
bull HOUGH A PHYSIOTHERAPY IN RESPIRATORY CARE LONDON CHAPMAN AND HALL 1993
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1997) POSTURAL DRAINAGE AND GASTRO-OESOPHAGEAL REFLUX IN INFANTS WITH CYSTIC FIBROSIS ARCHIVES OF DISEASE IN CHILDHOOD 76 148-150
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1998) POSTURAL DRAINAGE IN CYSTIC FIBROSIS IS THERE A LINK WITH GASTRO-OESOPHAGEAL REFLUX JOURNAL OF PAEDIATRIC CHILD HEALTH 34 330-334
bull CECINS NM JENKINS SC PENGELLEY J ET AL (1999) THE ACTIVE CYCLE OF BREATHING TECHNIQUES-TO TIP OR NOT TO TIP RESPIRATORY MEDICINE 93 660-665
bull CONSTANTINI D BRIVIO A BRUSA D ET AL (2001) PEP MASK VERSUS POSTURAL DRAINAGE IN INFANTS A LONG-TERM COMPARATIVE TRIAL PEADIATRIC PULMONOLOGY
bull HOUGH A (2001) PHYSIOTHERAPY IN RESPIRATORY CARE AN EVIDENCE-BASED APPROACH TO RESPIRATORY AND CARDIAC MANAGEMENT CENGAGE LEARNING EMEA
bull INTERNATIONAL PHYSIOTHERAPY GROUP FOR CYSTIC FIBROSIS PHYSIOTHERAPY IN THE TREATMENT OF CYSTIC FIBROSIS (2009) HTTPSWWWECFSEUIPG_CFBOOKLET INTERNATIONAL PHYSIOTHERAPY GROUP ndash THE BLUE BOOKLET
bull KONSTAN MW STERN RC DOERSHUK CF (1994) EFFICACY OF THE FLUTTER DEVICE FOR AIRWAY MUCUS CLEARANCE IN PATIENTS WITH CYSTIC FIBROSIS JOURNAL OF PEDIATRICS 124 (5 (PT 1) 689-693
bull MCILWAINE M BUTTON B AND DWAN K (2015) POSITIVE EXPIRATORY PRESSURE PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 6 ART NO CD003147 DOI 10100214651858CD003147PUB4
bull MESTRINER RG FERNANDES RO STAFFEN LC ET AL (2009) OPTIMUM DESIGN PARAMETERS FOR A THERAPIST-CONSTRUCTED POSITIVE-EXPIRATORY-PRESSURE THERAPY BOTTLE DEVICE RESPIRATORY CARE 54 504-8
bull MORRISON L AND AGNEW J (2014) OSCILLATING DEVICES FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 7 ART NO CD006842 DOI 10100214651858CD006842PUB
bull OERMANN CM SOCKRIDER MM GILES D ET AL (2001) COMPARISON OF HIGH-FREQUENCY CHEST WALL OSCILLATION AND OSCILLATING POSITIVE EXPIRATORY PRESSURE IN THE HOME MANAGEMENT OF CYSTIC FIBROSIS A PILOT STUDY PEDIATRIC PULMONOLOGY 32 (5) 372-7
bull PRASAD SA AND HUSSEY J (1995) PAEDIATRIC RESPIRATORY CARE A GUIDE FOR PHYSIOTHERAPISTS AND HEALTH PROFESSIONALS CHAPMAN amp HALL
bull PRYOR J (1999) PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN ADULTS EUROPEAN RESPIRATORY JOURNAL 14 (6) 1418-1424
bull PRYOR JA amp PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS CHURCHILL LIVINGSTONE
bull PRYOR JA WEBBER BA HODSON ME ET AL (1994) THE FLUTTER VRP1 AS AN ADJUNCT TO CHEST PHYSIOTHERAPY IN CYSTIC FIBROSIS RESPIRATORY MEDICINE 88677-81
bull WEST K WALLEN M FOLLETT J (2010) ACAPELLA VS PEP MASK THERAPY A RANDOMISED TRIAL IN CHILDREN WITH CYSTIC FIBROSIS DURING RESPIRATORY EXACERBATION PHYSIOTHERAPY THEORY PRACTICE 26143-9
bull WILSONLM AGNEW J MORRISON L ET AL (2014) AIRWAY CLEARANCE TECHNIQUES FOR CYSTIC FIBROSIS AN OVERVIEW OF COCHRANE SYSTEMATIC REVIEWS COCHRANE DATABASE OF SYSTEMATIC REVIEWS DOI 10100214651858CD011231
bull VOLSKO TA DIFIORE JM CHATBURN RL (2003) PERFORMANCE COMPARISON OF TWO OSCILLATORY POSITIVE PRESSURE DEVICES ACAPELLA VERSUS FLUTTER RESPIRATORY CARE 48 (2) 124- 130
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SEDDON PC KHAN Y RESPIRATORY PROBLEMS IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT ARCHIVES OF DISEASE IN CHILDHOOD 2003 01 JAN88(1)75-8
bull MARKS JH PULMONARY CARE OF CHILDREN AND ADOLESCENTS WITH DEVELOPMENTAL DISABILITIES PEDIATR CLIN NORTH AM 2008 DECEMBER55(6)1299-314
bull ARENS R MUZUMDAR H SLEEP SLEEP DISORDERED BREATHING AND NOCTURNAL HYPOVENTILATION IN CHILDREN WITH NEUROMUSCULAR DISEASES PAEDIATRIC RESPIRATORY REVIEWS 2010 MAR11(1)24-30
bull FITZGERALD DA FOLLETT J VAN ASPEREN PP ASSESSING AND MANAGING LUNG DISEASE AND SLEEP DISORDERED BREATHING IN CHILDREN WITH CEREBRAL PALSY PAEDIATRIC RESPIRATORY REVIEWS 2009 MARCH10(1)18-24
bull HSIAO KH NIXON GM THE EFFECT OF TREATMENT OF OBSTRUCTIVE SLEEP APNEA ON QUALITY OF LIFE IN CHILDREN WITH CEREBRAL PALSY RES DEV DISABIL 2008 MAR-APR29(2)133-40
bull LUNDBERG A OXYGEN CONSUMPTION IN RELATION TO WORKLOAD IN STUDENTS WITH CEREBRAL PALSY J APPL PHYSIO 197640873-5
bull SULLIVAN PB ROSENBLOOM L FEEDING THE DISABLED CHILD CLINICS IN DEVELOPMENTAL MEDICINE MACKEITH PRESS 1999140
bull MARTIN TR THE RELATIONSHIP BETWEEN MALNUTRITION AND LUNG INFECTIONS CLIN CHEST MED 19878359
bull MOSTAFA SM BHANDARI S RITCHIE G ET AL CONSTIPATION AND ITS IMPLICATIONS IN THE CRITICALLY ILL PATIENT BR J ANAESTH 200391815-9 3
bull GACOUIN A CAMUS C GROS A ET AL CONSTIPATION IN LONGTERM VENTILATED PATIENTS ASSOCIATED FACTORS AND IMPACT ON INTENSIVE CARE UNIT OUTCOMES CRIT CARE MED 2010381933- 8
bull NGUYEN T FRENETTE AJ JOHANSON C ET AL IMPAIRED GASTROINTESTINAL TRANSIT AND ITS ASSOCIATED MORBIDITY IN THE INTENSIVE CARE UNIT J CRIT CARE 201328537
bull ASAI T CONSTIPATION DOES IT INCREASE MORBIDITY AND MORTALITY IN CRITICALLY ILL PATIENTS CRIT CARE MED 2007352861-2
bull UNDERSTANDING THE PHYSIOLOGICAL EFFECTS OF UNTREATED PAIN NURSING TIMES VOL 99 ISSUE 37 PAGE NO 28
bull WINFIELD ET AL NON-PHARMACEUTICAL MANAGEMENT OF RESPIRATORY MORBIDITY IN CHILDREN WITH SEVERE GLOBAL DEVELOPMENTAL DELAY THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014
bull OLOUGHLIN EV SOMERVILLE HM SOMERVILLE ER DEALING WITH MULTISYSTEM DISEASE IN PEOPLE WITH A DEVELOPMENTAL DISABILITY MEDICAL JOURNAL OF AUSTRALIA 2009 JUN 1190(11)616-7
bull MESTROVIC J KARDUM G POLIC B MESTROVIC M MARKIC J SUSTIC A ET AL THE INFLUENCE OF CHRONIC HEALTH CONDITIONS ON SUSCEPTIBILITY TO SEVERE ACUTE ILLNESS OF CHILDREN TREATED IN PICU EUROPEAN JOURNAL OF PEDIATRICS 2006 AUG165(8)526-
9
bull HEALY F PANITCH HB PULMONARY COMPLICATIONS OF PEDIATRIC NEUROLOGICAL DISEASES PEDIATR ANN 2010 APR39(4)216-24
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SRIVASTAVA R JACKSON WD BARNHART DC DYSPHAGIA AND GASTROESOPHAGEAL REFLUX DISEASE DILEMMAS IN DIAGNOSIS AND MANAGEMENT IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT PEDIATR ANN 2010 APR39(4)225-31
bull SULLIVAN PB JUSZCZAK E BACHLET AME LAMBERT B VERNON-ROBERTS A GRANT HW ET AL GASTROSTOMY TUBE FEEDING IN CHILDREN WITH CEREBRAL PALSY A PROSPECTIVE LONGITUDINAL STUDY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 2005
FEBRUARY47(2)77-85
bull SOMERVILLE H TZANNES G WOOD J SHUN A HILL C ARROWSMITH F ET AL GASTROINTESTINAL AND NUTRITIONAL PROBLEMS IN SEVERE DEVELOPMENTAL DISABILITY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 200850(9)712-6
bull TODER DS RESPIRATORY PROBLEMS IN THE ADOLESCENT WITH DEVELOPMENTAL DELAY ADOLESCENT MEDICINE 2000 3 OCTOBER 200011(3)617-31
bull LEVIN K COLON A DIPALMA J FITZPATRICK S USING THE RADIONUCLIDE SALIVAGRAM TO DETECT PULMONARY ASPIRATION AND ESOPHAGEAL DYSMOTILITY CLIN NUCL MED 1993 FEB18(2)110-4
bull SCHROEDER AS KLING T HUSS K BORGGRAEFE I KOERTE IK BLASCHEK A ET AL BOTULINUM TOXIN TYPE A AND B FOR THE REDUCTION OF HYPERSALIVATION IN CHILDREN WITH NEUROLOGICAL DISORDERS A FOCUS ON EFFECTIVENESS AND THERAPY ADHERENCE
NEUROPEDIATRICS 201243(1)27-36
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull GOEMINNE P AND DUPONT L (2010) NON-CYSTIC FIBROSIS BRONCHIECTASIS DIAGNOSIS AND MANAGEMENT IN 21ST CENTURY POSTGRADUATE MEDICAL JOURNAL 86(1018) PP493-501
bull LEE A BUTTON B AND TANNENBAUM E (2017) AIRWAY-CLEARANCE TECHNIQUES IN CHILDREN AND ADOLESCENTS WITH CHRONIC SUPPURATIVE LUNG DISEASE AND BRONCHIECTASIS FRONTIERS IN PEDIATRICS 5
bull MANDAL P SIDHU M KOPE L POLLOCK W STEVENSON L PENTLAND J TURNBULL K MAC QUARRIE S AND HILL A (2012) A PILOT STUDY OF PULMONARY REHABILITATION AND CHEST PHYSIOTHERAPY VERSUS CHEST PHYSIOTHERAPY ALONE IN
BRONCHIECTASIS RESPIRATORY MEDICINE 106(12) PP1647-1654
bull MURRAY M PENTLAND J AND HILL A (2009) A RANDOMISED CROSSOVER TRIAL OF CHEST PHYSIOTHERAPY IN NON-CYSTIC FIBROSIS BRONCHIECTASIS EUROPEAN RESPIRATORY JOURNAL 34(5) PP1086-1092
bull NEWALL C STOCKLEY R AND HILL S (2005) EXERCISE TRAINING AND INSPIRATORY MUSCLE TRAINING IN PATIENTS WITH BRONCHIECTASIS THORAX 60(11) PP943-948
bull ONG H LEE A HILL C HOLLAND A AND DENEHY L (2011) EFFECTS OF PULMONARY REHABILITATION IN BRONCHIECTASIS A RETROSPECTIVE STUDY CHRONIC RESPIRATORY DISEASE 8(1) PP21-30
bull QUINT J MILLETT E JOSHI M NAVARATNAM V THOMAS S HURST J SMEETH L AND BROWN J (2015) CHANGES IN THE INCIDENCE PREVALENCE AND MORTALITY OF BRONCHIECTASIS IN THE UK FROM 2004 TO 2013 A POPULATION-BASED COHORT
STUDY EUROPEAN RESPIRATORY JOURNAL 47(1) PP186-193
bull SNIJDERS D FERNANDEZ DOMINGUEZ B CALGARO S BERTOZZI I ESCRIBANO MONTANER A PERILONGO G AND BARBATO A (2015) MUCOCILIARY CLEARANCE TECHNIQUES FOR TREATING NON-CYSTIC FIBROSIS BRONCHIECTASIS IS THERE
EVIDENCE INTERNATIONAL JOURNAL OF IMMUNOPATHOLOGY AND PHARMACOLOGY 28(2) PP150-159
ACTIVE CYCLE OF BREATHING
Breathing control
3-5 Deep Breaths or TEE
with 3 sec inspiratory
hold
Breathing control
3-5 Deep Breaths or TEE
with 3 sec inspiratory
hold
Breathing control
2-3 FET huffs amp coughs
Clear mucus
Active Cycle
of Breathing
Technique
(ACBT)
AUTOGENIC DRAINAGE
bull JEAN CHEVALLIER 1967 IN BELGIUM
bull OBSERVED CHILDREN SLEEPING
bull LOW LV VrsquoS HIGH LVrsquoS
bull 3 PHASES OF BREATHING
bull LOW
bull MID
bull HIGH
bull MOVING FROM RESIDUAL VOLUME TO TOTAL LUNG CAPACITY
bull AIM TO GENERATE INCREASED EXPIRATORY AIRFLOW PROGRESSIVELY THROUGH EACH GENERATION OF BRONCHI
bull SECRETIONS LOOSEN AND MOVE INTO LARGER AIRWAYS TO AID EXPECTORATION
AD CONTrsquoD
bull METHOD bull DIAGNOSTIC BREATH WHERE ABLE
bull LOW FLOW ON INSPIRATION IE QUIET BREATH IN
bull FASTER EXPIRATORY FLOW
bull SPEED OF EXPIRATORY FLOW bull TRANSPORTS SECRETIONS
bull SHEARS SECRETIONS FROM BRONCHIAL WALL
bull COMBINE WITH TREATMENTS
bull BENEFICIAL IN PATIENTS WITH SIGNIFICANT HYPER-REACTIVITY amp
HAEMOPTYSIS
AD IN NMD
bull PASSIVE AD
bull THERAPIST CONTROLS DEPTH OF LUNG VOLUMES
bull SAME PRINCIPALS
bull OFTEN USED IN CONJUNCTION WITH PEP TO PREVENT SMALL AIRWAY COLLAPSE
bull DEMONSTRATION TO FOLLOW
bull EXHALATION AGAINST A CONSTANT POSITIVE PRESSURE
bull AIDS REMOVAL OF BRONCHIAL SECRETIONS
bull PREVENTING AIRWAY COLLAPSE BY STENTING THE AIRWAYS
bull RECRUITMENT OF PREVIOUSLY OBSTRUCTED AIRWAYS
bull IMPROVE VENTILATION REDUCE ATELECTASIS
bull INCREASING INTRATHORACIC PRESSURE DISTAL TO RETAINED SECRETIONS BY COLLATERAL VENTILATION OR BY INCREASING FRC
bull MAINTAIN PULMONARY FUNCTION
POSITIVE EXPIRATORY PRESSURE (PEP)
bull MASK VALVE RESISTOR amp MANOMETER
bull O2CAN BE CONNECTED TO THE INHALATION SIDE IF REQUIRED
bull SIT IN GOOD POSITION WITH GOOD SEAL AROUND MOUTHPIECEMASK
bull SLOW INHALATION JUST A LITTLE LARGER THAN A NORMAL BREATH IN
(HOLD FOR 3 SECS IF USING MOUTHPIECE)
bull STEADY ACTIVE amp FULL EXHALATION
bull AIM FOR 10-20 CM H2O FOR 3-5 SECS
bull REPEAT 12-15 TIMES FOLLOWED BY FET amp COUGH
bull COMPLETE FOR 15-30 MINS (6-8 CYCLES OR SETS OF ABOVE)
PEP TREATMENT
bull BEFORE OR AT LEAST 1 HR AFTER A FEED
bull START WITH THE SMALLEST HOLERESISTOR THAT BABY CAN TOLERATE
bull USE A MANOMETER
bull HOLD THE BABY IN ARMS OR ON PARENTS LAP SIT ON GYM BALL
bull PLACE THE MASK OVER THE BABYrsquoS MOUTH amp NOSE
bull AIM FOR FEW BREATHS 30-60 SECONDS WHICH CAN BE BUILT UP TO 1-2 MINUTES AS TOLERATED
bull AIM TO REACH PRESSURES BETWEEN 5-15 CM H2O
bull REST FOR 30-60 SECONDS THEN REPEAT FOR ABOUT 5-10 MINUTES
bull COMBINE THIS WITH OTHER TREATMENTS
BABY PEP TREATMENT
OSCILLATING PEP
OSCILLATING PEP
bull DEVICES CAN BE INTRA-THORACIC OR EXTRA-THORACIC
bull INTRA-THORACIC DEVICES ARE PLACED IN THE MOUTH AND PROVIDE RESISTANCE DURING EXHALATION
bull ALTERS EXPIRATORY AIRFLOW
bull VIBRATIONS ON THE AIRWAY SURFACE
bull REDUCES MUCOUS VISCOSITY
bull ACCELERATION OF THE EXPIRATORY FLOW
bull PREVENTS AND TREATS AIRWAY COMPRESSION ATELECTASIS
bull IMPROVES AIRWAY PATENCY amp VENTILATION
bull DECREASES HYPERINFLATION
bull IMPROVES LUNG FUNCTION PARAMETERS
bull INCLUDES EXERCISE
OSCILLATING PEP TREATMENT
bull SIMILAR TO PEP
bull GOOD POSITION
bull PLACE MOUTHPIECE BETWEEN LIPS AND TEETH OR USE MASK
bull SLOW INHALE JUST A LITTLE LARGER THAN A NORMAL BREATH IN
bull HOLD FOR 3 SECONDS
bull STEADY ACTIVE amp FULL EXHALATION
bull ADJUST THE RESISTANCE AS REQUIRED
bull REPEAT 12-15 TIMES FOLLOWED BY FET amp COUGH
bull COMPLETE FOR 5-10 MINS
bull COMBINE WITH OTHER TREATMENTS
ACAPELLA
bull DETACHABLE MOUTHPIECEFACEMASK
bull ONE-WAY INSPIRATORY VALVE
bull EXPIRATORY RESISTANCEFREQUENCY ADJUSTMENT DIAL
bull COUNTERWEIGHTED PLUG amp MAGNET
bull MAINTAINS A RAISED FRC LEVEL
TREATMENT
bull EASY TO USE IN DIFFERENT POSITIONS
bull INHALE amp EXHALE THROUGH THE ACAPELLA
bull ROTATE THE FREQUENCY RESISTANCE DIAL UNTIL MAXIMUM VIBRATIONS ARE FELT WITHIN THE CHEST WALL
AEROBIKA bull COMBINES PEP WITH HIGH FREQUENCY OSCILLATIONS
bull CAN BE USED WITH A MANOMETER
bull NEBULISER CAN BE ENTRAINED INTO THE SYSTEM
bull POSSIBLE INCREASE IN TREATMENT COMPLIANCE BY DECREASING
TREATMENT TIMES
TECHNIQUE AS OSCILLATING PEP
BUBBLE PEP
Suction tubing (~1cm diameter) The end MUST sit at the bottom of the bottle
Plastic bottle Any widthshapediameter must be gt20cm tall 15cm fresh tapsterile water
(depth of water determines the amount of pressure ie cm H20
Washing up bowl
INDICATIONS
bull REDUCED LUNG VOLUME (FVClt50)
bull WEAK COUGH (PCFlt270)
bull SECRETIONS RETENTION
bull ATELECTASIS
bull REDUCED MECHANICAL COMPLIANCE
bull CHILD ABLE TO COMPLY
BENEFITS
bull INCREASE LUNG VOLUME = IMPROVES PCF
bull SECRETION CLEARANCE
bull MAY REVERSE ATELECTASIS
bull IMPROVE MECHANICAL COMPLIANCE = LUNG AND CHEST WALL MOBILITY
bull IMPROVE VOICE STRENGTH
LUNG VOLUME RECRUITMENT
bull LABEL NOT FOR RESUSCITATION
bull BEST IN SITTING
bull SUCTION READY
bull AGREE SIGNAL WITH CHILD WHEN MIC ACHIEVED
bull ASK TO BREATH OUT
bull PLACE MOUTHPIECE +- NOSE CLIP OR MASK
bull ASK TO BREATH IN AND HOLD WHILE GENTLY SQUEEZING BAG
bull WITHOUT LETTING AIR OUT ASK CHILD TO TAKE ANOTHER BREATH IN ON TOP OF THE FIRST BREATH AND SQUEEZE BAG IN TIME WITH BREATH
bull REPEAT UNTIL LUNGS ARE FULL (NORMALLY 3-5 BREATHS) OR SIGNAL
bull REMOVE MASK OR MOUTHPIECE ASK TO HOLD FOR 3-5 SECONDS
bull EXHALE OR IF SECRETIONS ARE PRESENT ENCOURAGE TO HAVE A COUGH OR MAC
bull REPEATED X3-5 X2-4 DAY
LVR TREATMENT
bull AIRWAY CLEARANCE OR THORACIC MOBILITY
bull AMBU RESUS BAG
bull GREEN ldquoPHYSIOrdquo BAG
bull MANUAL TECHNIQUES WITH BAGGING
bull MHI AT HOME
bull MANOMETERS
MHI
PHYSIO WITH NIV
bull PHYSIO SETTINGS
bull SECRETIONS
bull THORACIC MOBILITY
bull ALLOWS REST PERIOD PRE ACT
bull HUMIDIFICATION
bull INFLATABLE VEST CONNECTED BY TUBES TO AN AIR PULSE GENERATOR WHICH RAPIDLY INFLATES AND DEFLATES THE VEST PRODUCING OSCILLATIONS TO THE CHEST WALL
bull RAPID CHEST MOVEMENT MIMICS A COUGH-LIKE EXPIRATORY FLOW THAT SHEARS MUCUS AWAY FROM THE AIRWAY WALLS AND HELPS TO MOVE IT ALONG TO THE CENTRAL AIRWAYS
bull PASSIVE TREATMENT amp NOT POSITION DEPENDANT
bull COMBINATION OF RX
bull CONTRAINDICATIONS
bull HEAD ANDOR NECK INJURY THAT HAS NOT BEEN STABILISED
bull ACTIVE HAEMORRHAGE WITH HEMODYNAMIC INSTABILITY
HFCWO
HFCWO INDICATIONS
bull CHRONIC MUCUS HYPERSECRETION OR RETENTION ASSOCIATED WITH A CHRONIC PULMONARY OR NEUROMUSCULAR CONDITION
bull LRT SECRETIONS AND FREQUENT LRTI REQUIRING HOSPITAL ADMISSION
bull INEFFECTIVE COUGH OR INABILITY TO REMOVE MUCUS BY COUGHING
bull TENACIOUS SECRETIONS THAT ARE NOT EASILY MOBILISED WITH STANDARD CPT
bull MECHANICALLY VENTILATED WITH EVIDENCE OF SECRETION RETENTION
bull ALTERNATIVE AIRWAY CLEARANCE THERAPY PROVEN INEFFECTIVE OR CONTRAINDICATEDDO NOT TOLERATE STANDARD CPT
bull CONSTANT FATIGUE LACK OF STRENGTH OR ABILITY TO PERFORM ACTIVE TREATMENT
bull SYMPTOMATIC
bull POOR COMPLIANCE WITH OTHER AIRWAY CLEARANCE METHODS
bull HIGH BURDEN OF CARE
bull PATIENT UNABLE TO TOLERATE THE INCREASED WORK OF BREATHING bull ACTIVE HAEMOPTYSIS bull UNTREATED PNEUMOTHORAX bull INTRACRANIAL PRESSURE (ICP) gt 20 MMHG bull HAEMODYNAMIC INSTABILITY bull SEVERE CARDIOVASCULAR INSULTDISEASE bull RECENT FACIAL ORAL OR SKULL SURGERY OR TRAUMA bull ACUTE SINUSITIS bull EPISTAXIS bull POST OESOPHAGEAL amp LUNG SURGERY bull KNOWN OR SUSPECTED TYMPANIC MEMBRANE RUPTURE OR OTHER MIDDLE EAR
PATHOLOGY
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
POSSIBLE HAZARDSCOMPLICATIONS
bull INCREASED WORK OF BREATHING THAT MAY LEAD TO HYPOVENTILATION AND
HYPERCARBIA
bull INCREASED INTRACRANIAL PRESSURE
bull CARDIOVASCULAR COMPROMISE
bull NAUSEA
bull MYOCARDIAL ISCHEMIA
bull DECREASED VENOUS RETURN
bull AIR SWALLOWING WITH INCREASED LIKELIHOOD OF VOMITING AND
ASPIRATION
bull CLAUSTROPHOBIA
bull SKIN BREAK DOWN AND DISCOMFORT FROM MASK
bull PULMONARY BAROTRAUMA
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
MI-E
bull USED WITH CHILDREN WHO HAVE DECREASED INSPIRATORY EFFORT DUE TO EITHER SPINAL CORD INJURY OR NMW AND WHO HAVE AN IMPAIRED OR INEFFECTIVE COUGH WITH APPROPRIATE RESPIRATORY SYMPTOMS
bull CONSIDERED WHEN CONVENTIONAL COUGH ASSISTANCE TECHNIQUES BECOME INEFFECTIVE
bull ACCEPTED AS THE CORE STANDARD FOR CHILD WITH NMW
bull MIE WORKS BY
bull INFLATING THE LUNGS WITH GRADUAL POSITIVE AIRWAY PRESSURE ASSISTING INSPIRATION CALLED INSUFFLATION
bull FOLLOWED BY A RAPID SWITCH TO NEGATIVE PRESSURE WHICH SIMULATES THE FLOW CHANGES THAT OCCUR DURING A COUGH THEREBY ENHANCING EXPIRATORY FLOW CALLED EXSUFFLATION AND ASSISTING EXPECTORATION OF SECRETIONS
bull MOVEMENT AND EXERCISE BEST FUNCTIONAL METHOD OF AIRWAY CLEARANCE
bull CPET BETTER CORRELATION THAN LUNG FUNCTION IN SURVIVAL RATES IN PEOPLE WITH
CYSTIC FIBROSIS
bull RUNNINGWALKING BETTER FOR SECRETION CLEARANCE THAN BIKE DURING TO SHEARING
MECHANISM
bull CONSIDER ADDING IN HUFFS (DYER)
bull CONSIDER USE OF AD BELT
EXERCISE
bull APCP SUCTION GUIDELINES
bull TYPESNASOPHARANGEAL OROPHARANGEAL AND TRACHEOSTOMY
bull MAIN VARIABLES SUCTION TYPE AND SIZE DEPTH OF SUCTION
PRESSURE TECHNIQUE
SUCTION
SPUTUM
bull SPUTUM bull 95 WATER bull COLOUR bull VOLUME bull CONSISTENCY bull ODOUR
bull PURPOSE bull HUMIDIFICATION bull WATERPROOFING bull PROTECTION OF EPITHELIUM
HUMIDIFICATION
bull METABOLIC AND VENTILATORY REQUIREMENTS ARE X2-3 OF ADULTS
IMPLICATION
bull HEAT AND MOISTURE LOSSES FROM RESPIRATION WILL INCREASE BY X2-3
bull CONSUME GREATER AMOUNTS OF ENERGY AND WATER
HUMIDIFICATION INHALATION
THERAPY
bull TRACHEOSTOMY HME
bull WET DRY CIRCUIT
bull NEBULISERS INHALERS MUCOLYTICS
bull HUMIDIFIERS WITH NIV
bull OXYGEN
bull SYSTEMIC HYDRATION ENVIRONMENT
NEBULISERS
bull NEBULISER CHAMBER CONVERTS LIQUID INTO
RESPIRABLE PARTICLES
bull MOISTURE DESCENDS THROUGH THE HOLES IN THE SUPERFICIAL GEL LAYER
bull INCREASES THE SOL LAYER SO THE CILIARY BEAT IS OPTIMAL FOR MUCUS TRANSPORT
bull SHORT TERM HUMIDIFICATION
bull DAILY WASHING OF NEBULISER SYSTEM
TIMING OF DRUG AND PHYSIOTHERAPY
BEFORE TREATMENT
bull DNASE (PULMOZYME)
bull SALBUTAMOL
(VENTOLIN BLUE)
bull SALINE NEBS
AFTER TREATMENT
bull SERETIDE (PURPLE)
bull BECLOMETHASONE (BECOTIDE BROWN)
bull COLISTIN (COLOMYCIN PROMIXIN)
bull TOBRAMYCIN
CONCLUSION
bull BE AWARE OF CHILDrsquoS RESPIRATORY FUNCTION
bull CHOSE ACT BEST FOR THEM bull TYPE OF KETCHUP BOTTLE bull LV SECRETION RETENTION WOB
bull EARLY RESPIRATORY REFERRAL
bull RESPIRATORY CARE COMPETENCIES
bull EFFECTIVE SECRETION CLEARANCE AT HOMERESPITESCHOOL
bull USE OF PEAK COUGH FLOWS TO AID CHOICE OF ADJUNCT
0
50
100
150
200
250
300
350
400
0
50
100
150
200
250
300
350
400
Green
Key
Additional info
(please comment) Please refer to BTSACPRC Guideline
Lothian University Hospitals NHS Trust
n PCF
gt270lmin
Breathstack
ing tri-
flow
blowing
REFERENCES bull BTSACPRC GUIDELINE IS PUBLISHED IN THORAX VOL 67 SUPPLEMENT 1
bull AVAILABLE ONLINE AT HTTPTHORAXBMJCOMCONTENTVOL64ISSUESUPPLI
bull HTTPWWWBRIT-THORACICORGUKPHYSIOGUIDE
bull BRITISH THORACIC SOCIETY REPORTS VOL 1 NO 1 2009
bull ADAPTED PRYOR AJ AND PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS3RD ED
bull HOUGH A PHYSIOTHERAPY IN RESPIRATORY CARE LONDON CHAPMAN AND HALL 1993
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1997) POSTURAL DRAINAGE AND GASTRO-OESOPHAGEAL REFLUX IN INFANTS WITH CYSTIC FIBROSIS ARCHIVES OF DISEASE IN CHILDHOOD 76 148-150
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1998) POSTURAL DRAINAGE IN CYSTIC FIBROSIS IS THERE A LINK WITH GASTRO-OESOPHAGEAL REFLUX JOURNAL OF PAEDIATRIC CHILD HEALTH 34 330-334
bull CECINS NM JENKINS SC PENGELLEY J ET AL (1999) THE ACTIVE CYCLE OF BREATHING TECHNIQUES-TO TIP OR NOT TO TIP RESPIRATORY MEDICINE 93 660-665
bull CONSTANTINI D BRIVIO A BRUSA D ET AL (2001) PEP MASK VERSUS POSTURAL DRAINAGE IN INFANTS A LONG-TERM COMPARATIVE TRIAL PEADIATRIC PULMONOLOGY
bull HOUGH A (2001) PHYSIOTHERAPY IN RESPIRATORY CARE AN EVIDENCE-BASED APPROACH TO RESPIRATORY AND CARDIAC MANAGEMENT CENGAGE LEARNING EMEA
bull INTERNATIONAL PHYSIOTHERAPY GROUP FOR CYSTIC FIBROSIS PHYSIOTHERAPY IN THE TREATMENT OF CYSTIC FIBROSIS (2009) HTTPSWWWECFSEUIPG_CFBOOKLET INTERNATIONAL PHYSIOTHERAPY GROUP ndash THE BLUE BOOKLET
bull KONSTAN MW STERN RC DOERSHUK CF (1994) EFFICACY OF THE FLUTTER DEVICE FOR AIRWAY MUCUS CLEARANCE IN PATIENTS WITH CYSTIC FIBROSIS JOURNAL OF PEDIATRICS 124 (5 (PT 1) 689-693
bull MCILWAINE M BUTTON B AND DWAN K (2015) POSITIVE EXPIRATORY PRESSURE PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 6 ART NO CD003147 DOI 10100214651858CD003147PUB4
bull MESTRINER RG FERNANDES RO STAFFEN LC ET AL (2009) OPTIMUM DESIGN PARAMETERS FOR A THERAPIST-CONSTRUCTED POSITIVE-EXPIRATORY-PRESSURE THERAPY BOTTLE DEVICE RESPIRATORY CARE 54 504-8
bull MORRISON L AND AGNEW J (2014) OSCILLATING DEVICES FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 7 ART NO CD006842 DOI 10100214651858CD006842PUB
bull OERMANN CM SOCKRIDER MM GILES D ET AL (2001) COMPARISON OF HIGH-FREQUENCY CHEST WALL OSCILLATION AND OSCILLATING POSITIVE EXPIRATORY PRESSURE IN THE HOME MANAGEMENT OF CYSTIC FIBROSIS A PILOT STUDY PEDIATRIC PULMONOLOGY 32 (5) 372-7
bull PRASAD SA AND HUSSEY J (1995) PAEDIATRIC RESPIRATORY CARE A GUIDE FOR PHYSIOTHERAPISTS AND HEALTH PROFESSIONALS CHAPMAN amp HALL
bull PRYOR J (1999) PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN ADULTS EUROPEAN RESPIRATORY JOURNAL 14 (6) 1418-1424
bull PRYOR JA amp PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS CHURCHILL LIVINGSTONE
bull PRYOR JA WEBBER BA HODSON ME ET AL (1994) THE FLUTTER VRP1 AS AN ADJUNCT TO CHEST PHYSIOTHERAPY IN CYSTIC FIBROSIS RESPIRATORY MEDICINE 88677-81
bull WEST K WALLEN M FOLLETT J (2010) ACAPELLA VS PEP MASK THERAPY A RANDOMISED TRIAL IN CHILDREN WITH CYSTIC FIBROSIS DURING RESPIRATORY EXACERBATION PHYSIOTHERAPY THEORY PRACTICE 26143-9
bull WILSONLM AGNEW J MORRISON L ET AL (2014) AIRWAY CLEARANCE TECHNIQUES FOR CYSTIC FIBROSIS AN OVERVIEW OF COCHRANE SYSTEMATIC REVIEWS COCHRANE DATABASE OF SYSTEMATIC REVIEWS DOI 10100214651858CD011231
bull VOLSKO TA DIFIORE JM CHATBURN RL (2003) PERFORMANCE COMPARISON OF TWO OSCILLATORY POSITIVE PRESSURE DEVICES ACAPELLA VERSUS FLUTTER RESPIRATORY CARE 48 (2) 124- 130
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SEDDON PC KHAN Y RESPIRATORY PROBLEMS IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT ARCHIVES OF DISEASE IN CHILDHOOD 2003 01 JAN88(1)75-8
bull MARKS JH PULMONARY CARE OF CHILDREN AND ADOLESCENTS WITH DEVELOPMENTAL DISABILITIES PEDIATR CLIN NORTH AM 2008 DECEMBER55(6)1299-314
bull ARENS R MUZUMDAR H SLEEP SLEEP DISORDERED BREATHING AND NOCTURNAL HYPOVENTILATION IN CHILDREN WITH NEUROMUSCULAR DISEASES PAEDIATRIC RESPIRATORY REVIEWS 2010 MAR11(1)24-30
bull FITZGERALD DA FOLLETT J VAN ASPEREN PP ASSESSING AND MANAGING LUNG DISEASE AND SLEEP DISORDERED BREATHING IN CHILDREN WITH CEREBRAL PALSY PAEDIATRIC RESPIRATORY REVIEWS 2009 MARCH10(1)18-24
bull HSIAO KH NIXON GM THE EFFECT OF TREATMENT OF OBSTRUCTIVE SLEEP APNEA ON QUALITY OF LIFE IN CHILDREN WITH CEREBRAL PALSY RES DEV DISABIL 2008 MAR-APR29(2)133-40
bull LUNDBERG A OXYGEN CONSUMPTION IN RELATION TO WORKLOAD IN STUDENTS WITH CEREBRAL PALSY J APPL PHYSIO 197640873-5
bull SULLIVAN PB ROSENBLOOM L FEEDING THE DISABLED CHILD CLINICS IN DEVELOPMENTAL MEDICINE MACKEITH PRESS 1999140
bull MARTIN TR THE RELATIONSHIP BETWEEN MALNUTRITION AND LUNG INFECTIONS CLIN CHEST MED 19878359
bull MOSTAFA SM BHANDARI S RITCHIE G ET AL CONSTIPATION AND ITS IMPLICATIONS IN THE CRITICALLY ILL PATIENT BR J ANAESTH 200391815-9 3
bull GACOUIN A CAMUS C GROS A ET AL CONSTIPATION IN LONGTERM VENTILATED PATIENTS ASSOCIATED FACTORS AND IMPACT ON INTENSIVE CARE UNIT OUTCOMES CRIT CARE MED 2010381933- 8
bull NGUYEN T FRENETTE AJ JOHANSON C ET AL IMPAIRED GASTROINTESTINAL TRANSIT AND ITS ASSOCIATED MORBIDITY IN THE INTENSIVE CARE UNIT J CRIT CARE 201328537
bull ASAI T CONSTIPATION DOES IT INCREASE MORBIDITY AND MORTALITY IN CRITICALLY ILL PATIENTS CRIT CARE MED 2007352861-2
bull UNDERSTANDING THE PHYSIOLOGICAL EFFECTS OF UNTREATED PAIN NURSING TIMES VOL 99 ISSUE 37 PAGE NO 28
bull WINFIELD ET AL NON-PHARMACEUTICAL MANAGEMENT OF RESPIRATORY MORBIDITY IN CHILDREN WITH SEVERE GLOBAL DEVELOPMENTAL DELAY THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014
bull OLOUGHLIN EV SOMERVILLE HM SOMERVILLE ER DEALING WITH MULTISYSTEM DISEASE IN PEOPLE WITH A DEVELOPMENTAL DISABILITY MEDICAL JOURNAL OF AUSTRALIA 2009 JUN 1190(11)616-7
bull MESTROVIC J KARDUM G POLIC B MESTROVIC M MARKIC J SUSTIC A ET AL THE INFLUENCE OF CHRONIC HEALTH CONDITIONS ON SUSCEPTIBILITY TO SEVERE ACUTE ILLNESS OF CHILDREN TREATED IN PICU EUROPEAN JOURNAL OF PEDIATRICS 2006 AUG165(8)526-
9
bull HEALY F PANITCH HB PULMONARY COMPLICATIONS OF PEDIATRIC NEUROLOGICAL DISEASES PEDIATR ANN 2010 APR39(4)216-24
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SRIVASTAVA R JACKSON WD BARNHART DC DYSPHAGIA AND GASTROESOPHAGEAL REFLUX DISEASE DILEMMAS IN DIAGNOSIS AND MANAGEMENT IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT PEDIATR ANN 2010 APR39(4)225-31
bull SULLIVAN PB JUSZCZAK E BACHLET AME LAMBERT B VERNON-ROBERTS A GRANT HW ET AL GASTROSTOMY TUBE FEEDING IN CHILDREN WITH CEREBRAL PALSY A PROSPECTIVE LONGITUDINAL STUDY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 2005
FEBRUARY47(2)77-85
bull SOMERVILLE H TZANNES G WOOD J SHUN A HILL C ARROWSMITH F ET AL GASTROINTESTINAL AND NUTRITIONAL PROBLEMS IN SEVERE DEVELOPMENTAL DISABILITY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 200850(9)712-6
bull TODER DS RESPIRATORY PROBLEMS IN THE ADOLESCENT WITH DEVELOPMENTAL DELAY ADOLESCENT MEDICINE 2000 3 OCTOBER 200011(3)617-31
bull LEVIN K COLON A DIPALMA J FITZPATRICK S USING THE RADIONUCLIDE SALIVAGRAM TO DETECT PULMONARY ASPIRATION AND ESOPHAGEAL DYSMOTILITY CLIN NUCL MED 1993 FEB18(2)110-4
bull SCHROEDER AS KLING T HUSS K BORGGRAEFE I KOERTE IK BLASCHEK A ET AL BOTULINUM TOXIN TYPE A AND B FOR THE REDUCTION OF HYPERSALIVATION IN CHILDREN WITH NEUROLOGICAL DISORDERS A FOCUS ON EFFECTIVENESS AND THERAPY ADHERENCE
NEUROPEDIATRICS 201243(1)27-36
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull GOEMINNE P AND DUPONT L (2010) NON-CYSTIC FIBROSIS BRONCHIECTASIS DIAGNOSIS AND MANAGEMENT IN 21ST CENTURY POSTGRADUATE MEDICAL JOURNAL 86(1018) PP493-501
bull LEE A BUTTON B AND TANNENBAUM E (2017) AIRWAY-CLEARANCE TECHNIQUES IN CHILDREN AND ADOLESCENTS WITH CHRONIC SUPPURATIVE LUNG DISEASE AND BRONCHIECTASIS FRONTIERS IN PEDIATRICS 5
bull MANDAL P SIDHU M KOPE L POLLOCK W STEVENSON L PENTLAND J TURNBULL K MAC QUARRIE S AND HILL A (2012) A PILOT STUDY OF PULMONARY REHABILITATION AND CHEST PHYSIOTHERAPY VERSUS CHEST PHYSIOTHERAPY ALONE IN
BRONCHIECTASIS RESPIRATORY MEDICINE 106(12) PP1647-1654
bull MURRAY M PENTLAND J AND HILL A (2009) A RANDOMISED CROSSOVER TRIAL OF CHEST PHYSIOTHERAPY IN NON-CYSTIC FIBROSIS BRONCHIECTASIS EUROPEAN RESPIRATORY JOURNAL 34(5) PP1086-1092
bull NEWALL C STOCKLEY R AND HILL S (2005) EXERCISE TRAINING AND INSPIRATORY MUSCLE TRAINING IN PATIENTS WITH BRONCHIECTASIS THORAX 60(11) PP943-948
bull ONG H LEE A HILL C HOLLAND A AND DENEHY L (2011) EFFECTS OF PULMONARY REHABILITATION IN BRONCHIECTASIS A RETROSPECTIVE STUDY CHRONIC RESPIRATORY DISEASE 8(1) PP21-30
bull QUINT J MILLETT E JOSHI M NAVARATNAM V THOMAS S HURST J SMEETH L AND BROWN J (2015) CHANGES IN THE INCIDENCE PREVALENCE AND MORTALITY OF BRONCHIECTASIS IN THE UK FROM 2004 TO 2013 A POPULATION-BASED COHORT
STUDY EUROPEAN RESPIRATORY JOURNAL 47(1) PP186-193
bull SNIJDERS D FERNANDEZ DOMINGUEZ B CALGARO S BERTOZZI I ESCRIBANO MONTANER A PERILONGO G AND BARBATO A (2015) MUCOCILIARY CLEARANCE TECHNIQUES FOR TREATING NON-CYSTIC FIBROSIS BRONCHIECTASIS IS THERE
EVIDENCE INTERNATIONAL JOURNAL OF IMMUNOPATHOLOGY AND PHARMACOLOGY 28(2) PP150-159
AUTOGENIC DRAINAGE
bull JEAN CHEVALLIER 1967 IN BELGIUM
bull OBSERVED CHILDREN SLEEPING
bull LOW LV VrsquoS HIGH LVrsquoS
bull 3 PHASES OF BREATHING
bull LOW
bull MID
bull HIGH
bull MOVING FROM RESIDUAL VOLUME TO TOTAL LUNG CAPACITY
bull AIM TO GENERATE INCREASED EXPIRATORY AIRFLOW PROGRESSIVELY THROUGH EACH GENERATION OF BRONCHI
bull SECRETIONS LOOSEN AND MOVE INTO LARGER AIRWAYS TO AID EXPECTORATION
AD CONTrsquoD
bull METHOD bull DIAGNOSTIC BREATH WHERE ABLE
bull LOW FLOW ON INSPIRATION IE QUIET BREATH IN
bull FASTER EXPIRATORY FLOW
bull SPEED OF EXPIRATORY FLOW bull TRANSPORTS SECRETIONS
bull SHEARS SECRETIONS FROM BRONCHIAL WALL
bull COMBINE WITH TREATMENTS
bull BENEFICIAL IN PATIENTS WITH SIGNIFICANT HYPER-REACTIVITY amp
HAEMOPTYSIS
AD IN NMD
bull PASSIVE AD
bull THERAPIST CONTROLS DEPTH OF LUNG VOLUMES
bull SAME PRINCIPALS
bull OFTEN USED IN CONJUNCTION WITH PEP TO PREVENT SMALL AIRWAY COLLAPSE
bull DEMONSTRATION TO FOLLOW
bull EXHALATION AGAINST A CONSTANT POSITIVE PRESSURE
bull AIDS REMOVAL OF BRONCHIAL SECRETIONS
bull PREVENTING AIRWAY COLLAPSE BY STENTING THE AIRWAYS
bull RECRUITMENT OF PREVIOUSLY OBSTRUCTED AIRWAYS
bull IMPROVE VENTILATION REDUCE ATELECTASIS
bull INCREASING INTRATHORACIC PRESSURE DISTAL TO RETAINED SECRETIONS BY COLLATERAL VENTILATION OR BY INCREASING FRC
bull MAINTAIN PULMONARY FUNCTION
POSITIVE EXPIRATORY PRESSURE (PEP)
bull MASK VALVE RESISTOR amp MANOMETER
bull O2CAN BE CONNECTED TO THE INHALATION SIDE IF REQUIRED
bull SIT IN GOOD POSITION WITH GOOD SEAL AROUND MOUTHPIECEMASK
bull SLOW INHALATION JUST A LITTLE LARGER THAN A NORMAL BREATH IN
(HOLD FOR 3 SECS IF USING MOUTHPIECE)
bull STEADY ACTIVE amp FULL EXHALATION
bull AIM FOR 10-20 CM H2O FOR 3-5 SECS
bull REPEAT 12-15 TIMES FOLLOWED BY FET amp COUGH
bull COMPLETE FOR 15-30 MINS (6-8 CYCLES OR SETS OF ABOVE)
PEP TREATMENT
bull BEFORE OR AT LEAST 1 HR AFTER A FEED
bull START WITH THE SMALLEST HOLERESISTOR THAT BABY CAN TOLERATE
bull USE A MANOMETER
bull HOLD THE BABY IN ARMS OR ON PARENTS LAP SIT ON GYM BALL
bull PLACE THE MASK OVER THE BABYrsquoS MOUTH amp NOSE
bull AIM FOR FEW BREATHS 30-60 SECONDS WHICH CAN BE BUILT UP TO 1-2 MINUTES AS TOLERATED
bull AIM TO REACH PRESSURES BETWEEN 5-15 CM H2O
bull REST FOR 30-60 SECONDS THEN REPEAT FOR ABOUT 5-10 MINUTES
bull COMBINE THIS WITH OTHER TREATMENTS
BABY PEP TREATMENT
OSCILLATING PEP
OSCILLATING PEP
bull DEVICES CAN BE INTRA-THORACIC OR EXTRA-THORACIC
bull INTRA-THORACIC DEVICES ARE PLACED IN THE MOUTH AND PROVIDE RESISTANCE DURING EXHALATION
bull ALTERS EXPIRATORY AIRFLOW
bull VIBRATIONS ON THE AIRWAY SURFACE
bull REDUCES MUCOUS VISCOSITY
bull ACCELERATION OF THE EXPIRATORY FLOW
bull PREVENTS AND TREATS AIRWAY COMPRESSION ATELECTASIS
bull IMPROVES AIRWAY PATENCY amp VENTILATION
bull DECREASES HYPERINFLATION
bull IMPROVES LUNG FUNCTION PARAMETERS
bull INCLUDES EXERCISE
OSCILLATING PEP TREATMENT
bull SIMILAR TO PEP
bull GOOD POSITION
bull PLACE MOUTHPIECE BETWEEN LIPS AND TEETH OR USE MASK
bull SLOW INHALE JUST A LITTLE LARGER THAN A NORMAL BREATH IN
bull HOLD FOR 3 SECONDS
bull STEADY ACTIVE amp FULL EXHALATION
bull ADJUST THE RESISTANCE AS REQUIRED
bull REPEAT 12-15 TIMES FOLLOWED BY FET amp COUGH
bull COMPLETE FOR 5-10 MINS
bull COMBINE WITH OTHER TREATMENTS
ACAPELLA
bull DETACHABLE MOUTHPIECEFACEMASK
bull ONE-WAY INSPIRATORY VALVE
bull EXPIRATORY RESISTANCEFREQUENCY ADJUSTMENT DIAL
bull COUNTERWEIGHTED PLUG amp MAGNET
bull MAINTAINS A RAISED FRC LEVEL
TREATMENT
bull EASY TO USE IN DIFFERENT POSITIONS
bull INHALE amp EXHALE THROUGH THE ACAPELLA
bull ROTATE THE FREQUENCY RESISTANCE DIAL UNTIL MAXIMUM VIBRATIONS ARE FELT WITHIN THE CHEST WALL
AEROBIKA bull COMBINES PEP WITH HIGH FREQUENCY OSCILLATIONS
bull CAN BE USED WITH A MANOMETER
bull NEBULISER CAN BE ENTRAINED INTO THE SYSTEM
bull POSSIBLE INCREASE IN TREATMENT COMPLIANCE BY DECREASING
TREATMENT TIMES
TECHNIQUE AS OSCILLATING PEP
BUBBLE PEP
Suction tubing (~1cm diameter) The end MUST sit at the bottom of the bottle
Plastic bottle Any widthshapediameter must be gt20cm tall 15cm fresh tapsterile water
(depth of water determines the amount of pressure ie cm H20
Washing up bowl
INDICATIONS
bull REDUCED LUNG VOLUME (FVClt50)
bull WEAK COUGH (PCFlt270)
bull SECRETIONS RETENTION
bull ATELECTASIS
bull REDUCED MECHANICAL COMPLIANCE
bull CHILD ABLE TO COMPLY
BENEFITS
bull INCREASE LUNG VOLUME = IMPROVES PCF
bull SECRETION CLEARANCE
bull MAY REVERSE ATELECTASIS
bull IMPROVE MECHANICAL COMPLIANCE = LUNG AND CHEST WALL MOBILITY
bull IMPROVE VOICE STRENGTH
LUNG VOLUME RECRUITMENT
bull LABEL NOT FOR RESUSCITATION
bull BEST IN SITTING
bull SUCTION READY
bull AGREE SIGNAL WITH CHILD WHEN MIC ACHIEVED
bull ASK TO BREATH OUT
bull PLACE MOUTHPIECE +- NOSE CLIP OR MASK
bull ASK TO BREATH IN AND HOLD WHILE GENTLY SQUEEZING BAG
bull WITHOUT LETTING AIR OUT ASK CHILD TO TAKE ANOTHER BREATH IN ON TOP OF THE FIRST BREATH AND SQUEEZE BAG IN TIME WITH BREATH
bull REPEAT UNTIL LUNGS ARE FULL (NORMALLY 3-5 BREATHS) OR SIGNAL
bull REMOVE MASK OR MOUTHPIECE ASK TO HOLD FOR 3-5 SECONDS
bull EXHALE OR IF SECRETIONS ARE PRESENT ENCOURAGE TO HAVE A COUGH OR MAC
bull REPEATED X3-5 X2-4 DAY
LVR TREATMENT
bull AIRWAY CLEARANCE OR THORACIC MOBILITY
bull AMBU RESUS BAG
bull GREEN ldquoPHYSIOrdquo BAG
bull MANUAL TECHNIQUES WITH BAGGING
bull MHI AT HOME
bull MANOMETERS
MHI
PHYSIO WITH NIV
bull PHYSIO SETTINGS
bull SECRETIONS
bull THORACIC MOBILITY
bull ALLOWS REST PERIOD PRE ACT
bull HUMIDIFICATION
bull INFLATABLE VEST CONNECTED BY TUBES TO AN AIR PULSE GENERATOR WHICH RAPIDLY INFLATES AND DEFLATES THE VEST PRODUCING OSCILLATIONS TO THE CHEST WALL
bull RAPID CHEST MOVEMENT MIMICS A COUGH-LIKE EXPIRATORY FLOW THAT SHEARS MUCUS AWAY FROM THE AIRWAY WALLS AND HELPS TO MOVE IT ALONG TO THE CENTRAL AIRWAYS
bull PASSIVE TREATMENT amp NOT POSITION DEPENDANT
bull COMBINATION OF RX
bull CONTRAINDICATIONS
bull HEAD ANDOR NECK INJURY THAT HAS NOT BEEN STABILISED
bull ACTIVE HAEMORRHAGE WITH HEMODYNAMIC INSTABILITY
HFCWO
HFCWO INDICATIONS
bull CHRONIC MUCUS HYPERSECRETION OR RETENTION ASSOCIATED WITH A CHRONIC PULMONARY OR NEUROMUSCULAR CONDITION
bull LRT SECRETIONS AND FREQUENT LRTI REQUIRING HOSPITAL ADMISSION
bull INEFFECTIVE COUGH OR INABILITY TO REMOVE MUCUS BY COUGHING
bull TENACIOUS SECRETIONS THAT ARE NOT EASILY MOBILISED WITH STANDARD CPT
bull MECHANICALLY VENTILATED WITH EVIDENCE OF SECRETION RETENTION
bull ALTERNATIVE AIRWAY CLEARANCE THERAPY PROVEN INEFFECTIVE OR CONTRAINDICATEDDO NOT TOLERATE STANDARD CPT
bull CONSTANT FATIGUE LACK OF STRENGTH OR ABILITY TO PERFORM ACTIVE TREATMENT
bull SYMPTOMATIC
bull POOR COMPLIANCE WITH OTHER AIRWAY CLEARANCE METHODS
bull HIGH BURDEN OF CARE
bull PATIENT UNABLE TO TOLERATE THE INCREASED WORK OF BREATHING bull ACTIVE HAEMOPTYSIS bull UNTREATED PNEUMOTHORAX bull INTRACRANIAL PRESSURE (ICP) gt 20 MMHG bull HAEMODYNAMIC INSTABILITY bull SEVERE CARDIOVASCULAR INSULTDISEASE bull RECENT FACIAL ORAL OR SKULL SURGERY OR TRAUMA bull ACUTE SINUSITIS bull EPISTAXIS bull POST OESOPHAGEAL amp LUNG SURGERY bull KNOWN OR SUSPECTED TYMPANIC MEMBRANE RUPTURE OR OTHER MIDDLE EAR
PATHOLOGY
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
POSSIBLE HAZARDSCOMPLICATIONS
bull INCREASED WORK OF BREATHING THAT MAY LEAD TO HYPOVENTILATION AND
HYPERCARBIA
bull INCREASED INTRACRANIAL PRESSURE
bull CARDIOVASCULAR COMPROMISE
bull NAUSEA
bull MYOCARDIAL ISCHEMIA
bull DECREASED VENOUS RETURN
bull AIR SWALLOWING WITH INCREASED LIKELIHOOD OF VOMITING AND
ASPIRATION
bull CLAUSTROPHOBIA
bull SKIN BREAK DOWN AND DISCOMFORT FROM MASK
bull PULMONARY BAROTRAUMA
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
MI-E
bull USED WITH CHILDREN WHO HAVE DECREASED INSPIRATORY EFFORT DUE TO EITHER SPINAL CORD INJURY OR NMW AND WHO HAVE AN IMPAIRED OR INEFFECTIVE COUGH WITH APPROPRIATE RESPIRATORY SYMPTOMS
bull CONSIDERED WHEN CONVENTIONAL COUGH ASSISTANCE TECHNIQUES BECOME INEFFECTIVE
bull ACCEPTED AS THE CORE STANDARD FOR CHILD WITH NMW
bull MIE WORKS BY
bull INFLATING THE LUNGS WITH GRADUAL POSITIVE AIRWAY PRESSURE ASSISTING INSPIRATION CALLED INSUFFLATION
bull FOLLOWED BY A RAPID SWITCH TO NEGATIVE PRESSURE WHICH SIMULATES THE FLOW CHANGES THAT OCCUR DURING A COUGH THEREBY ENHANCING EXPIRATORY FLOW CALLED EXSUFFLATION AND ASSISTING EXPECTORATION OF SECRETIONS
bull MOVEMENT AND EXERCISE BEST FUNCTIONAL METHOD OF AIRWAY CLEARANCE
bull CPET BETTER CORRELATION THAN LUNG FUNCTION IN SURVIVAL RATES IN PEOPLE WITH
CYSTIC FIBROSIS
bull RUNNINGWALKING BETTER FOR SECRETION CLEARANCE THAN BIKE DURING TO SHEARING
MECHANISM
bull CONSIDER ADDING IN HUFFS (DYER)
bull CONSIDER USE OF AD BELT
EXERCISE
bull APCP SUCTION GUIDELINES
bull TYPESNASOPHARANGEAL OROPHARANGEAL AND TRACHEOSTOMY
bull MAIN VARIABLES SUCTION TYPE AND SIZE DEPTH OF SUCTION
PRESSURE TECHNIQUE
SUCTION
SPUTUM
bull SPUTUM bull 95 WATER bull COLOUR bull VOLUME bull CONSISTENCY bull ODOUR
bull PURPOSE bull HUMIDIFICATION bull WATERPROOFING bull PROTECTION OF EPITHELIUM
HUMIDIFICATION
bull METABOLIC AND VENTILATORY REQUIREMENTS ARE X2-3 OF ADULTS
IMPLICATION
bull HEAT AND MOISTURE LOSSES FROM RESPIRATION WILL INCREASE BY X2-3
bull CONSUME GREATER AMOUNTS OF ENERGY AND WATER
HUMIDIFICATION INHALATION
THERAPY
bull TRACHEOSTOMY HME
bull WET DRY CIRCUIT
bull NEBULISERS INHALERS MUCOLYTICS
bull HUMIDIFIERS WITH NIV
bull OXYGEN
bull SYSTEMIC HYDRATION ENVIRONMENT
NEBULISERS
bull NEBULISER CHAMBER CONVERTS LIQUID INTO
RESPIRABLE PARTICLES
bull MOISTURE DESCENDS THROUGH THE HOLES IN THE SUPERFICIAL GEL LAYER
bull INCREASES THE SOL LAYER SO THE CILIARY BEAT IS OPTIMAL FOR MUCUS TRANSPORT
bull SHORT TERM HUMIDIFICATION
bull DAILY WASHING OF NEBULISER SYSTEM
TIMING OF DRUG AND PHYSIOTHERAPY
BEFORE TREATMENT
bull DNASE (PULMOZYME)
bull SALBUTAMOL
(VENTOLIN BLUE)
bull SALINE NEBS
AFTER TREATMENT
bull SERETIDE (PURPLE)
bull BECLOMETHASONE (BECOTIDE BROWN)
bull COLISTIN (COLOMYCIN PROMIXIN)
bull TOBRAMYCIN
CONCLUSION
bull BE AWARE OF CHILDrsquoS RESPIRATORY FUNCTION
bull CHOSE ACT BEST FOR THEM bull TYPE OF KETCHUP BOTTLE bull LV SECRETION RETENTION WOB
bull EARLY RESPIRATORY REFERRAL
bull RESPIRATORY CARE COMPETENCIES
bull EFFECTIVE SECRETION CLEARANCE AT HOMERESPITESCHOOL
bull USE OF PEAK COUGH FLOWS TO AID CHOICE OF ADJUNCT
0
50
100
150
200
250
300
350
400
0
50
100
150
200
250
300
350
400
Green
Key
Additional info
(please comment) Please refer to BTSACPRC Guideline
Lothian University Hospitals NHS Trust
n PCF
gt270lmin
Breathstack
ing tri-
flow
blowing
REFERENCES bull BTSACPRC GUIDELINE IS PUBLISHED IN THORAX VOL 67 SUPPLEMENT 1
bull AVAILABLE ONLINE AT HTTPTHORAXBMJCOMCONTENTVOL64ISSUESUPPLI
bull HTTPWWWBRIT-THORACICORGUKPHYSIOGUIDE
bull BRITISH THORACIC SOCIETY REPORTS VOL 1 NO 1 2009
bull ADAPTED PRYOR AJ AND PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS3RD ED
bull HOUGH A PHYSIOTHERAPY IN RESPIRATORY CARE LONDON CHAPMAN AND HALL 1993
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1997) POSTURAL DRAINAGE AND GASTRO-OESOPHAGEAL REFLUX IN INFANTS WITH CYSTIC FIBROSIS ARCHIVES OF DISEASE IN CHILDHOOD 76 148-150
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1998) POSTURAL DRAINAGE IN CYSTIC FIBROSIS IS THERE A LINK WITH GASTRO-OESOPHAGEAL REFLUX JOURNAL OF PAEDIATRIC CHILD HEALTH 34 330-334
bull CECINS NM JENKINS SC PENGELLEY J ET AL (1999) THE ACTIVE CYCLE OF BREATHING TECHNIQUES-TO TIP OR NOT TO TIP RESPIRATORY MEDICINE 93 660-665
bull CONSTANTINI D BRIVIO A BRUSA D ET AL (2001) PEP MASK VERSUS POSTURAL DRAINAGE IN INFANTS A LONG-TERM COMPARATIVE TRIAL PEADIATRIC PULMONOLOGY
bull HOUGH A (2001) PHYSIOTHERAPY IN RESPIRATORY CARE AN EVIDENCE-BASED APPROACH TO RESPIRATORY AND CARDIAC MANAGEMENT CENGAGE LEARNING EMEA
bull INTERNATIONAL PHYSIOTHERAPY GROUP FOR CYSTIC FIBROSIS PHYSIOTHERAPY IN THE TREATMENT OF CYSTIC FIBROSIS (2009) HTTPSWWWECFSEUIPG_CFBOOKLET INTERNATIONAL PHYSIOTHERAPY GROUP ndash THE BLUE BOOKLET
bull KONSTAN MW STERN RC DOERSHUK CF (1994) EFFICACY OF THE FLUTTER DEVICE FOR AIRWAY MUCUS CLEARANCE IN PATIENTS WITH CYSTIC FIBROSIS JOURNAL OF PEDIATRICS 124 (5 (PT 1) 689-693
bull MCILWAINE M BUTTON B AND DWAN K (2015) POSITIVE EXPIRATORY PRESSURE PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 6 ART NO CD003147 DOI 10100214651858CD003147PUB4
bull MESTRINER RG FERNANDES RO STAFFEN LC ET AL (2009) OPTIMUM DESIGN PARAMETERS FOR A THERAPIST-CONSTRUCTED POSITIVE-EXPIRATORY-PRESSURE THERAPY BOTTLE DEVICE RESPIRATORY CARE 54 504-8
bull MORRISON L AND AGNEW J (2014) OSCILLATING DEVICES FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 7 ART NO CD006842 DOI 10100214651858CD006842PUB
bull OERMANN CM SOCKRIDER MM GILES D ET AL (2001) COMPARISON OF HIGH-FREQUENCY CHEST WALL OSCILLATION AND OSCILLATING POSITIVE EXPIRATORY PRESSURE IN THE HOME MANAGEMENT OF CYSTIC FIBROSIS A PILOT STUDY PEDIATRIC PULMONOLOGY 32 (5) 372-7
bull PRASAD SA AND HUSSEY J (1995) PAEDIATRIC RESPIRATORY CARE A GUIDE FOR PHYSIOTHERAPISTS AND HEALTH PROFESSIONALS CHAPMAN amp HALL
bull PRYOR J (1999) PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN ADULTS EUROPEAN RESPIRATORY JOURNAL 14 (6) 1418-1424
bull PRYOR JA amp PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS CHURCHILL LIVINGSTONE
bull PRYOR JA WEBBER BA HODSON ME ET AL (1994) THE FLUTTER VRP1 AS AN ADJUNCT TO CHEST PHYSIOTHERAPY IN CYSTIC FIBROSIS RESPIRATORY MEDICINE 88677-81
bull WEST K WALLEN M FOLLETT J (2010) ACAPELLA VS PEP MASK THERAPY A RANDOMISED TRIAL IN CHILDREN WITH CYSTIC FIBROSIS DURING RESPIRATORY EXACERBATION PHYSIOTHERAPY THEORY PRACTICE 26143-9
bull WILSONLM AGNEW J MORRISON L ET AL (2014) AIRWAY CLEARANCE TECHNIQUES FOR CYSTIC FIBROSIS AN OVERVIEW OF COCHRANE SYSTEMATIC REVIEWS COCHRANE DATABASE OF SYSTEMATIC REVIEWS DOI 10100214651858CD011231
bull VOLSKO TA DIFIORE JM CHATBURN RL (2003) PERFORMANCE COMPARISON OF TWO OSCILLATORY POSITIVE PRESSURE DEVICES ACAPELLA VERSUS FLUTTER RESPIRATORY CARE 48 (2) 124- 130
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SEDDON PC KHAN Y RESPIRATORY PROBLEMS IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT ARCHIVES OF DISEASE IN CHILDHOOD 2003 01 JAN88(1)75-8
bull MARKS JH PULMONARY CARE OF CHILDREN AND ADOLESCENTS WITH DEVELOPMENTAL DISABILITIES PEDIATR CLIN NORTH AM 2008 DECEMBER55(6)1299-314
bull ARENS R MUZUMDAR H SLEEP SLEEP DISORDERED BREATHING AND NOCTURNAL HYPOVENTILATION IN CHILDREN WITH NEUROMUSCULAR DISEASES PAEDIATRIC RESPIRATORY REVIEWS 2010 MAR11(1)24-30
bull FITZGERALD DA FOLLETT J VAN ASPEREN PP ASSESSING AND MANAGING LUNG DISEASE AND SLEEP DISORDERED BREATHING IN CHILDREN WITH CEREBRAL PALSY PAEDIATRIC RESPIRATORY REVIEWS 2009 MARCH10(1)18-24
bull HSIAO KH NIXON GM THE EFFECT OF TREATMENT OF OBSTRUCTIVE SLEEP APNEA ON QUALITY OF LIFE IN CHILDREN WITH CEREBRAL PALSY RES DEV DISABIL 2008 MAR-APR29(2)133-40
bull LUNDBERG A OXYGEN CONSUMPTION IN RELATION TO WORKLOAD IN STUDENTS WITH CEREBRAL PALSY J APPL PHYSIO 197640873-5
bull SULLIVAN PB ROSENBLOOM L FEEDING THE DISABLED CHILD CLINICS IN DEVELOPMENTAL MEDICINE MACKEITH PRESS 1999140
bull MARTIN TR THE RELATIONSHIP BETWEEN MALNUTRITION AND LUNG INFECTIONS CLIN CHEST MED 19878359
bull MOSTAFA SM BHANDARI S RITCHIE G ET AL CONSTIPATION AND ITS IMPLICATIONS IN THE CRITICALLY ILL PATIENT BR J ANAESTH 200391815-9 3
bull GACOUIN A CAMUS C GROS A ET AL CONSTIPATION IN LONGTERM VENTILATED PATIENTS ASSOCIATED FACTORS AND IMPACT ON INTENSIVE CARE UNIT OUTCOMES CRIT CARE MED 2010381933- 8
bull NGUYEN T FRENETTE AJ JOHANSON C ET AL IMPAIRED GASTROINTESTINAL TRANSIT AND ITS ASSOCIATED MORBIDITY IN THE INTENSIVE CARE UNIT J CRIT CARE 201328537
bull ASAI T CONSTIPATION DOES IT INCREASE MORBIDITY AND MORTALITY IN CRITICALLY ILL PATIENTS CRIT CARE MED 2007352861-2
bull UNDERSTANDING THE PHYSIOLOGICAL EFFECTS OF UNTREATED PAIN NURSING TIMES VOL 99 ISSUE 37 PAGE NO 28
bull WINFIELD ET AL NON-PHARMACEUTICAL MANAGEMENT OF RESPIRATORY MORBIDITY IN CHILDREN WITH SEVERE GLOBAL DEVELOPMENTAL DELAY THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014
bull OLOUGHLIN EV SOMERVILLE HM SOMERVILLE ER DEALING WITH MULTISYSTEM DISEASE IN PEOPLE WITH A DEVELOPMENTAL DISABILITY MEDICAL JOURNAL OF AUSTRALIA 2009 JUN 1190(11)616-7
bull MESTROVIC J KARDUM G POLIC B MESTROVIC M MARKIC J SUSTIC A ET AL THE INFLUENCE OF CHRONIC HEALTH CONDITIONS ON SUSCEPTIBILITY TO SEVERE ACUTE ILLNESS OF CHILDREN TREATED IN PICU EUROPEAN JOURNAL OF PEDIATRICS 2006 AUG165(8)526-
9
bull HEALY F PANITCH HB PULMONARY COMPLICATIONS OF PEDIATRIC NEUROLOGICAL DISEASES PEDIATR ANN 2010 APR39(4)216-24
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SRIVASTAVA R JACKSON WD BARNHART DC DYSPHAGIA AND GASTROESOPHAGEAL REFLUX DISEASE DILEMMAS IN DIAGNOSIS AND MANAGEMENT IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT PEDIATR ANN 2010 APR39(4)225-31
bull SULLIVAN PB JUSZCZAK E BACHLET AME LAMBERT B VERNON-ROBERTS A GRANT HW ET AL GASTROSTOMY TUBE FEEDING IN CHILDREN WITH CEREBRAL PALSY A PROSPECTIVE LONGITUDINAL STUDY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 2005
FEBRUARY47(2)77-85
bull SOMERVILLE H TZANNES G WOOD J SHUN A HILL C ARROWSMITH F ET AL GASTROINTESTINAL AND NUTRITIONAL PROBLEMS IN SEVERE DEVELOPMENTAL DISABILITY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 200850(9)712-6
bull TODER DS RESPIRATORY PROBLEMS IN THE ADOLESCENT WITH DEVELOPMENTAL DELAY ADOLESCENT MEDICINE 2000 3 OCTOBER 200011(3)617-31
bull LEVIN K COLON A DIPALMA J FITZPATRICK S USING THE RADIONUCLIDE SALIVAGRAM TO DETECT PULMONARY ASPIRATION AND ESOPHAGEAL DYSMOTILITY CLIN NUCL MED 1993 FEB18(2)110-4
bull SCHROEDER AS KLING T HUSS K BORGGRAEFE I KOERTE IK BLASCHEK A ET AL BOTULINUM TOXIN TYPE A AND B FOR THE REDUCTION OF HYPERSALIVATION IN CHILDREN WITH NEUROLOGICAL DISORDERS A FOCUS ON EFFECTIVENESS AND THERAPY ADHERENCE
NEUROPEDIATRICS 201243(1)27-36
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull GOEMINNE P AND DUPONT L (2010) NON-CYSTIC FIBROSIS BRONCHIECTASIS DIAGNOSIS AND MANAGEMENT IN 21ST CENTURY POSTGRADUATE MEDICAL JOURNAL 86(1018) PP493-501
bull LEE A BUTTON B AND TANNENBAUM E (2017) AIRWAY-CLEARANCE TECHNIQUES IN CHILDREN AND ADOLESCENTS WITH CHRONIC SUPPURATIVE LUNG DISEASE AND BRONCHIECTASIS FRONTIERS IN PEDIATRICS 5
bull MANDAL P SIDHU M KOPE L POLLOCK W STEVENSON L PENTLAND J TURNBULL K MAC QUARRIE S AND HILL A (2012) A PILOT STUDY OF PULMONARY REHABILITATION AND CHEST PHYSIOTHERAPY VERSUS CHEST PHYSIOTHERAPY ALONE IN
BRONCHIECTASIS RESPIRATORY MEDICINE 106(12) PP1647-1654
bull MURRAY M PENTLAND J AND HILL A (2009) A RANDOMISED CROSSOVER TRIAL OF CHEST PHYSIOTHERAPY IN NON-CYSTIC FIBROSIS BRONCHIECTASIS EUROPEAN RESPIRATORY JOURNAL 34(5) PP1086-1092
bull NEWALL C STOCKLEY R AND HILL S (2005) EXERCISE TRAINING AND INSPIRATORY MUSCLE TRAINING IN PATIENTS WITH BRONCHIECTASIS THORAX 60(11) PP943-948
bull ONG H LEE A HILL C HOLLAND A AND DENEHY L (2011) EFFECTS OF PULMONARY REHABILITATION IN BRONCHIECTASIS A RETROSPECTIVE STUDY CHRONIC RESPIRATORY DISEASE 8(1) PP21-30
bull QUINT J MILLETT E JOSHI M NAVARATNAM V THOMAS S HURST J SMEETH L AND BROWN J (2015) CHANGES IN THE INCIDENCE PREVALENCE AND MORTALITY OF BRONCHIECTASIS IN THE UK FROM 2004 TO 2013 A POPULATION-BASED COHORT
STUDY EUROPEAN RESPIRATORY JOURNAL 47(1) PP186-193
bull SNIJDERS D FERNANDEZ DOMINGUEZ B CALGARO S BERTOZZI I ESCRIBANO MONTANER A PERILONGO G AND BARBATO A (2015) MUCOCILIARY CLEARANCE TECHNIQUES FOR TREATING NON-CYSTIC FIBROSIS BRONCHIECTASIS IS THERE
EVIDENCE INTERNATIONAL JOURNAL OF IMMUNOPATHOLOGY AND PHARMACOLOGY 28(2) PP150-159
AD CONTrsquoD
bull METHOD bull DIAGNOSTIC BREATH WHERE ABLE
bull LOW FLOW ON INSPIRATION IE QUIET BREATH IN
bull FASTER EXPIRATORY FLOW
bull SPEED OF EXPIRATORY FLOW bull TRANSPORTS SECRETIONS
bull SHEARS SECRETIONS FROM BRONCHIAL WALL
bull COMBINE WITH TREATMENTS
bull BENEFICIAL IN PATIENTS WITH SIGNIFICANT HYPER-REACTIVITY amp
HAEMOPTYSIS
AD IN NMD
bull PASSIVE AD
bull THERAPIST CONTROLS DEPTH OF LUNG VOLUMES
bull SAME PRINCIPALS
bull OFTEN USED IN CONJUNCTION WITH PEP TO PREVENT SMALL AIRWAY COLLAPSE
bull DEMONSTRATION TO FOLLOW
bull EXHALATION AGAINST A CONSTANT POSITIVE PRESSURE
bull AIDS REMOVAL OF BRONCHIAL SECRETIONS
bull PREVENTING AIRWAY COLLAPSE BY STENTING THE AIRWAYS
bull RECRUITMENT OF PREVIOUSLY OBSTRUCTED AIRWAYS
bull IMPROVE VENTILATION REDUCE ATELECTASIS
bull INCREASING INTRATHORACIC PRESSURE DISTAL TO RETAINED SECRETIONS BY COLLATERAL VENTILATION OR BY INCREASING FRC
bull MAINTAIN PULMONARY FUNCTION
POSITIVE EXPIRATORY PRESSURE (PEP)
bull MASK VALVE RESISTOR amp MANOMETER
bull O2CAN BE CONNECTED TO THE INHALATION SIDE IF REQUIRED
bull SIT IN GOOD POSITION WITH GOOD SEAL AROUND MOUTHPIECEMASK
bull SLOW INHALATION JUST A LITTLE LARGER THAN A NORMAL BREATH IN
(HOLD FOR 3 SECS IF USING MOUTHPIECE)
bull STEADY ACTIVE amp FULL EXHALATION
bull AIM FOR 10-20 CM H2O FOR 3-5 SECS
bull REPEAT 12-15 TIMES FOLLOWED BY FET amp COUGH
bull COMPLETE FOR 15-30 MINS (6-8 CYCLES OR SETS OF ABOVE)
PEP TREATMENT
bull BEFORE OR AT LEAST 1 HR AFTER A FEED
bull START WITH THE SMALLEST HOLERESISTOR THAT BABY CAN TOLERATE
bull USE A MANOMETER
bull HOLD THE BABY IN ARMS OR ON PARENTS LAP SIT ON GYM BALL
bull PLACE THE MASK OVER THE BABYrsquoS MOUTH amp NOSE
bull AIM FOR FEW BREATHS 30-60 SECONDS WHICH CAN BE BUILT UP TO 1-2 MINUTES AS TOLERATED
bull AIM TO REACH PRESSURES BETWEEN 5-15 CM H2O
bull REST FOR 30-60 SECONDS THEN REPEAT FOR ABOUT 5-10 MINUTES
bull COMBINE THIS WITH OTHER TREATMENTS
BABY PEP TREATMENT
OSCILLATING PEP
OSCILLATING PEP
bull DEVICES CAN BE INTRA-THORACIC OR EXTRA-THORACIC
bull INTRA-THORACIC DEVICES ARE PLACED IN THE MOUTH AND PROVIDE RESISTANCE DURING EXHALATION
bull ALTERS EXPIRATORY AIRFLOW
bull VIBRATIONS ON THE AIRWAY SURFACE
bull REDUCES MUCOUS VISCOSITY
bull ACCELERATION OF THE EXPIRATORY FLOW
bull PREVENTS AND TREATS AIRWAY COMPRESSION ATELECTASIS
bull IMPROVES AIRWAY PATENCY amp VENTILATION
bull DECREASES HYPERINFLATION
bull IMPROVES LUNG FUNCTION PARAMETERS
bull INCLUDES EXERCISE
OSCILLATING PEP TREATMENT
bull SIMILAR TO PEP
bull GOOD POSITION
bull PLACE MOUTHPIECE BETWEEN LIPS AND TEETH OR USE MASK
bull SLOW INHALE JUST A LITTLE LARGER THAN A NORMAL BREATH IN
bull HOLD FOR 3 SECONDS
bull STEADY ACTIVE amp FULL EXHALATION
bull ADJUST THE RESISTANCE AS REQUIRED
bull REPEAT 12-15 TIMES FOLLOWED BY FET amp COUGH
bull COMPLETE FOR 5-10 MINS
bull COMBINE WITH OTHER TREATMENTS
ACAPELLA
bull DETACHABLE MOUTHPIECEFACEMASK
bull ONE-WAY INSPIRATORY VALVE
bull EXPIRATORY RESISTANCEFREQUENCY ADJUSTMENT DIAL
bull COUNTERWEIGHTED PLUG amp MAGNET
bull MAINTAINS A RAISED FRC LEVEL
TREATMENT
bull EASY TO USE IN DIFFERENT POSITIONS
bull INHALE amp EXHALE THROUGH THE ACAPELLA
bull ROTATE THE FREQUENCY RESISTANCE DIAL UNTIL MAXIMUM VIBRATIONS ARE FELT WITHIN THE CHEST WALL
AEROBIKA bull COMBINES PEP WITH HIGH FREQUENCY OSCILLATIONS
bull CAN BE USED WITH A MANOMETER
bull NEBULISER CAN BE ENTRAINED INTO THE SYSTEM
bull POSSIBLE INCREASE IN TREATMENT COMPLIANCE BY DECREASING
TREATMENT TIMES
TECHNIQUE AS OSCILLATING PEP
BUBBLE PEP
Suction tubing (~1cm diameter) The end MUST sit at the bottom of the bottle
Plastic bottle Any widthshapediameter must be gt20cm tall 15cm fresh tapsterile water
(depth of water determines the amount of pressure ie cm H20
Washing up bowl
INDICATIONS
bull REDUCED LUNG VOLUME (FVClt50)
bull WEAK COUGH (PCFlt270)
bull SECRETIONS RETENTION
bull ATELECTASIS
bull REDUCED MECHANICAL COMPLIANCE
bull CHILD ABLE TO COMPLY
BENEFITS
bull INCREASE LUNG VOLUME = IMPROVES PCF
bull SECRETION CLEARANCE
bull MAY REVERSE ATELECTASIS
bull IMPROVE MECHANICAL COMPLIANCE = LUNG AND CHEST WALL MOBILITY
bull IMPROVE VOICE STRENGTH
LUNG VOLUME RECRUITMENT
bull LABEL NOT FOR RESUSCITATION
bull BEST IN SITTING
bull SUCTION READY
bull AGREE SIGNAL WITH CHILD WHEN MIC ACHIEVED
bull ASK TO BREATH OUT
bull PLACE MOUTHPIECE +- NOSE CLIP OR MASK
bull ASK TO BREATH IN AND HOLD WHILE GENTLY SQUEEZING BAG
bull WITHOUT LETTING AIR OUT ASK CHILD TO TAKE ANOTHER BREATH IN ON TOP OF THE FIRST BREATH AND SQUEEZE BAG IN TIME WITH BREATH
bull REPEAT UNTIL LUNGS ARE FULL (NORMALLY 3-5 BREATHS) OR SIGNAL
bull REMOVE MASK OR MOUTHPIECE ASK TO HOLD FOR 3-5 SECONDS
bull EXHALE OR IF SECRETIONS ARE PRESENT ENCOURAGE TO HAVE A COUGH OR MAC
bull REPEATED X3-5 X2-4 DAY
LVR TREATMENT
bull AIRWAY CLEARANCE OR THORACIC MOBILITY
bull AMBU RESUS BAG
bull GREEN ldquoPHYSIOrdquo BAG
bull MANUAL TECHNIQUES WITH BAGGING
bull MHI AT HOME
bull MANOMETERS
MHI
PHYSIO WITH NIV
bull PHYSIO SETTINGS
bull SECRETIONS
bull THORACIC MOBILITY
bull ALLOWS REST PERIOD PRE ACT
bull HUMIDIFICATION
bull INFLATABLE VEST CONNECTED BY TUBES TO AN AIR PULSE GENERATOR WHICH RAPIDLY INFLATES AND DEFLATES THE VEST PRODUCING OSCILLATIONS TO THE CHEST WALL
bull RAPID CHEST MOVEMENT MIMICS A COUGH-LIKE EXPIRATORY FLOW THAT SHEARS MUCUS AWAY FROM THE AIRWAY WALLS AND HELPS TO MOVE IT ALONG TO THE CENTRAL AIRWAYS
bull PASSIVE TREATMENT amp NOT POSITION DEPENDANT
bull COMBINATION OF RX
bull CONTRAINDICATIONS
bull HEAD ANDOR NECK INJURY THAT HAS NOT BEEN STABILISED
bull ACTIVE HAEMORRHAGE WITH HEMODYNAMIC INSTABILITY
HFCWO
HFCWO INDICATIONS
bull CHRONIC MUCUS HYPERSECRETION OR RETENTION ASSOCIATED WITH A CHRONIC PULMONARY OR NEUROMUSCULAR CONDITION
bull LRT SECRETIONS AND FREQUENT LRTI REQUIRING HOSPITAL ADMISSION
bull INEFFECTIVE COUGH OR INABILITY TO REMOVE MUCUS BY COUGHING
bull TENACIOUS SECRETIONS THAT ARE NOT EASILY MOBILISED WITH STANDARD CPT
bull MECHANICALLY VENTILATED WITH EVIDENCE OF SECRETION RETENTION
bull ALTERNATIVE AIRWAY CLEARANCE THERAPY PROVEN INEFFECTIVE OR CONTRAINDICATEDDO NOT TOLERATE STANDARD CPT
bull CONSTANT FATIGUE LACK OF STRENGTH OR ABILITY TO PERFORM ACTIVE TREATMENT
bull SYMPTOMATIC
bull POOR COMPLIANCE WITH OTHER AIRWAY CLEARANCE METHODS
bull HIGH BURDEN OF CARE
bull PATIENT UNABLE TO TOLERATE THE INCREASED WORK OF BREATHING bull ACTIVE HAEMOPTYSIS bull UNTREATED PNEUMOTHORAX bull INTRACRANIAL PRESSURE (ICP) gt 20 MMHG bull HAEMODYNAMIC INSTABILITY bull SEVERE CARDIOVASCULAR INSULTDISEASE bull RECENT FACIAL ORAL OR SKULL SURGERY OR TRAUMA bull ACUTE SINUSITIS bull EPISTAXIS bull POST OESOPHAGEAL amp LUNG SURGERY bull KNOWN OR SUSPECTED TYMPANIC MEMBRANE RUPTURE OR OTHER MIDDLE EAR
PATHOLOGY
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
POSSIBLE HAZARDSCOMPLICATIONS
bull INCREASED WORK OF BREATHING THAT MAY LEAD TO HYPOVENTILATION AND
HYPERCARBIA
bull INCREASED INTRACRANIAL PRESSURE
bull CARDIOVASCULAR COMPROMISE
bull NAUSEA
bull MYOCARDIAL ISCHEMIA
bull DECREASED VENOUS RETURN
bull AIR SWALLOWING WITH INCREASED LIKELIHOOD OF VOMITING AND
ASPIRATION
bull CLAUSTROPHOBIA
bull SKIN BREAK DOWN AND DISCOMFORT FROM MASK
bull PULMONARY BAROTRAUMA
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
MI-E
bull USED WITH CHILDREN WHO HAVE DECREASED INSPIRATORY EFFORT DUE TO EITHER SPINAL CORD INJURY OR NMW AND WHO HAVE AN IMPAIRED OR INEFFECTIVE COUGH WITH APPROPRIATE RESPIRATORY SYMPTOMS
bull CONSIDERED WHEN CONVENTIONAL COUGH ASSISTANCE TECHNIQUES BECOME INEFFECTIVE
bull ACCEPTED AS THE CORE STANDARD FOR CHILD WITH NMW
bull MIE WORKS BY
bull INFLATING THE LUNGS WITH GRADUAL POSITIVE AIRWAY PRESSURE ASSISTING INSPIRATION CALLED INSUFFLATION
bull FOLLOWED BY A RAPID SWITCH TO NEGATIVE PRESSURE WHICH SIMULATES THE FLOW CHANGES THAT OCCUR DURING A COUGH THEREBY ENHANCING EXPIRATORY FLOW CALLED EXSUFFLATION AND ASSISTING EXPECTORATION OF SECRETIONS
bull MOVEMENT AND EXERCISE BEST FUNCTIONAL METHOD OF AIRWAY CLEARANCE
bull CPET BETTER CORRELATION THAN LUNG FUNCTION IN SURVIVAL RATES IN PEOPLE WITH
CYSTIC FIBROSIS
bull RUNNINGWALKING BETTER FOR SECRETION CLEARANCE THAN BIKE DURING TO SHEARING
MECHANISM
bull CONSIDER ADDING IN HUFFS (DYER)
bull CONSIDER USE OF AD BELT
EXERCISE
bull APCP SUCTION GUIDELINES
bull TYPESNASOPHARANGEAL OROPHARANGEAL AND TRACHEOSTOMY
bull MAIN VARIABLES SUCTION TYPE AND SIZE DEPTH OF SUCTION
PRESSURE TECHNIQUE
SUCTION
SPUTUM
bull SPUTUM bull 95 WATER bull COLOUR bull VOLUME bull CONSISTENCY bull ODOUR
bull PURPOSE bull HUMIDIFICATION bull WATERPROOFING bull PROTECTION OF EPITHELIUM
HUMIDIFICATION
bull METABOLIC AND VENTILATORY REQUIREMENTS ARE X2-3 OF ADULTS
IMPLICATION
bull HEAT AND MOISTURE LOSSES FROM RESPIRATION WILL INCREASE BY X2-3
bull CONSUME GREATER AMOUNTS OF ENERGY AND WATER
HUMIDIFICATION INHALATION
THERAPY
bull TRACHEOSTOMY HME
bull WET DRY CIRCUIT
bull NEBULISERS INHALERS MUCOLYTICS
bull HUMIDIFIERS WITH NIV
bull OXYGEN
bull SYSTEMIC HYDRATION ENVIRONMENT
NEBULISERS
bull NEBULISER CHAMBER CONVERTS LIQUID INTO
RESPIRABLE PARTICLES
bull MOISTURE DESCENDS THROUGH THE HOLES IN THE SUPERFICIAL GEL LAYER
bull INCREASES THE SOL LAYER SO THE CILIARY BEAT IS OPTIMAL FOR MUCUS TRANSPORT
bull SHORT TERM HUMIDIFICATION
bull DAILY WASHING OF NEBULISER SYSTEM
TIMING OF DRUG AND PHYSIOTHERAPY
BEFORE TREATMENT
bull DNASE (PULMOZYME)
bull SALBUTAMOL
(VENTOLIN BLUE)
bull SALINE NEBS
AFTER TREATMENT
bull SERETIDE (PURPLE)
bull BECLOMETHASONE (BECOTIDE BROWN)
bull COLISTIN (COLOMYCIN PROMIXIN)
bull TOBRAMYCIN
CONCLUSION
bull BE AWARE OF CHILDrsquoS RESPIRATORY FUNCTION
bull CHOSE ACT BEST FOR THEM bull TYPE OF KETCHUP BOTTLE bull LV SECRETION RETENTION WOB
bull EARLY RESPIRATORY REFERRAL
bull RESPIRATORY CARE COMPETENCIES
bull EFFECTIVE SECRETION CLEARANCE AT HOMERESPITESCHOOL
bull USE OF PEAK COUGH FLOWS TO AID CHOICE OF ADJUNCT
0
50
100
150
200
250
300
350
400
0
50
100
150
200
250
300
350
400
Green
Key
Additional info
(please comment) Please refer to BTSACPRC Guideline
Lothian University Hospitals NHS Trust
n PCF
gt270lmin
Breathstack
ing tri-
flow
blowing
REFERENCES bull BTSACPRC GUIDELINE IS PUBLISHED IN THORAX VOL 67 SUPPLEMENT 1
bull AVAILABLE ONLINE AT HTTPTHORAXBMJCOMCONTENTVOL64ISSUESUPPLI
bull HTTPWWWBRIT-THORACICORGUKPHYSIOGUIDE
bull BRITISH THORACIC SOCIETY REPORTS VOL 1 NO 1 2009
bull ADAPTED PRYOR AJ AND PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS3RD ED
bull HOUGH A PHYSIOTHERAPY IN RESPIRATORY CARE LONDON CHAPMAN AND HALL 1993
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1997) POSTURAL DRAINAGE AND GASTRO-OESOPHAGEAL REFLUX IN INFANTS WITH CYSTIC FIBROSIS ARCHIVES OF DISEASE IN CHILDHOOD 76 148-150
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1998) POSTURAL DRAINAGE IN CYSTIC FIBROSIS IS THERE A LINK WITH GASTRO-OESOPHAGEAL REFLUX JOURNAL OF PAEDIATRIC CHILD HEALTH 34 330-334
bull CECINS NM JENKINS SC PENGELLEY J ET AL (1999) THE ACTIVE CYCLE OF BREATHING TECHNIQUES-TO TIP OR NOT TO TIP RESPIRATORY MEDICINE 93 660-665
bull CONSTANTINI D BRIVIO A BRUSA D ET AL (2001) PEP MASK VERSUS POSTURAL DRAINAGE IN INFANTS A LONG-TERM COMPARATIVE TRIAL PEADIATRIC PULMONOLOGY
bull HOUGH A (2001) PHYSIOTHERAPY IN RESPIRATORY CARE AN EVIDENCE-BASED APPROACH TO RESPIRATORY AND CARDIAC MANAGEMENT CENGAGE LEARNING EMEA
bull INTERNATIONAL PHYSIOTHERAPY GROUP FOR CYSTIC FIBROSIS PHYSIOTHERAPY IN THE TREATMENT OF CYSTIC FIBROSIS (2009) HTTPSWWWECFSEUIPG_CFBOOKLET INTERNATIONAL PHYSIOTHERAPY GROUP ndash THE BLUE BOOKLET
bull KONSTAN MW STERN RC DOERSHUK CF (1994) EFFICACY OF THE FLUTTER DEVICE FOR AIRWAY MUCUS CLEARANCE IN PATIENTS WITH CYSTIC FIBROSIS JOURNAL OF PEDIATRICS 124 (5 (PT 1) 689-693
bull MCILWAINE M BUTTON B AND DWAN K (2015) POSITIVE EXPIRATORY PRESSURE PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 6 ART NO CD003147 DOI 10100214651858CD003147PUB4
bull MESTRINER RG FERNANDES RO STAFFEN LC ET AL (2009) OPTIMUM DESIGN PARAMETERS FOR A THERAPIST-CONSTRUCTED POSITIVE-EXPIRATORY-PRESSURE THERAPY BOTTLE DEVICE RESPIRATORY CARE 54 504-8
bull MORRISON L AND AGNEW J (2014) OSCILLATING DEVICES FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 7 ART NO CD006842 DOI 10100214651858CD006842PUB
bull OERMANN CM SOCKRIDER MM GILES D ET AL (2001) COMPARISON OF HIGH-FREQUENCY CHEST WALL OSCILLATION AND OSCILLATING POSITIVE EXPIRATORY PRESSURE IN THE HOME MANAGEMENT OF CYSTIC FIBROSIS A PILOT STUDY PEDIATRIC PULMONOLOGY 32 (5) 372-7
bull PRASAD SA AND HUSSEY J (1995) PAEDIATRIC RESPIRATORY CARE A GUIDE FOR PHYSIOTHERAPISTS AND HEALTH PROFESSIONALS CHAPMAN amp HALL
bull PRYOR J (1999) PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN ADULTS EUROPEAN RESPIRATORY JOURNAL 14 (6) 1418-1424
bull PRYOR JA amp PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS CHURCHILL LIVINGSTONE
bull PRYOR JA WEBBER BA HODSON ME ET AL (1994) THE FLUTTER VRP1 AS AN ADJUNCT TO CHEST PHYSIOTHERAPY IN CYSTIC FIBROSIS RESPIRATORY MEDICINE 88677-81
bull WEST K WALLEN M FOLLETT J (2010) ACAPELLA VS PEP MASK THERAPY A RANDOMISED TRIAL IN CHILDREN WITH CYSTIC FIBROSIS DURING RESPIRATORY EXACERBATION PHYSIOTHERAPY THEORY PRACTICE 26143-9
bull WILSONLM AGNEW J MORRISON L ET AL (2014) AIRWAY CLEARANCE TECHNIQUES FOR CYSTIC FIBROSIS AN OVERVIEW OF COCHRANE SYSTEMATIC REVIEWS COCHRANE DATABASE OF SYSTEMATIC REVIEWS DOI 10100214651858CD011231
bull VOLSKO TA DIFIORE JM CHATBURN RL (2003) PERFORMANCE COMPARISON OF TWO OSCILLATORY POSITIVE PRESSURE DEVICES ACAPELLA VERSUS FLUTTER RESPIRATORY CARE 48 (2) 124- 130
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SEDDON PC KHAN Y RESPIRATORY PROBLEMS IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT ARCHIVES OF DISEASE IN CHILDHOOD 2003 01 JAN88(1)75-8
bull MARKS JH PULMONARY CARE OF CHILDREN AND ADOLESCENTS WITH DEVELOPMENTAL DISABILITIES PEDIATR CLIN NORTH AM 2008 DECEMBER55(6)1299-314
bull ARENS R MUZUMDAR H SLEEP SLEEP DISORDERED BREATHING AND NOCTURNAL HYPOVENTILATION IN CHILDREN WITH NEUROMUSCULAR DISEASES PAEDIATRIC RESPIRATORY REVIEWS 2010 MAR11(1)24-30
bull FITZGERALD DA FOLLETT J VAN ASPEREN PP ASSESSING AND MANAGING LUNG DISEASE AND SLEEP DISORDERED BREATHING IN CHILDREN WITH CEREBRAL PALSY PAEDIATRIC RESPIRATORY REVIEWS 2009 MARCH10(1)18-24
bull HSIAO KH NIXON GM THE EFFECT OF TREATMENT OF OBSTRUCTIVE SLEEP APNEA ON QUALITY OF LIFE IN CHILDREN WITH CEREBRAL PALSY RES DEV DISABIL 2008 MAR-APR29(2)133-40
bull LUNDBERG A OXYGEN CONSUMPTION IN RELATION TO WORKLOAD IN STUDENTS WITH CEREBRAL PALSY J APPL PHYSIO 197640873-5
bull SULLIVAN PB ROSENBLOOM L FEEDING THE DISABLED CHILD CLINICS IN DEVELOPMENTAL MEDICINE MACKEITH PRESS 1999140
bull MARTIN TR THE RELATIONSHIP BETWEEN MALNUTRITION AND LUNG INFECTIONS CLIN CHEST MED 19878359
bull MOSTAFA SM BHANDARI S RITCHIE G ET AL CONSTIPATION AND ITS IMPLICATIONS IN THE CRITICALLY ILL PATIENT BR J ANAESTH 200391815-9 3
bull GACOUIN A CAMUS C GROS A ET AL CONSTIPATION IN LONGTERM VENTILATED PATIENTS ASSOCIATED FACTORS AND IMPACT ON INTENSIVE CARE UNIT OUTCOMES CRIT CARE MED 2010381933- 8
bull NGUYEN T FRENETTE AJ JOHANSON C ET AL IMPAIRED GASTROINTESTINAL TRANSIT AND ITS ASSOCIATED MORBIDITY IN THE INTENSIVE CARE UNIT J CRIT CARE 201328537
bull ASAI T CONSTIPATION DOES IT INCREASE MORBIDITY AND MORTALITY IN CRITICALLY ILL PATIENTS CRIT CARE MED 2007352861-2
bull UNDERSTANDING THE PHYSIOLOGICAL EFFECTS OF UNTREATED PAIN NURSING TIMES VOL 99 ISSUE 37 PAGE NO 28
bull WINFIELD ET AL NON-PHARMACEUTICAL MANAGEMENT OF RESPIRATORY MORBIDITY IN CHILDREN WITH SEVERE GLOBAL DEVELOPMENTAL DELAY THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014
bull OLOUGHLIN EV SOMERVILLE HM SOMERVILLE ER DEALING WITH MULTISYSTEM DISEASE IN PEOPLE WITH A DEVELOPMENTAL DISABILITY MEDICAL JOURNAL OF AUSTRALIA 2009 JUN 1190(11)616-7
bull MESTROVIC J KARDUM G POLIC B MESTROVIC M MARKIC J SUSTIC A ET AL THE INFLUENCE OF CHRONIC HEALTH CONDITIONS ON SUSCEPTIBILITY TO SEVERE ACUTE ILLNESS OF CHILDREN TREATED IN PICU EUROPEAN JOURNAL OF PEDIATRICS 2006 AUG165(8)526-
9
bull HEALY F PANITCH HB PULMONARY COMPLICATIONS OF PEDIATRIC NEUROLOGICAL DISEASES PEDIATR ANN 2010 APR39(4)216-24
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SRIVASTAVA R JACKSON WD BARNHART DC DYSPHAGIA AND GASTROESOPHAGEAL REFLUX DISEASE DILEMMAS IN DIAGNOSIS AND MANAGEMENT IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT PEDIATR ANN 2010 APR39(4)225-31
bull SULLIVAN PB JUSZCZAK E BACHLET AME LAMBERT B VERNON-ROBERTS A GRANT HW ET AL GASTROSTOMY TUBE FEEDING IN CHILDREN WITH CEREBRAL PALSY A PROSPECTIVE LONGITUDINAL STUDY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 2005
FEBRUARY47(2)77-85
bull SOMERVILLE H TZANNES G WOOD J SHUN A HILL C ARROWSMITH F ET AL GASTROINTESTINAL AND NUTRITIONAL PROBLEMS IN SEVERE DEVELOPMENTAL DISABILITY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 200850(9)712-6
bull TODER DS RESPIRATORY PROBLEMS IN THE ADOLESCENT WITH DEVELOPMENTAL DELAY ADOLESCENT MEDICINE 2000 3 OCTOBER 200011(3)617-31
bull LEVIN K COLON A DIPALMA J FITZPATRICK S USING THE RADIONUCLIDE SALIVAGRAM TO DETECT PULMONARY ASPIRATION AND ESOPHAGEAL DYSMOTILITY CLIN NUCL MED 1993 FEB18(2)110-4
bull SCHROEDER AS KLING T HUSS K BORGGRAEFE I KOERTE IK BLASCHEK A ET AL BOTULINUM TOXIN TYPE A AND B FOR THE REDUCTION OF HYPERSALIVATION IN CHILDREN WITH NEUROLOGICAL DISORDERS A FOCUS ON EFFECTIVENESS AND THERAPY ADHERENCE
NEUROPEDIATRICS 201243(1)27-36
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull GOEMINNE P AND DUPONT L (2010) NON-CYSTIC FIBROSIS BRONCHIECTASIS DIAGNOSIS AND MANAGEMENT IN 21ST CENTURY POSTGRADUATE MEDICAL JOURNAL 86(1018) PP493-501
bull LEE A BUTTON B AND TANNENBAUM E (2017) AIRWAY-CLEARANCE TECHNIQUES IN CHILDREN AND ADOLESCENTS WITH CHRONIC SUPPURATIVE LUNG DISEASE AND BRONCHIECTASIS FRONTIERS IN PEDIATRICS 5
bull MANDAL P SIDHU M KOPE L POLLOCK W STEVENSON L PENTLAND J TURNBULL K MAC QUARRIE S AND HILL A (2012) A PILOT STUDY OF PULMONARY REHABILITATION AND CHEST PHYSIOTHERAPY VERSUS CHEST PHYSIOTHERAPY ALONE IN
BRONCHIECTASIS RESPIRATORY MEDICINE 106(12) PP1647-1654
bull MURRAY M PENTLAND J AND HILL A (2009) A RANDOMISED CROSSOVER TRIAL OF CHEST PHYSIOTHERAPY IN NON-CYSTIC FIBROSIS BRONCHIECTASIS EUROPEAN RESPIRATORY JOURNAL 34(5) PP1086-1092
bull NEWALL C STOCKLEY R AND HILL S (2005) EXERCISE TRAINING AND INSPIRATORY MUSCLE TRAINING IN PATIENTS WITH BRONCHIECTASIS THORAX 60(11) PP943-948
bull ONG H LEE A HILL C HOLLAND A AND DENEHY L (2011) EFFECTS OF PULMONARY REHABILITATION IN BRONCHIECTASIS A RETROSPECTIVE STUDY CHRONIC RESPIRATORY DISEASE 8(1) PP21-30
bull QUINT J MILLETT E JOSHI M NAVARATNAM V THOMAS S HURST J SMEETH L AND BROWN J (2015) CHANGES IN THE INCIDENCE PREVALENCE AND MORTALITY OF BRONCHIECTASIS IN THE UK FROM 2004 TO 2013 A POPULATION-BASED COHORT
STUDY EUROPEAN RESPIRATORY JOURNAL 47(1) PP186-193
bull SNIJDERS D FERNANDEZ DOMINGUEZ B CALGARO S BERTOZZI I ESCRIBANO MONTANER A PERILONGO G AND BARBATO A (2015) MUCOCILIARY CLEARANCE TECHNIQUES FOR TREATING NON-CYSTIC FIBROSIS BRONCHIECTASIS IS THERE
EVIDENCE INTERNATIONAL JOURNAL OF IMMUNOPATHOLOGY AND PHARMACOLOGY 28(2) PP150-159
AD IN NMD
bull PASSIVE AD
bull THERAPIST CONTROLS DEPTH OF LUNG VOLUMES
bull SAME PRINCIPALS
bull OFTEN USED IN CONJUNCTION WITH PEP TO PREVENT SMALL AIRWAY COLLAPSE
bull DEMONSTRATION TO FOLLOW
bull EXHALATION AGAINST A CONSTANT POSITIVE PRESSURE
bull AIDS REMOVAL OF BRONCHIAL SECRETIONS
bull PREVENTING AIRWAY COLLAPSE BY STENTING THE AIRWAYS
bull RECRUITMENT OF PREVIOUSLY OBSTRUCTED AIRWAYS
bull IMPROVE VENTILATION REDUCE ATELECTASIS
bull INCREASING INTRATHORACIC PRESSURE DISTAL TO RETAINED SECRETIONS BY COLLATERAL VENTILATION OR BY INCREASING FRC
bull MAINTAIN PULMONARY FUNCTION
POSITIVE EXPIRATORY PRESSURE (PEP)
bull MASK VALVE RESISTOR amp MANOMETER
bull O2CAN BE CONNECTED TO THE INHALATION SIDE IF REQUIRED
bull SIT IN GOOD POSITION WITH GOOD SEAL AROUND MOUTHPIECEMASK
bull SLOW INHALATION JUST A LITTLE LARGER THAN A NORMAL BREATH IN
(HOLD FOR 3 SECS IF USING MOUTHPIECE)
bull STEADY ACTIVE amp FULL EXHALATION
bull AIM FOR 10-20 CM H2O FOR 3-5 SECS
bull REPEAT 12-15 TIMES FOLLOWED BY FET amp COUGH
bull COMPLETE FOR 15-30 MINS (6-8 CYCLES OR SETS OF ABOVE)
PEP TREATMENT
bull BEFORE OR AT LEAST 1 HR AFTER A FEED
bull START WITH THE SMALLEST HOLERESISTOR THAT BABY CAN TOLERATE
bull USE A MANOMETER
bull HOLD THE BABY IN ARMS OR ON PARENTS LAP SIT ON GYM BALL
bull PLACE THE MASK OVER THE BABYrsquoS MOUTH amp NOSE
bull AIM FOR FEW BREATHS 30-60 SECONDS WHICH CAN BE BUILT UP TO 1-2 MINUTES AS TOLERATED
bull AIM TO REACH PRESSURES BETWEEN 5-15 CM H2O
bull REST FOR 30-60 SECONDS THEN REPEAT FOR ABOUT 5-10 MINUTES
bull COMBINE THIS WITH OTHER TREATMENTS
BABY PEP TREATMENT
OSCILLATING PEP
OSCILLATING PEP
bull DEVICES CAN BE INTRA-THORACIC OR EXTRA-THORACIC
bull INTRA-THORACIC DEVICES ARE PLACED IN THE MOUTH AND PROVIDE RESISTANCE DURING EXHALATION
bull ALTERS EXPIRATORY AIRFLOW
bull VIBRATIONS ON THE AIRWAY SURFACE
bull REDUCES MUCOUS VISCOSITY
bull ACCELERATION OF THE EXPIRATORY FLOW
bull PREVENTS AND TREATS AIRWAY COMPRESSION ATELECTASIS
bull IMPROVES AIRWAY PATENCY amp VENTILATION
bull DECREASES HYPERINFLATION
bull IMPROVES LUNG FUNCTION PARAMETERS
bull INCLUDES EXERCISE
OSCILLATING PEP TREATMENT
bull SIMILAR TO PEP
bull GOOD POSITION
bull PLACE MOUTHPIECE BETWEEN LIPS AND TEETH OR USE MASK
bull SLOW INHALE JUST A LITTLE LARGER THAN A NORMAL BREATH IN
bull HOLD FOR 3 SECONDS
bull STEADY ACTIVE amp FULL EXHALATION
bull ADJUST THE RESISTANCE AS REQUIRED
bull REPEAT 12-15 TIMES FOLLOWED BY FET amp COUGH
bull COMPLETE FOR 5-10 MINS
bull COMBINE WITH OTHER TREATMENTS
ACAPELLA
bull DETACHABLE MOUTHPIECEFACEMASK
bull ONE-WAY INSPIRATORY VALVE
bull EXPIRATORY RESISTANCEFREQUENCY ADJUSTMENT DIAL
bull COUNTERWEIGHTED PLUG amp MAGNET
bull MAINTAINS A RAISED FRC LEVEL
TREATMENT
bull EASY TO USE IN DIFFERENT POSITIONS
bull INHALE amp EXHALE THROUGH THE ACAPELLA
bull ROTATE THE FREQUENCY RESISTANCE DIAL UNTIL MAXIMUM VIBRATIONS ARE FELT WITHIN THE CHEST WALL
AEROBIKA bull COMBINES PEP WITH HIGH FREQUENCY OSCILLATIONS
bull CAN BE USED WITH A MANOMETER
bull NEBULISER CAN BE ENTRAINED INTO THE SYSTEM
bull POSSIBLE INCREASE IN TREATMENT COMPLIANCE BY DECREASING
TREATMENT TIMES
TECHNIQUE AS OSCILLATING PEP
BUBBLE PEP
Suction tubing (~1cm diameter) The end MUST sit at the bottom of the bottle
Plastic bottle Any widthshapediameter must be gt20cm tall 15cm fresh tapsterile water
(depth of water determines the amount of pressure ie cm H20
Washing up bowl
INDICATIONS
bull REDUCED LUNG VOLUME (FVClt50)
bull WEAK COUGH (PCFlt270)
bull SECRETIONS RETENTION
bull ATELECTASIS
bull REDUCED MECHANICAL COMPLIANCE
bull CHILD ABLE TO COMPLY
BENEFITS
bull INCREASE LUNG VOLUME = IMPROVES PCF
bull SECRETION CLEARANCE
bull MAY REVERSE ATELECTASIS
bull IMPROVE MECHANICAL COMPLIANCE = LUNG AND CHEST WALL MOBILITY
bull IMPROVE VOICE STRENGTH
LUNG VOLUME RECRUITMENT
bull LABEL NOT FOR RESUSCITATION
bull BEST IN SITTING
bull SUCTION READY
bull AGREE SIGNAL WITH CHILD WHEN MIC ACHIEVED
bull ASK TO BREATH OUT
bull PLACE MOUTHPIECE +- NOSE CLIP OR MASK
bull ASK TO BREATH IN AND HOLD WHILE GENTLY SQUEEZING BAG
bull WITHOUT LETTING AIR OUT ASK CHILD TO TAKE ANOTHER BREATH IN ON TOP OF THE FIRST BREATH AND SQUEEZE BAG IN TIME WITH BREATH
bull REPEAT UNTIL LUNGS ARE FULL (NORMALLY 3-5 BREATHS) OR SIGNAL
bull REMOVE MASK OR MOUTHPIECE ASK TO HOLD FOR 3-5 SECONDS
bull EXHALE OR IF SECRETIONS ARE PRESENT ENCOURAGE TO HAVE A COUGH OR MAC
bull REPEATED X3-5 X2-4 DAY
LVR TREATMENT
bull AIRWAY CLEARANCE OR THORACIC MOBILITY
bull AMBU RESUS BAG
bull GREEN ldquoPHYSIOrdquo BAG
bull MANUAL TECHNIQUES WITH BAGGING
bull MHI AT HOME
bull MANOMETERS
MHI
PHYSIO WITH NIV
bull PHYSIO SETTINGS
bull SECRETIONS
bull THORACIC MOBILITY
bull ALLOWS REST PERIOD PRE ACT
bull HUMIDIFICATION
bull INFLATABLE VEST CONNECTED BY TUBES TO AN AIR PULSE GENERATOR WHICH RAPIDLY INFLATES AND DEFLATES THE VEST PRODUCING OSCILLATIONS TO THE CHEST WALL
bull RAPID CHEST MOVEMENT MIMICS A COUGH-LIKE EXPIRATORY FLOW THAT SHEARS MUCUS AWAY FROM THE AIRWAY WALLS AND HELPS TO MOVE IT ALONG TO THE CENTRAL AIRWAYS
bull PASSIVE TREATMENT amp NOT POSITION DEPENDANT
bull COMBINATION OF RX
bull CONTRAINDICATIONS
bull HEAD ANDOR NECK INJURY THAT HAS NOT BEEN STABILISED
bull ACTIVE HAEMORRHAGE WITH HEMODYNAMIC INSTABILITY
HFCWO
HFCWO INDICATIONS
bull CHRONIC MUCUS HYPERSECRETION OR RETENTION ASSOCIATED WITH A CHRONIC PULMONARY OR NEUROMUSCULAR CONDITION
bull LRT SECRETIONS AND FREQUENT LRTI REQUIRING HOSPITAL ADMISSION
bull INEFFECTIVE COUGH OR INABILITY TO REMOVE MUCUS BY COUGHING
bull TENACIOUS SECRETIONS THAT ARE NOT EASILY MOBILISED WITH STANDARD CPT
bull MECHANICALLY VENTILATED WITH EVIDENCE OF SECRETION RETENTION
bull ALTERNATIVE AIRWAY CLEARANCE THERAPY PROVEN INEFFECTIVE OR CONTRAINDICATEDDO NOT TOLERATE STANDARD CPT
bull CONSTANT FATIGUE LACK OF STRENGTH OR ABILITY TO PERFORM ACTIVE TREATMENT
bull SYMPTOMATIC
bull POOR COMPLIANCE WITH OTHER AIRWAY CLEARANCE METHODS
bull HIGH BURDEN OF CARE
bull PATIENT UNABLE TO TOLERATE THE INCREASED WORK OF BREATHING bull ACTIVE HAEMOPTYSIS bull UNTREATED PNEUMOTHORAX bull INTRACRANIAL PRESSURE (ICP) gt 20 MMHG bull HAEMODYNAMIC INSTABILITY bull SEVERE CARDIOVASCULAR INSULTDISEASE bull RECENT FACIAL ORAL OR SKULL SURGERY OR TRAUMA bull ACUTE SINUSITIS bull EPISTAXIS bull POST OESOPHAGEAL amp LUNG SURGERY bull KNOWN OR SUSPECTED TYMPANIC MEMBRANE RUPTURE OR OTHER MIDDLE EAR
PATHOLOGY
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
POSSIBLE HAZARDSCOMPLICATIONS
bull INCREASED WORK OF BREATHING THAT MAY LEAD TO HYPOVENTILATION AND
HYPERCARBIA
bull INCREASED INTRACRANIAL PRESSURE
bull CARDIOVASCULAR COMPROMISE
bull NAUSEA
bull MYOCARDIAL ISCHEMIA
bull DECREASED VENOUS RETURN
bull AIR SWALLOWING WITH INCREASED LIKELIHOOD OF VOMITING AND
ASPIRATION
bull CLAUSTROPHOBIA
bull SKIN BREAK DOWN AND DISCOMFORT FROM MASK
bull PULMONARY BAROTRAUMA
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
MI-E
bull USED WITH CHILDREN WHO HAVE DECREASED INSPIRATORY EFFORT DUE TO EITHER SPINAL CORD INJURY OR NMW AND WHO HAVE AN IMPAIRED OR INEFFECTIVE COUGH WITH APPROPRIATE RESPIRATORY SYMPTOMS
bull CONSIDERED WHEN CONVENTIONAL COUGH ASSISTANCE TECHNIQUES BECOME INEFFECTIVE
bull ACCEPTED AS THE CORE STANDARD FOR CHILD WITH NMW
bull MIE WORKS BY
bull INFLATING THE LUNGS WITH GRADUAL POSITIVE AIRWAY PRESSURE ASSISTING INSPIRATION CALLED INSUFFLATION
bull FOLLOWED BY A RAPID SWITCH TO NEGATIVE PRESSURE WHICH SIMULATES THE FLOW CHANGES THAT OCCUR DURING A COUGH THEREBY ENHANCING EXPIRATORY FLOW CALLED EXSUFFLATION AND ASSISTING EXPECTORATION OF SECRETIONS
bull MOVEMENT AND EXERCISE BEST FUNCTIONAL METHOD OF AIRWAY CLEARANCE
bull CPET BETTER CORRELATION THAN LUNG FUNCTION IN SURVIVAL RATES IN PEOPLE WITH
CYSTIC FIBROSIS
bull RUNNINGWALKING BETTER FOR SECRETION CLEARANCE THAN BIKE DURING TO SHEARING
MECHANISM
bull CONSIDER ADDING IN HUFFS (DYER)
bull CONSIDER USE OF AD BELT
EXERCISE
bull APCP SUCTION GUIDELINES
bull TYPESNASOPHARANGEAL OROPHARANGEAL AND TRACHEOSTOMY
bull MAIN VARIABLES SUCTION TYPE AND SIZE DEPTH OF SUCTION
PRESSURE TECHNIQUE
SUCTION
SPUTUM
bull SPUTUM bull 95 WATER bull COLOUR bull VOLUME bull CONSISTENCY bull ODOUR
bull PURPOSE bull HUMIDIFICATION bull WATERPROOFING bull PROTECTION OF EPITHELIUM
HUMIDIFICATION
bull METABOLIC AND VENTILATORY REQUIREMENTS ARE X2-3 OF ADULTS
IMPLICATION
bull HEAT AND MOISTURE LOSSES FROM RESPIRATION WILL INCREASE BY X2-3
bull CONSUME GREATER AMOUNTS OF ENERGY AND WATER
HUMIDIFICATION INHALATION
THERAPY
bull TRACHEOSTOMY HME
bull WET DRY CIRCUIT
bull NEBULISERS INHALERS MUCOLYTICS
bull HUMIDIFIERS WITH NIV
bull OXYGEN
bull SYSTEMIC HYDRATION ENVIRONMENT
NEBULISERS
bull NEBULISER CHAMBER CONVERTS LIQUID INTO
RESPIRABLE PARTICLES
bull MOISTURE DESCENDS THROUGH THE HOLES IN THE SUPERFICIAL GEL LAYER
bull INCREASES THE SOL LAYER SO THE CILIARY BEAT IS OPTIMAL FOR MUCUS TRANSPORT
bull SHORT TERM HUMIDIFICATION
bull DAILY WASHING OF NEBULISER SYSTEM
TIMING OF DRUG AND PHYSIOTHERAPY
BEFORE TREATMENT
bull DNASE (PULMOZYME)
bull SALBUTAMOL
(VENTOLIN BLUE)
bull SALINE NEBS
AFTER TREATMENT
bull SERETIDE (PURPLE)
bull BECLOMETHASONE (BECOTIDE BROWN)
bull COLISTIN (COLOMYCIN PROMIXIN)
bull TOBRAMYCIN
CONCLUSION
bull BE AWARE OF CHILDrsquoS RESPIRATORY FUNCTION
bull CHOSE ACT BEST FOR THEM bull TYPE OF KETCHUP BOTTLE bull LV SECRETION RETENTION WOB
bull EARLY RESPIRATORY REFERRAL
bull RESPIRATORY CARE COMPETENCIES
bull EFFECTIVE SECRETION CLEARANCE AT HOMERESPITESCHOOL
bull USE OF PEAK COUGH FLOWS TO AID CHOICE OF ADJUNCT
0
50
100
150
200
250
300
350
400
0
50
100
150
200
250
300
350
400
Green
Key
Additional info
(please comment) Please refer to BTSACPRC Guideline
Lothian University Hospitals NHS Trust
n PCF
gt270lmin
Breathstack
ing tri-
flow
blowing
REFERENCES bull BTSACPRC GUIDELINE IS PUBLISHED IN THORAX VOL 67 SUPPLEMENT 1
bull AVAILABLE ONLINE AT HTTPTHORAXBMJCOMCONTENTVOL64ISSUESUPPLI
bull HTTPWWWBRIT-THORACICORGUKPHYSIOGUIDE
bull BRITISH THORACIC SOCIETY REPORTS VOL 1 NO 1 2009
bull ADAPTED PRYOR AJ AND PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS3RD ED
bull HOUGH A PHYSIOTHERAPY IN RESPIRATORY CARE LONDON CHAPMAN AND HALL 1993
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1997) POSTURAL DRAINAGE AND GASTRO-OESOPHAGEAL REFLUX IN INFANTS WITH CYSTIC FIBROSIS ARCHIVES OF DISEASE IN CHILDHOOD 76 148-150
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1998) POSTURAL DRAINAGE IN CYSTIC FIBROSIS IS THERE A LINK WITH GASTRO-OESOPHAGEAL REFLUX JOURNAL OF PAEDIATRIC CHILD HEALTH 34 330-334
bull CECINS NM JENKINS SC PENGELLEY J ET AL (1999) THE ACTIVE CYCLE OF BREATHING TECHNIQUES-TO TIP OR NOT TO TIP RESPIRATORY MEDICINE 93 660-665
bull CONSTANTINI D BRIVIO A BRUSA D ET AL (2001) PEP MASK VERSUS POSTURAL DRAINAGE IN INFANTS A LONG-TERM COMPARATIVE TRIAL PEADIATRIC PULMONOLOGY
bull HOUGH A (2001) PHYSIOTHERAPY IN RESPIRATORY CARE AN EVIDENCE-BASED APPROACH TO RESPIRATORY AND CARDIAC MANAGEMENT CENGAGE LEARNING EMEA
bull INTERNATIONAL PHYSIOTHERAPY GROUP FOR CYSTIC FIBROSIS PHYSIOTHERAPY IN THE TREATMENT OF CYSTIC FIBROSIS (2009) HTTPSWWWECFSEUIPG_CFBOOKLET INTERNATIONAL PHYSIOTHERAPY GROUP ndash THE BLUE BOOKLET
bull KONSTAN MW STERN RC DOERSHUK CF (1994) EFFICACY OF THE FLUTTER DEVICE FOR AIRWAY MUCUS CLEARANCE IN PATIENTS WITH CYSTIC FIBROSIS JOURNAL OF PEDIATRICS 124 (5 (PT 1) 689-693
bull MCILWAINE M BUTTON B AND DWAN K (2015) POSITIVE EXPIRATORY PRESSURE PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 6 ART NO CD003147 DOI 10100214651858CD003147PUB4
bull MESTRINER RG FERNANDES RO STAFFEN LC ET AL (2009) OPTIMUM DESIGN PARAMETERS FOR A THERAPIST-CONSTRUCTED POSITIVE-EXPIRATORY-PRESSURE THERAPY BOTTLE DEVICE RESPIRATORY CARE 54 504-8
bull MORRISON L AND AGNEW J (2014) OSCILLATING DEVICES FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 7 ART NO CD006842 DOI 10100214651858CD006842PUB
bull OERMANN CM SOCKRIDER MM GILES D ET AL (2001) COMPARISON OF HIGH-FREQUENCY CHEST WALL OSCILLATION AND OSCILLATING POSITIVE EXPIRATORY PRESSURE IN THE HOME MANAGEMENT OF CYSTIC FIBROSIS A PILOT STUDY PEDIATRIC PULMONOLOGY 32 (5) 372-7
bull PRASAD SA AND HUSSEY J (1995) PAEDIATRIC RESPIRATORY CARE A GUIDE FOR PHYSIOTHERAPISTS AND HEALTH PROFESSIONALS CHAPMAN amp HALL
bull PRYOR J (1999) PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN ADULTS EUROPEAN RESPIRATORY JOURNAL 14 (6) 1418-1424
bull PRYOR JA amp PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS CHURCHILL LIVINGSTONE
bull PRYOR JA WEBBER BA HODSON ME ET AL (1994) THE FLUTTER VRP1 AS AN ADJUNCT TO CHEST PHYSIOTHERAPY IN CYSTIC FIBROSIS RESPIRATORY MEDICINE 88677-81
bull WEST K WALLEN M FOLLETT J (2010) ACAPELLA VS PEP MASK THERAPY A RANDOMISED TRIAL IN CHILDREN WITH CYSTIC FIBROSIS DURING RESPIRATORY EXACERBATION PHYSIOTHERAPY THEORY PRACTICE 26143-9
bull WILSONLM AGNEW J MORRISON L ET AL (2014) AIRWAY CLEARANCE TECHNIQUES FOR CYSTIC FIBROSIS AN OVERVIEW OF COCHRANE SYSTEMATIC REVIEWS COCHRANE DATABASE OF SYSTEMATIC REVIEWS DOI 10100214651858CD011231
bull VOLSKO TA DIFIORE JM CHATBURN RL (2003) PERFORMANCE COMPARISON OF TWO OSCILLATORY POSITIVE PRESSURE DEVICES ACAPELLA VERSUS FLUTTER RESPIRATORY CARE 48 (2) 124- 130
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SEDDON PC KHAN Y RESPIRATORY PROBLEMS IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT ARCHIVES OF DISEASE IN CHILDHOOD 2003 01 JAN88(1)75-8
bull MARKS JH PULMONARY CARE OF CHILDREN AND ADOLESCENTS WITH DEVELOPMENTAL DISABILITIES PEDIATR CLIN NORTH AM 2008 DECEMBER55(6)1299-314
bull ARENS R MUZUMDAR H SLEEP SLEEP DISORDERED BREATHING AND NOCTURNAL HYPOVENTILATION IN CHILDREN WITH NEUROMUSCULAR DISEASES PAEDIATRIC RESPIRATORY REVIEWS 2010 MAR11(1)24-30
bull FITZGERALD DA FOLLETT J VAN ASPEREN PP ASSESSING AND MANAGING LUNG DISEASE AND SLEEP DISORDERED BREATHING IN CHILDREN WITH CEREBRAL PALSY PAEDIATRIC RESPIRATORY REVIEWS 2009 MARCH10(1)18-24
bull HSIAO KH NIXON GM THE EFFECT OF TREATMENT OF OBSTRUCTIVE SLEEP APNEA ON QUALITY OF LIFE IN CHILDREN WITH CEREBRAL PALSY RES DEV DISABIL 2008 MAR-APR29(2)133-40
bull LUNDBERG A OXYGEN CONSUMPTION IN RELATION TO WORKLOAD IN STUDENTS WITH CEREBRAL PALSY J APPL PHYSIO 197640873-5
bull SULLIVAN PB ROSENBLOOM L FEEDING THE DISABLED CHILD CLINICS IN DEVELOPMENTAL MEDICINE MACKEITH PRESS 1999140
bull MARTIN TR THE RELATIONSHIP BETWEEN MALNUTRITION AND LUNG INFECTIONS CLIN CHEST MED 19878359
bull MOSTAFA SM BHANDARI S RITCHIE G ET AL CONSTIPATION AND ITS IMPLICATIONS IN THE CRITICALLY ILL PATIENT BR J ANAESTH 200391815-9 3
bull GACOUIN A CAMUS C GROS A ET AL CONSTIPATION IN LONGTERM VENTILATED PATIENTS ASSOCIATED FACTORS AND IMPACT ON INTENSIVE CARE UNIT OUTCOMES CRIT CARE MED 2010381933- 8
bull NGUYEN T FRENETTE AJ JOHANSON C ET AL IMPAIRED GASTROINTESTINAL TRANSIT AND ITS ASSOCIATED MORBIDITY IN THE INTENSIVE CARE UNIT J CRIT CARE 201328537
bull ASAI T CONSTIPATION DOES IT INCREASE MORBIDITY AND MORTALITY IN CRITICALLY ILL PATIENTS CRIT CARE MED 2007352861-2
bull UNDERSTANDING THE PHYSIOLOGICAL EFFECTS OF UNTREATED PAIN NURSING TIMES VOL 99 ISSUE 37 PAGE NO 28
bull WINFIELD ET AL NON-PHARMACEUTICAL MANAGEMENT OF RESPIRATORY MORBIDITY IN CHILDREN WITH SEVERE GLOBAL DEVELOPMENTAL DELAY THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014
bull OLOUGHLIN EV SOMERVILLE HM SOMERVILLE ER DEALING WITH MULTISYSTEM DISEASE IN PEOPLE WITH A DEVELOPMENTAL DISABILITY MEDICAL JOURNAL OF AUSTRALIA 2009 JUN 1190(11)616-7
bull MESTROVIC J KARDUM G POLIC B MESTROVIC M MARKIC J SUSTIC A ET AL THE INFLUENCE OF CHRONIC HEALTH CONDITIONS ON SUSCEPTIBILITY TO SEVERE ACUTE ILLNESS OF CHILDREN TREATED IN PICU EUROPEAN JOURNAL OF PEDIATRICS 2006 AUG165(8)526-
9
bull HEALY F PANITCH HB PULMONARY COMPLICATIONS OF PEDIATRIC NEUROLOGICAL DISEASES PEDIATR ANN 2010 APR39(4)216-24
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SRIVASTAVA R JACKSON WD BARNHART DC DYSPHAGIA AND GASTROESOPHAGEAL REFLUX DISEASE DILEMMAS IN DIAGNOSIS AND MANAGEMENT IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT PEDIATR ANN 2010 APR39(4)225-31
bull SULLIVAN PB JUSZCZAK E BACHLET AME LAMBERT B VERNON-ROBERTS A GRANT HW ET AL GASTROSTOMY TUBE FEEDING IN CHILDREN WITH CEREBRAL PALSY A PROSPECTIVE LONGITUDINAL STUDY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 2005
FEBRUARY47(2)77-85
bull SOMERVILLE H TZANNES G WOOD J SHUN A HILL C ARROWSMITH F ET AL GASTROINTESTINAL AND NUTRITIONAL PROBLEMS IN SEVERE DEVELOPMENTAL DISABILITY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 200850(9)712-6
bull TODER DS RESPIRATORY PROBLEMS IN THE ADOLESCENT WITH DEVELOPMENTAL DELAY ADOLESCENT MEDICINE 2000 3 OCTOBER 200011(3)617-31
bull LEVIN K COLON A DIPALMA J FITZPATRICK S USING THE RADIONUCLIDE SALIVAGRAM TO DETECT PULMONARY ASPIRATION AND ESOPHAGEAL DYSMOTILITY CLIN NUCL MED 1993 FEB18(2)110-4
bull SCHROEDER AS KLING T HUSS K BORGGRAEFE I KOERTE IK BLASCHEK A ET AL BOTULINUM TOXIN TYPE A AND B FOR THE REDUCTION OF HYPERSALIVATION IN CHILDREN WITH NEUROLOGICAL DISORDERS A FOCUS ON EFFECTIVENESS AND THERAPY ADHERENCE
NEUROPEDIATRICS 201243(1)27-36
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull GOEMINNE P AND DUPONT L (2010) NON-CYSTIC FIBROSIS BRONCHIECTASIS DIAGNOSIS AND MANAGEMENT IN 21ST CENTURY POSTGRADUATE MEDICAL JOURNAL 86(1018) PP493-501
bull LEE A BUTTON B AND TANNENBAUM E (2017) AIRWAY-CLEARANCE TECHNIQUES IN CHILDREN AND ADOLESCENTS WITH CHRONIC SUPPURATIVE LUNG DISEASE AND BRONCHIECTASIS FRONTIERS IN PEDIATRICS 5
bull MANDAL P SIDHU M KOPE L POLLOCK W STEVENSON L PENTLAND J TURNBULL K MAC QUARRIE S AND HILL A (2012) A PILOT STUDY OF PULMONARY REHABILITATION AND CHEST PHYSIOTHERAPY VERSUS CHEST PHYSIOTHERAPY ALONE IN
BRONCHIECTASIS RESPIRATORY MEDICINE 106(12) PP1647-1654
bull MURRAY M PENTLAND J AND HILL A (2009) A RANDOMISED CROSSOVER TRIAL OF CHEST PHYSIOTHERAPY IN NON-CYSTIC FIBROSIS BRONCHIECTASIS EUROPEAN RESPIRATORY JOURNAL 34(5) PP1086-1092
bull NEWALL C STOCKLEY R AND HILL S (2005) EXERCISE TRAINING AND INSPIRATORY MUSCLE TRAINING IN PATIENTS WITH BRONCHIECTASIS THORAX 60(11) PP943-948
bull ONG H LEE A HILL C HOLLAND A AND DENEHY L (2011) EFFECTS OF PULMONARY REHABILITATION IN BRONCHIECTASIS A RETROSPECTIVE STUDY CHRONIC RESPIRATORY DISEASE 8(1) PP21-30
bull QUINT J MILLETT E JOSHI M NAVARATNAM V THOMAS S HURST J SMEETH L AND BROWN J (2015) CHANGES IN THE INCIDENCE PREVALENCE AND MORTALITY OF BRONCHIECTASIS IN THE UK FROM 2004 TO 2013 A POPULATION-BASED COHORT
STUDY EUROPEAN RESPIRATORY JOURNAL 47(1) PP186-193
bull SNIJDERS D FERNANDEZ DOMINGUEZ B CALGARO S BERTOZZI I ESCRIBANO MONTANER A PERILONGO G AND BARBATO A (2015) MUCOCILIARY CLEARANCE TECHNIQUES FOR TREATING NON-CYSTIC FIBROSIS BRONCHIECTASIS IS THERE
EVIDENCE INTERNATIONAL JOURNAL OF IMMUNOPATHOLOGY AND PHARMACOLOGY 28(2) PP150-159
bull EXHALATION AGAINST A CONSTANT POSITIVE PRESSURE
bull AIDS REMOVAL OF BRONCHIAL SECRETIONS
bull PREVENTING AIRWAY COLLAPSE BY STENTING THE AIRWAYS
bull RECRUITMENT OF PREVIOUSLY OBSTRUCTED AIRWAYS
bull IMPROVE VENTILATION REDUCE ATELECTASIS
bull INCREASING INTRATHORACIC PRESSURE DISTAL TO RETAINED SECRETIONS BY COLLATERAL VENTILATION OR BY INCREASING FRC
bull MAINTAIN PULMONARY FUNCTION
POSITIVE EXPIRATORY PRESSURE (PEP)
bull MASK VALVE RESISTOR amp MANOMETER
bull O2CAN BE CONNECTED TO THE INHALATION SIDE IF REQUIRED
bull SIT IN GOOD POSITION WITH GOOD SEAL AROUND MOUTHPIECEMASK
bull SLOW INHALATION JUST A LITTLE LARGER THAN A NORMAL BREATH IN
(HOLD FOR 3 SECS IF USING MOUTHPIECE)
bull STEADY ACTIVE amp FULL EXHALATION
bull AIM FOR 10-20 CM H2O FOR 3-5 SECS
bull REPEAT 12-15 TIMES FOLLOWED BY FET amp COUGH
bull COMPLETE FOR 15-30 MINS (6-8 CYCLES OR SETS OF ABOVE)
PEP TREATMENT
bull BEFORE OR AT LEAST 1 HR AFTER A FEED
bull START WITH THE SMALLEST HOLERESISTOR THAT BABY CAN TOLERATE
bull USE A MANOMETER
bull HOLD THE BABY IN ARMS OR ON PARENTS LAP SIT ON GYM BALL
bull PLACE THE MASK OVER THE BABYrsquoS MOUTH amp NOSE
bull AIM FOR FEW BREATHS 30-60 SECONDS WHICH CAN BE BUILT UP TO 1-2 MINUTES AS TOLERATED
bull AIM TO REACH PRESSURES BETWEEN 5-15 CM H2O
bull REST FOR 30-60 SECONDS THEN REPEAT FOR ABOUT 5-10 MINUTES
bull COMBINE THIS WITH OTHER TREATMENTS
BABY PEP TREATMENT
OSCILLATING PEP
OSCILLATING PEP
bull DEVICES CAN BE INTRA-THORACIC OR EXTRA-THORACIC
bull INTRA-THORACIC DEVICES ARE PLACED IN THE MOUTH AND PROVIDE RESISTANCE DURING EXHALATION
bull ALTERS EXPIRATORY AIRFLOW
bull VIBRATIONS ON THE AIRWAY SURFACE
bull REDUCES MUCOUS VISCOSITY
bull ACCELERATION OF THE EXPIRATORY FLOW
bull PREVENTS AND TREATS AIRWAY COMPRESSION ATELECTASIS
bull IMPROVES AIRWAY PATENCY amp VENTILATION
bull DECREASES HYPERINFLATION
bull IMPROVES LUNG FUNCTION PARAMETERS
bull INCLUDES EXERCISE
OSCILLATING PEP TREATMENT
bull SIMILAR TO PEP
bull GOOD POSITION
bull PLACE MOUTHPIECE BETWEEN LIPS AND TEETH OR USE MASK
bull SLOW INHALE JUST A LITTLE LARGER THAN A NORMAL BREATH IN
bull HOLD FOR 3 SECONDS
bull STEADY ACTIVE amp FULL EXHALATION
bull ADJUST THE RESISTANCE AS REQUIRED
bull REPEAT 12-15 TIMES FOLLOWED BY FET amp COUGH
bull COMPLETE FOR 5-10 MINS
bull COMBINE WITH OTHER TREATMENTS
ACAPELLA
bull DETACHABLE MOUTHPIECEFACEMASK
bull ONE-WAY INSPIRATORY VALVE
bull EXPIRATORY RESISTANCEFREQUENCY ADJUSTMENT DIAL
bull COUNTERWEIGHTED PLUG amp MAGNET
bull MAINTAINS A RAISED FRC LEVEL
TREATMENT
bull EASY TO USE IN DIFFERENT POSITIONS
bull INHALE amp EXHALE THROUGH THE ACAPELLA
bull ROTATE THE FREQUENCY RESISTANCE DIAL UNTIL MAXIMUM VIBRATIONS ARE FELT WITHIN THE CHEST WALL
AEROBIKA bull COMBINES PEP WITH HIGH FREQUENCY OSCILLATIONS
bull CAN BE USED WITH A MANOMETER
bull NEBULISER CAN BE ENTRAINED INTO THE SYSTEM
bull POSSIBLE INCREASE IN TREATMENT COMPLIANCE BY DECREASING
TREATMENT TIMES
TECHNIQUE AS OSCILLATING PEP
BUBBLE PEP
Suction tubing (~1cm diameter) The end MUST sit at the bottom of the bottle
Plastic bottle Any widthshapediameter must be gt20cm tall 15cm fresh tapsterile water
(depth of water determines the amount of pressure ie cm H20
Washing up bowl
INDICATIONS
bull REDUCED LUNG VOLUME (FVClt50)
bull WEAK COUGH (PCFlt270)
bull SECRETIONS RETENTION
bull ATELECTASIS
bull REDUCED MECHANICAL COMPLIANCE
bull CHILD ABLE TO COMPLY
BENEFITS
bull INCREASE LUNG VOLUME = IMPROVES PCF
bull SECRETION CLEARANCE
bull MAY REVERSE ATELECTASIS
bull IMPROVE MECHANICAL COMPLIANCE = LUNG AND CHEST WALL MOBILITY
bull IMPROVE VOICE STRENGTH
LUNG VOLUME RECRUITMENT
bull LABEL NOT FOR RESUSCITATION
bull BEST IN SITTING
bull SUCTION READY
bull AGREE SIGNAL WITH CHILD WHEN MIC ACHIEVED
bull ASK TO BREATH OUT
bull PLACE MOUTHPIECE +- NOSE CLIP OR MASK
bull ASK TO BREATH IN AND HOLD WHILE GENTLY SQUEEZING BAG
bull WITHOUT LETTING AIR OUT ASK CHILD TO TAKE ANOTHER BREATH IN ON TOP OF THE FIRST BREATH AND SQUEEZE BAG IN TIME WITH BREATH
bull REPEAT UNTIL LUNGS ARE FULL (NORMALLY 3-5 BREATHS) OR SIGNAL
bull REMOVE MASK OR MOUTHPIECE ASK TO HOLD FOR 3-5 SECONDS
bull EXHALE OR IF SECRETIONS ARE PRESENT ENCOURAGE TO HAVE A COUGH OR MAC
bull REPEATED X3-5 X2-4 DAY
LVR TREATMENT
bull AIRWAY CLEARANCE OR THORACIC MOBILITY
bull AMBU RESUS BAG
bull GREEN ldquoPHYSIOrdquo BAG
bull MANUAL TECHNIQUES WITH BAGGING
bull MHI AT HOME
bull MANOMETERS
MHI
PHYSIO WITH NIV
bull PHYSIO SETTINGS
bull SECRETIONS
bull THORACIC MOBILITY
bull ALLOWS REST PERIOD PRE ACT
bull HUMIDIFICATION
bull INFLATABLE VEST CONNECTED BY TUBES TO AN AIR PULSE GENERATOR WHICH RAPIDLY INFLATES AND DEFLATES THE VEST PRODUCING OSCILLATIONS TO THE CHEST WALL
bull RAPID CHEST MOVEMENT MIMICS A COUGH-LIKE EXPIRATORY FLOW THAT SHEARS MUCUS AWAY FROM THE AIRWAY WALLS AND HELPS TO MOVE IT ALONG TO THE CENTRAL AIRWAYS
bull PASSIVE TREATMENT amp NOT POSITION DEPENDANT
bull COMBINATION OF RX
bull CONTRAINDICATIONS
bull HEAD ANDOR NECK INJURY THAT HAS NOT BEEN STABILISED
bull ACTIVE HAEMORRHAGE WITH HEMODYNAMIC INSTABILITY
HFCWO
HFCWO INDICATIONS
bull CHRONIC MUCUS HYPERSECRETION OR RETENTION ASSOCIATED WITH A CHRONIC PULMONARY OR NEUROMUSCULAR CONDITION
bull LRT SECRETIONS AND FREQUENT LRTI REQUIRING HOSPITAL ADMISSION
bull INEFFECTIVE COUGH OR INABILITY TO REMOVE MUCUS BY COUGHING
bull TENACIOUS SECRETIONS THAT ARE NOT EASILY MOBILISED WITH STANDARD CPT
bull MECHANICALLY VENTILATED WITH EVIDENCE OF SECRETION RETENTION
bull ALTERNATIVE AIRWAY CLEARANCE THERAPY PROVEN INEFFECTIVE OR CONTRAINDICATEDDO NOT TOLERATE STANDARD CPT
bull CONSTANT FATIGUE LACK OF STRENGTH OR ABILITY TO PERFORM ACTIVE TREATMENT
bull SYMPTOMATIC
bull POOR COMPLIANCE WITH OTHER AIRWAY CLEARANCE METHODS
bull HIGH BURDEN OF CARE
bull PATIENT UNABLE TO TOLERATE THE INCREASED WORK OF BREATHING bull ACTIVE HAEMOPTYSIS bull UNTREATED PNEUMOTHORAX bull INTRACRANIAL PRESSURE (ICP) gt 20 MMHG bull HAEMODYNAMIC INSTABILITY bull SEVERE CARDIOVASCULAR INSULTDISEASE bull RECENT FACIAL ORAL OR SKULL SURGERY OR TRAUMA bull ACUTE SINUSITIS bull EPISTAXIS bull POST OESOPHAGEAL amp LUNG SURGERY bull KNOWN OR SUSPECTED TYMPANIC MEMBRANE RUPTURE OR OTHER MIDDLE EAR
PATHOLOGY
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
POSSIBLE HAZARDSCOMPLICATIONS
bull INCREASED WORK OF BREATHING THAT MAY LEAD TO HYPOVENTILATION AND
HYPERCARBIA
bull INCREASED INTRACRANIAL PRESSURE
bull CARDIOVASCULAR COMPROMISE
bull NAUSEA
bull MYOCARDIAL ISCHEMIA
bull DECREASED VENOUS RETURN
bull AIR SWALLOWING WITH INCREASED LIKELIHOOD OF VOMITING AND
ASPIRATION
bull CLAUSTROPHOBIA
bull SKIN BREAK DOWN AND DISCOMFORT FROM MASK
bull PULMONARY BAROTRAUMA
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
MI-E
bull USED WITH CHILDREN WHO HAVE DECREASED INSPIRATORY EFFORT DUE TO EITHER SPINAL CORD INJURY OR NMW AND WHO HAVE AN IMPAIRED OR INEFFECTIVE COUGH WITH APPROPRIATE RESPIRATORY SYMPTOMS
bull CONSIDERED WHEN CONVENTIONAL COUGH ASSISTANCE TECHNIQUES BECOME INEFFECTIVE
bull ACCEPTED AS THE CORE STANDARD FOR CHILD WITH NMW
bull MIE WORKS BY
bull INFLATING THE LUNGS WITH GRADUAL POSITIVE AIRWAY PRESSURE ASSISTING INSPIRATION CALLED INSUFFLATION
bull FOLLOWED BY A RAPID SWITCH TO NEGATIVE PRESSURE WHICH SIMULATES THE FLOW CHANGES THAT OCCUR DURING A COUGH THEREBY ENHANCING EXPIRATORY FLOW CALLED EXSUFFLATION AND ASSISTING EXPECTORATION OF SECRETIONS
bull MOVEMENT AND EXERCISE BEST FUNCTIONAL METHOD OF AIRWAY CLEARANCE
bull CPET BETTER CORRELATION THAN LUNG FUNCTION IN SURVIVAL RATES IN PEOPLE WITH
CYSTIC FIBROSIS
bull RUNNINGWALKING BETTER FOR SECRETION CLEARANCE THAN BIKE DURING TO SHEARING
MECHANISM
bull CONSIDER ADDING IN HUFFS (DYER)
bull CONSIDER USE OF AD BELT
EXERCISE
bull APCP SUCTION GUIDELINES
bull TYPESNASOPHARANGEAL OROPHARANGEAL AND TRACHEOSTOMY
bull MAIN VARIABLES SUCTION TYPE AND SIZE DEPTH OF SUCTION
PRESSURE TECHNIQUE
SUCTION
SPUTUM
bull SPUTUM bull 95 WATER bull COLOUR bull VOLUME bull CONSISTENCY bull ODOUR
bull PURPOSE bull HUMIDIFICATION bull WATERPROOFING bull PROTECTION OF EPITHELIUM
HUMIDIFICATION
bull METABOLIC AND VENTILATORY REQUIREMENTS ARE X2-3 OF ADULTS
IMPLICATION
bull HEAT AND MOISTURE LOSSES FROM RESPIRATION WILL INCREASE BY X2-3
bull CONSUME GREATER AMOUNTS OF ENERGY AND WATER
HUMIDIFICATION INHALATION
THERAPY
bull TRACHEOSTOMY HME
bull WET DRY CIRCUIT
bull NEBULISERS INHALERS MUCOLYTICS
bull HUMIDIFIERS WITH NIV
bull OXYGEN
bull SYSTEMIC HYDRATION ENVIRONMENT
NEBULISERS
bull NEBULISER CHAMBER CONVERTS LIQUID INTO
RESPIRABLE PARTICLES
bull MOISTURE DESCENDS THROUGH THE HOLES IN THE SUPERFICIAL GEL LAYER
bull INCREASES THE SOL LAYER SO THE CILIARY BEAT IS OPTIMAL FOR MUCUS TRANSPORT
bull SHORT TERM HUMIDIFICATION
bull DAILY WASHING OF NEBULISER SYSTEM
TIMING OF DRUG AND PHYSIOTHERAPY
BEFORE TREATMENT
bull DNASE (PULMOZYME)
bull SALBUTAMOL
(VENTOLIN BLUE)
bull SALINE NEBS
AFTER TREATMENT
bull SERETIDE (PURPLE)
bull BECLOMETHASONE (BECOTIDE BROWN)
bull COLISTIN (COLOMYCIN PROMIXIN)
bull TOBRAMYCIN
CONCLUSION
bull BE AWARE OF CHILDrsquoS RESPIRATORY FUNCTION
bull CHOSE ACT BEST FOR THEM bull TYPE OF KETCHUP BOTTLE bull LV SECRETION RETENTION WOB
bull EARLY RESPIRATORY REFERRAL
bull RESPIRATORY CARE COMPETENCIES
bull EFFECTIVE SECRETION CLEARANCE AT HOMERESPITESCHOOL
bull USE OF PEAK COUGH FLOWS TO AID CHOICE OF ADJUNCT
0
50
100
150
200
250
300
350
400
0
50
100
150
200
250
300
350
400
Green
Key
Additional info
(please comment) Please refer to BTSACPRC Guideline
Lothian University Hospitals NHS Trust
n PCF
gt270lmin
Breathstack
ing tri-
flow
blowing
REFERENCES bull BTSACPRC GUIDELINE IS PUBLISHED IN THORAX VOL 67 SUPPLEMENT 1
bull AVAILABLE ONLINE AT HTTPTHORAXBMJCOMCONTENTVOL64ISSUESUPPLI
bull HTTPWWWBRIT-THORACICORGUKPHYSIOGUIDE
bull BRITISH THORACIC SOCIETY REPORTS VOL 1 NO 1 2009
bull ADAPTED PRYOR AJ AND PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS3RD ED
bull HOUGH A PHYSIOTHERAPY IN RESPIRATORY CARE LONDON CHAPMAN AND HALL 1993
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1997) POSTURAL DRAINAGE AND GASTRO-OESOPHAGEAL REFLUX IN INFANTS WITH CYSTIC FIBROSIS ARCHIVES OF DISEASE IN CHILDHOOD 76 148-150
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1998) POSTURAL DRAINAGE IN CYSTIC FIBROSIS IS THERE A LINK WITH GASTRO-OESOPHAGEAL REFLUX JOURNAL OF PAEDIATRIC CHILD HEALTH 34 330-334
bull CECINS NM JENKINS SC PENGELLEY J ET AL (1999) THE ACTIVE CYCLE OF BREATHING TECHNIQUES-TO TIP OR NOT TO TIP RESPIRATORY MEDICINE 93 660-665
bull CONSTANTINI D BRIVIO A BRUSA D ET AL (2001) PEP MASK VERSUS POSTURAL DRAINAGE IN INFANTS A LONG-TERM COMPARATIVE TRIAL PEADIATRIC PULMONOLOGY
bull HOUGH A (2001) PHYSIOTHERAPY IN RESPIRATORY CARE AN EVIDENCE-BASED APPROACH TO RESPIRATORY AND CARDIAC MANAGEMENT CENGAGE LEARNING EMEA
bull INTERNATIONAL PHYSIOTHERAPY GROUP FOR CYSTIC FIBROSIS PHYSIOTHERAPY IN THE TREATMENT OF CYSTIC FIBROSIS (2009) HTTPSWWWECFSEUIPG_CFBOOKLET INTERNATIONAL PHYSIOTHERAPY GROUP ndash THE BLUE BOOKLET
bull KONSTAN MW STERN RC DOERSHUK CF (1994) EFFICACY OF THE FLUTTER DEVICE FOR AIRWAY MUCUS CLEARANCE IN PATIENTS WITH CYSTIC FIBROSIS JOURNAL OF PEDIATRICS 124 (5 (PT 1) 689-693
bull MCILWAINE M BUTTON B AND DWAN K (2015) POSITIVE EXPIRATORY PRESSURE PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 6 ART NO CD003147 DOI 10100214651858CD003147PUB4
bull MESTRINER RG FERNANDES RO STAFFEN LC ET AL (2009) OPTIMUM DESIGN PARAMETERS FOR A THERAPIST-CONSTRUCTED POSITIVE-EXPIRATORY-PRESSURE THERAPY BOTTLE DEVICE RESPIRATORY CARE 54 504-8
bull MORRISON L AND AGNEW J (2014) OSCILLATING DEVICES FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 7 ART NO CD006842 DOI 10100214651858CD006842PUB
bull OERMANN CM SOCKRIDER MM GILES D ET AL (2001) COMPARISON OF HIGH-FREQUENCY CHEST WALL OSCILLATION AND OSCILLATING POSITIVE EXPIRATORY PRESSURE IN THE HOME MANAGEMENT OF CYSTIC FIBROSIS A PILOT STUDY PEDIATRIC PULMONOLOGY 32 (5) 372-7
bull PRASAD SA AND HUSSEY J (1995) PAEDIATRIC RESPIRATORY CARE A GUIDE FOR PHYSIOTHERAPISTS AND HEALTH PROFESSIONALS CHAPMAN amp HALL
bull PRYOR J (1999) PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN ADULTS EUROPEAN RESPIRATORY JOURNAL 14 (6) 1418-1424
bull PRYOR JA amp PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS CHURCHILL LIVINGSTONE
bull PRYOR JA WEBBER BA HODSON ME ET AL (1994) THE FLUTTER VRP1 AS AN ADJUNCT TO CHEST PHYSIOTHERAPY IN CYSTIC FIBROSIS RESPIRATORY MEDICINE 88677-81
bull WEST K WALLEN M FOLLETT J (2010) ACAPELLA VS PEP MASK THERAPY A RANDOMISED TRIAL IN CHILDREN WITH CYSTIC FIBROSIS DURING RESPIRATORY EXACERBATION PHYSIOTHERAPY THEORY PRACTICE 26143-9
bull WILSONLM AGNEW J MORRISON L ET AL (2014) AIRWAY CLEARANCE TECHNIQUES FOR CYSTIC FIBROSIS AN OVERVIEW OF COCHRANE SYSTEMATIC REVIEWS COCHRANE DATABASE OF SYSTEMATIC REVIEWS DOI 10100214651858CD011231
bull VOLSKO TA DIFIORE JM CHATBURN RL (2003) PERFORMANCE COMPARISON OF TWO OSCILLATORY POSITIVE PRESSURE DEVICES ACAPELLA VERSUS FLUTTER RESPIRATORY CARE 48 (2) 124- 130
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SEDDON PC KHAN Y RESPIRATORY PROBLEMS IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT ARCHIVES OF DISEASE IN CHILDHOOD 2003 01 JAN88(1)75-8
bull MARKS JH PULMONARY CARE OF CHILDREN AND ADOLESCENTS WITH DEVELOPMENTAL DISABILITIES PEDIATR CLIN NORTH AM 2008 DECEMBER55(6)1299-314
bull ARENS R MUZUMDAR H SLEEP SLEEP DISORDERED BREATHING AND NOCTURNAL HYPOVENTILATION IN CHILDREN WITH NEUROMUSCULAR DISEASES PAEDIATRIC RESPIRATORY REVIEWS 2010 MAR11(1)24-30
bull FITZGERALD DA FOLLETT J VAN ASPEREN PP ASSESSING AND MANAGING LUNG DISEASE AND SLEEP DISORDERED BREATHING IN CHILDREN WITH CEREBRAL PALSY PAEDIATRIC RESPIRATORY REVIEWS 2009 MARCH10(1)18-24
bull HSIAO KH NIXON GM THE EFFECT OF TREATMENT OF OBSTRUCTIVE SLEEP APNEA ON QUALITY OF LIFE IN CHILDREN WITH CEREBRAL PALSY RES DEV DISABIL 2008 MAR-APR29(2)133-40
bull LUNDBERG A OXYGEN CONSUMPTION IN RELATION TO WORKLOAD IN STUDENTS WITH CEREBRAL PALSY J APPL PHYSIO 197640873-5
bull SULLIVAN PB ROSENBLOOM L FEEDING THE DISABLED CHILD CLINICS IN DEVELOPMENTAL MEDICINE MACKEITH PRESS 1999140
bull MARTIN TR THE RELATIONSHIP BETWEEN MALNUTRITION AND LUNG INFECTIONS CLIN CHEST MED 19878359
bull MOSTAFA SM BHANDARI S RITCHIE G ET AL CONSTIPATION AND ITS IMPLICATIONS IN THE CRITICALLY ILL PATIENT BR J ANAESTH 200391815-9 3
bull GACOUIN A CAMUS C GROS A ET AL CONSTIPATION IN LONGTERM VENTILATED PATIENTS ASSOCIATED FACTORS AND IMPACT ON INTENSIVE CARE UNIT OUTCOMES CRIT CARE MED 2010381933- 8
bull NGUYEN T FRENETTE AJ JOHANSON C ET AL IMPAIRED GASTROINTESTINAL TRANSIT AND ITS ASSOCIATED MORBIDITY IN THE INTENSIVE CARE UNIT J CRIT CARE 201328537
bull ASAI T CONSTIPATION DOES IT INCREASE MORBIDITY AND MORTALITY IN CRITICALLY ILL PATIENTS CRIT CARE MED 2007352861-2
bull UNDERSTANDING THE PHYSIOLOGICAL EFFECTS OF UNTREATED PAIN NURSING TIMES VOL 99 ISSUE 37 PAGE NO 28
bull WINFIELD ET AL NON-PHARMACEUTICAL MANAGEMENT OF RESPIRATORY MORBIDITY IN CHILDREN WITH SEVERE GLOBAL DEVELOPMENTAL DELAY THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014
bull OLOUGHLIN EV SOMERVILLE HM SOMERVILLE ER DEALING WITH MULTISYSTEM DISEASE IN PEOPLE WITH A DEVELOPMENTAL DISABILITY MEDICAL JOURNAL OF AUSTRALIA 2009 JUN 1190(11)616-7
bull MESTROVIC J KARDUM G POLIC B MESTROVIC M MARKIC J SUSTIC A ET AL THE INFLUENCE OF CHRONIC HEALTH CONDITIONS ON SUSCEPTIBILITY TO SEVERE ACUTE ILLNESS OF CHILDREN TREATED IN PICU EUROPEAN JOURNAL OF PEDIATRICS 2006 AUG165(8)526-
9
bull HEALY F PANITCH HB PULMONARY COMPLICATIONS OF PEDIATRIC NEUROLOGICAL DISEASES PEDIATR ANN 2010 APR39(4)216-24
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SRIVASTAVA R JACKSON WD BARNHART DC DYSPHAGIA AND GASTROESOPHAGEAL REFLUX DISEASE DILEMMAS IN DIAGNOSIS AND MANAGEMENT IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT PEDIATR ANN 2010 APR39(4)225-31
bull SULLIVAN PB JUSZCZAK E BACHLET AME LAMBERT B VERNON-ROBERTS A GRANT HW ET AL GASTROSTOMY TUBE FEEDING IN CHILDREN WITH CEREBRAL PALSY A PROSPECTIVE LONGITUDINAL STUDY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 2005
FEBRUARY47(2)77-85
bull SOMERVILLE H TZANNES G WOOD J SHUN A HILL C ARROWSMITH F ET AL GASTROINTESTINAL AND NUTRITIONAL PROBLEMS IN SEVERE DEVELOPMENTAL DISABILITY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 200850(9)712-6
bull TODER DS RESPIRATORY PROBLEMS IN THE ADOLESCENT WITH DEVELOPMENTAL DELAY ADOLESCENT MEDICINE 2000 3 OCTOBER 200011(3)617-31
bull LEVIN K COLON A DIPALMA J FITZPATRICK S USING THE RADIONUCLIDE SALIVAGRAM TO DETECT PULMONARY ASPIRATION AND ESOPHAGEAL DYSMOTILITY CLIN NUCL MED 1993 FEB18(2)110-4
bull SCHROEDER AS KLING T HUSS K BORGGRAEFE I KOERTE IK BLASCHEK A ET AL BOTULINUM TOXIN TYPE A AND B FOR THE REDUCTION OF HYPERSALIVATION IN CHILDREN WITH NEUROLOGICAL DISORDERS A FOCUS ON EFFECTIVENESS AND THERAPY ADHERENCE
NEUROPEDIATRICS 201243(1)27-36
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull GOEMINNE P AND DUPONT L (2010) NON-CYSTIC FIBROSIS BRONCHIECTASIS DIAGNOSIS AND MANAGEMENT IN 21ST CENTURY POSTGRADUATE MEDICAL JOURNAL 86(1018) PP493-501
bull LEE A BUTTON B AND TANNENBAUM E (2017) AIRWAY-CLEARANCE TECHNIQUES IN CHILDREN AND ADOLESCENTS WITH CHRONIC SUPPURATIVE LUNG DISEASE AND BRONCHIECTASIS FRONTIERS IN PEDIATRICS 5
bull MANDAL P SIDHU M KOPE L POLLOCK W STEVENSON L PENTLAND J TURNBULL K MAC QUARRIE S AND HILL A (2012) A PILOT STUDY OF PULMONARY REHABILITATION AND CHEST PHYSIOTHERAPY VERSUS CHEST PHYSIOTHERAPY ALONE IN
BRONCHIECTASIS RESPIRATORY MEDICINE 106(12) PP1647-1654
bull MURRAY M PENTLAND J AND HILL A (2009) A RANDOMISED CROSSOVER TRIAL OF CHEST PHYSIOTHERAPY IN NON-CYSTIC FIBROSIS BRONCHIECTASIS EUROPEAN RESPIRATORY JOURNAL 34(5) PP1086-1092
bull NEWALL C STOCKLEY R AND HILL S (2005) EXERCISE TRAINING AND INSPIRATORY MUSCLE TRAINING IN PATIENTS WITH BRONCHIECTASIS THORAX 60(11) PP943-948
bull ONG H LEE A HILL C HOLLAND A AND DENEHY L (2011) EFFECTS OF PULMONARY REHABILITATION IN BRONCHIECTASIS A RETROSPECTIVE STUDY CHRONIC RESPIRATORY DISEASE 8(1) PP21-30
bull QUINT J MILLETT E JOSHI M NAVARATNAM V THOMAS S HURST J SMEETH L AND BROWN J (2015) CHANGES IN THE INCIDENCE PREVALENCE AND MORTALITY OF BRONCHIECTASIS IN THE UK FROM 2004 TO 2013 A POPULATION-BASED COHORT
STUDY EUROPEAN RESPIRATORY JOURNAL 47(1) PP186-193
bull SNIJDERS D FERNANDEZ DOMINGUEZ B CALGARO S BERTOZZI I ESCRIBANO MONTANER A PERILONGO G AND BARBATO A (2015) MUCOCILIARY CLEARANCE TECHNIQUES FOR TREATING NON-CYSTIC FIBROSIS BRONCHIECTASIS IS THERE
EVIDENCE INTERNATIONAL JOURNAL OF IMMUNOPATHOLOGY AND PHARMACOLOGY 28(2) PP150-159
bull MASK VALVE RESISTOR amp MANOMETER
bull O2CAN BE CONNECTED TO THE INHALATION SIDE IF REQUIRED
bull SIT IN GOOD POSITION WITH GOOD SEAL AROUND MOUTHPIECEMASK
bull SLOW INHALATION JUST A LITTLE LARGER THAN A NORMAL BREATH IN
(HOLD FOR 3 SECS IF USING MOUTHPIECE)
bull STEADY ACTIVE amp FULL EXHALATION
bull AIM FOR 10-20 CM H2O FOR 3-5 SECS
bull REPEAT 12-15 TIMES FOLLOWED BY FET amp COUGH
bull COMPLETE FOR 15-30 MINS (6-8 CYCLES OR SETS OF ABOVE)
PEP TREATMENT
bull BEFORE OR AT LEAST 1 HR AFTER A FEED
bull START WITH THE SMALLEST HOLERESISTOR THAT BABY CAN TOLERATE
bull USE A MANOMETER
bull HOLD THE BABY IN ARMS OR ON PARENTS LAP SIT ON GYM BALL
bull PLACE THE MASK OVER THE BABYrsquoS MOUTH amp NOSE
bull AIM FOR FEW BREATHS 30-60 SECONDS WHICH CAN BE BUILT UP TO 1-2 MINUTES AS TOLERATED
bull AIM TO REACH PRESSURES BETWEEN 5-15 CM H2O
bull REST FOR 30-60 SECONDS THEN REPEAT FOR ABOUT 5-10 MINUTES
bull COMBINE THIS WITH OTHER TREATMENTS
BABY PEP TREATMENT
OSCILLATING PEP
OSCILLATING PEP
bull DEVICES CAN BE INTRA-THORACIC OR EXTRA-THORACIC
bull INTRA-THORACIC DEVICES ARE PLACED IN THE MOUTH AND PROVIDE RESISTANCE DURING EXHALATION
bull ALTERS EXPIRATORY AIRFLOW
bull VIBRATIONS ON THE AIRWAY SURFACE
bull REDUCES MUCOUS VISCOSITY
bull ACCELERATION OF THE EXPIRATORY FLOW
bull PREVENTS AND TREATS AIRWAY COMPRESSION ATELECTASIS
bull IMPROVES AIRWAY PATENCY amp VENTILATION
bull DECREASES HYPERINFLATION
bull IMPROVES LUNG FUNCTION PARAMETERS
bull INCLUDES EXERCISE
OSCILLATING PEP TREATMENT
bull SIMILAR TO PEP
bull GOOD POSITION
bull PLACE MOUTHPIECE BETWEEN LIPS AND TEETH OR USE MASK
bull SLOW INHALE JUST A LITTLE LARGER THAN A NORMAL BREATH IN
bull HOLD FOR 3 SECONDS
bull STEADY ACTIVE amp FULL EXHALATION
bull ADJUST THE RESISTANCE AS REQUIRED
bull REPEAT 12-15 TIMES FOLLOWED BY FET amp COUGH
bull COMPLETE FOR 5-10 MINS
bull COMBINE WITH OTHER TREATMENTS
ACAPELLA
bull DETACHABLE MOUTHPIECEFACEMASK
bull ONE-WAY INSPIRATORY VALVE
bull EXPIRATORY RESISTANCEFREQUENCY ADJUSTMENT DIAL
bull COUNTERWEIGHTED PLUG amp MAGNET
bull MAINTAINS A RAISED FRC LEVEL
TREATMENT
bull EASY TO USE IN DIFFERENT POSITIONS
bull INHALE amp EXHALE THROUGH THE ACAPELLA
bull ROTATE THE FREQUENCY RESISTANCE DIAL UNTIL MAXIMUM VIBRATIONS ARE FELT WITHIN THE CHEST WALL
AEROBIKA bull COMBINES PEP WITH HIGH FREQUENCY OSCILLATIONS
bull CAN BE USED WITH A MANOMETER
bull NEBULISER CAN BE ENTRAINED INTO THE SYSTEM
bull POSSIBLE INCREASE IN TREATMENT COMPLIANCE BY DECREASING
TREATMENT TIMES
TECHNIQUE AS OSCILLATING PEP
BUBBLE PEP
Suction tubing (~1cm diameter) The end MUST sit at the bottom of the bottle
Plastic bottle Any widthshapediameter must be gt20cm tall 15cm fresh tapsterile water
(depth of water determines the amount of pressure ie cm H20
Washing up bowl
INDICATIONS
bull REDUCED LUNG VOLUME (FVClt50)
bull WEAK COUGH (PCFlt270)
bull SECRETIONS RETENTION
bull ATELECTASIS
bull REDUCED MECHANICAL COMPLIANCE
bull CHILD ABLE TO COMPLY
BENEFITS
bull INCREASE LUNG VOLUME = IMPROVES PCF
bull SECRETION CLEARANCE
bull MAY REVERSE ATELECTASIS
bull IMPROVE MECHANICAL COMPLIANCE = LUNG AND CHEST WALL MOBILITY
bull IMPROVE VOICE STRENGTH
LUNG VOLUME RECRUITMENT
bull LABEL NOT FOR RESUSCITATION
bull BEST IN SITTING
bull SUCTION READY
bull AGREE SIGNAL WITH CHILD WHEN MIC ACHIEVED
bull ASK TO BREATH OUT
bull PLACE MOUTHPIECE +- NOSE CLIP OR MASK
bull ASK TO BREATH IN AND HOLD WHILE GENTLY SQUEEZING BAG
bull WITHOUT LETTING AIR OUT ASK CHILD TO TAKE ANOTHER BREATH IN ON TOP OF THE FIRST BREATH AND SQUEEZE BAG IN TIME WITH BREATH
bull REPEAT UNTIL LUNGS ARE FULL (NORMALLY 3-5 BREATHS) OR SIGNAL
bull REMOVE MASK OR MOUTHPIECE ASK TO HOLD FOR 3-5 SECONDS
bull EXHALE OR IF SECRETIONS ARE PRESENT ENCOURAGE TO HAVE A COUGH OR MAC
bull REPEATED X3-5 X2-4 DAY
LVR TREATMENT
bull AIRWAY CLEARANCE OR THORACIC MOBILITY
bull AMBU RESUS BAG
bull GREEN ldquoPHYSIOrdquo BAG
bull MANUAL TECHNIQUES WITH BAGGING
bull MHI AT HOME
bull MANOMETERS
MHI
PHYSIO WITH NIV
bull PHYSIO SETTINGS
bull SECRETIONS
bull THORACIC MOBILITY
bull ALLOWS REST PERIOD PRE ACT
bull HUMIDIFICATION
bull INFLATABLE VEST CONNECTED BY TUBES TO AN AIR PULSE GENERATOR WHICH RAPIDLY INFLATES AND DEFLATES THE VEST PRODUCING OSCILLATIONS TO THE CHEST WALL
bull RAPID CHEST MOVEMENT MIMICS A COUGH-LIKE EXPIRATORY FLOW THAT SHEARS MUCUS AWAY FROM THE AIRWAY WALLS AND HELPS TO MOVE IT ALONG TO THE CENTRAL AIRWAYS
bull PASSIVE TREATMENT amp NOT POSITION DEPENDANT
bull COMBINATION OF RX
bull CONTRAINDICATIONS
bull HEAD ANDOR NECK INJURY THAT HAS NOT BEEN STABILISED
bull ACTIVE HAEMORRHAGE WITH HEMODYNAMIC INSTABILITY
HFCWO
HFCWO INDICATIONS
bull CHRONIC MUCUS HYPERSECRETION OR RETENTION ASSOCIATED WITH A CHRONIC PULMONARY OR NEUROMUSCULAR CONDITION
bull LRT SECRETIONS AND FREQUENT LRTI REQUIRING HOSPITAL ADMISSION
bull INEFFECTIVE COUGH OR INABILITY TO REMOVE MUCUS BY COUGHING
bull TENACIOUS SECRETIONS THAT ARE NOT EASILY MOBILISED WITH STANDARD CPT
bull MECHANICALLY VENTILATED WITH EVIDENCE OF SECRETION RETENTION
bull ALTERNATIVE AIRWAY CLEARANCE THERAPY PROVEN INEFFECTIVE OR CONTRAINDICATEDDO NOT TOLERATE STANDARD CPT
bull CONSTANT FATIGUE LACK OF STRENGTH OR ABILITY TO PERFORM ACTIVE TREATMENT
bull SYMPTOMATIC
bull POOR COMPLIANCE WITH OTHER AIRWAY CLEARANCE METHODS
bull HIGH BURDEN OF CARE
bull PATIENT UNABLE TO TOLERATE THE INCREASED WORK OF BREATHING bull ACTIVE HAEMOPTYSIS bull UNTREATED PNEUMOTHORAX bull INTRACRANIAL PRESSURE (ICP) gt 20 MMHG bull HAEMODYNAMIC INSTABILITY bull SEVERE CARDIOVASCULAR INSULTDISEASE bull RECENT FACIAL ORAL OR SKULL SURGERY OR TRAUMA bull ACUTE SINUSITIS bull EPISTAXIS bull POST OESOPHAGEAL amp LUNG SURGERY bull KNOWN OR SUSPECTED TYMPANIC MEMBRANE RUPTURE OR OTHER MIDDLE EAR
PATHOLOGY
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
POSSIBLE HAZARDSCOMPLICATIONS
bull INCREASED WORK OF BREATHING THAT MAY LEAD TO HYPOVENTILATION AND
HYPERCARBIA
bull INCREASED INTRACRANIAL PRESSURE
bull CARDIOVASCULAR COMPROMISE
bull NAUSEA
bull MYOCARDIAL ISCHEMIA
bull DECREASED VENOUS RETURN
bull AIR SWALLOWING WITH INCREASED LIKELIHOOD OF VOMITING AND
ASPIRATION
bull CLAUSTROPHOBIA
bull SKIN BREAK DOWN AND DISCOMFORT FROM MASK
bull PULMONARY BAROTRAUMA
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
MI-E
bull USED WITH CHILDREN WHO HAVE DECREASED INSPIRATORY EFFORT DUE TO EITHER SPINAL CORD INJURY OR NMW AND WHO HAVE AN IMPAIRED OR INEFFECTIVE COUGH WITH APPROPRIATE RESPIRATORY SYMPTOMS
bull CONSIDERED WHEN CONVENTIONAL COUGH ASSISTANCE TECHNIQUES BECOME INEFFECTIVE
bull ACCEPTED AS THE CORE STANDARD FOR CHILD WITH NMW
bull MIE WORKS BY
bull INFLATING THE LUNGS WITH GRADUAL POSITIVE AIRWAY PRESSURE ASSISTING INSPIRATION CALLED INSUFFLATION
bull FOLLOWED BY A RAPID SWITCH TO NEGATIVE PRESSURE WHICH SIMULATES THE FLOW CHANGES THAT OCCUR DURING A COUGH THEREBY ENHANCING EXPIRATORY FLOW CALLED EXSUFFLATION AND ASSISTING EXPECTORATION OF SECRETIONS
bull MOVEMENT AND EXERCISE BEST FUNCTIONAL METHOD OF AIRWAY CLEARANCE
bull CPET BETTER CORRELATION THAN LUNG FUNCTION IN SURVIVAL RATES IN PEOPLE WITH
CYSTIC FIBROSIS
bull RUNNINGWALKING BETTER FOR SECRETION CLEARANCE THAN BIKE DURING TO SHEARING
MECHANISM
bull CONSIDER ADDING IN HUFFS (DYER)
bull CONSIDER USE OF AD BELT
EXERCISE
bull APCP SUCTION GUIDELINES
bull TYPESNASOPHARANGEAL OROPHARANGEAL AND TRACHEOSTOMY
bull MAIN VARIABLES SUCTION TYPE AND SIZE DEPTH OF SUCTION
PRESSURE TECHNIQUE
SUCTION
SPUTUM
bull SPUTUM bull 95 WATER bull COLOUR bull VOLUME bull CONSISTENCY bull ODOUR
bull PURPOSE bull HUMIDIFICATION bull WATERPROOFING bull PROTECTION OF EPITHELIUM
HUMIDIFICATION
bull METABOLIC AND VENTILATORY REQUIREMENTS ARE X2-3 OF ADULTS
IMPLICATION
bull HEAT AND MOISTURE LOSSES FROM RESPIRATION WILL INCREASE BY X2-3
bull CONSUME GREATER AMOUNTS OF ENERGY AND WATER
HUMIDIFICATION INHALATION
THERAPY
bull TRACHEOSTOMY HME
bull WET DRY CIRCUIT
bull NEBULISERS INHALERS MUCOLYTICS
bull HUMIDIFIERS WITH NIV
bull OXYGEN
bull SYSTEMIC HYDRATION ENVIRONMENT
NEBULISERS
bull NEBULISER CHAMBER CONVERTS LIQUID INTO
RESPIRABLE PARTICLES
bull MOISTURE DESCENDS THROUGH THE HOLES IN THE SUPERFICIAL GEL LAYER
bull INCREASES THE SOL LAYER SO THE CILIARY BEAT IS OPTIMAL FOR MUCUS TRANSPORT
bull SHORT TERM HUMIDIFICATION
bull DAILY WASHING OF NEBULISER SYSTEM
TIMING OF DRUG AND PHYSIOTHERAPY
BEFORE TREATMENT
bull DNASE (PULMOZYME)
bull SALBUTAMOL
(VENTOLIN BLUE)
bull SALINE NEBS
AFTER TREATMENT
bull SERETIDE (PURPLE)
bull BECLOMETHASONE (BECOTIDE BROWN)
bull COLISTIN (COLOMYCIN PROMIXIN)
bull TOBRAMYCIN
CONCLUSION
bull BE AWARE OF CHILDrsquoS RESPIRATORY FUNCTION
bull CHOSE ACT BEST FOR THEM bull TYPE OF KETCHUP BOTTLE bull LV SECRETION RETENTION WOB
bull EARLY RESPIRATORY REFERRAL
bull RESPIRATORY CARE COMPETENCIES
bull EFFECTIVE SECRETION CLEARANCE AT HOMERESPITESCHOOL
bull USE OF PEAK COUGH FLOWS TO AID CHOICE OF ADJUNCT
0
50
100
150
200
250
300
350
400
0
50
100
150
200
250
300
350
400
Green
Key
Additional info
(please comment) Please refer to BTSACPRC Guideline
Lothian University Hospitals NHS Trust
n PCF
gt270lmin
Breathstack
ing tri-
flow
blowing
REFERENCES bull BTSACPRC GUIDELINE IS PUBLISHED IN THORAX VOL 67 SUPPLEMENT 1
bull AVAILABLE ONLINE AT HTTPTHORAXBMJCOMCONTENTVOL64ISSUESUPPLI
bull HTTPWWWBRIT-THORACICORGUKPHYSIOGUIDE
bull BRITISH THORACIC SOCIETY REPORTS VOL 1 NO 1 2009
bull ADAPTED PRYOR AJ AND PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS3RD ED
bull HOUGH A PHYSIOTHERAPY IN RESPIRATORY CARE LONDON CHAPMAN AND HALL 1993
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1997) POSTURAL DRAINAGE AND GASTRO-OESOPHAGEAL REFLUX IN INFANTS WITH CYSTIC FIBROSIS ARCHIVES OF DISEASE IN CHILDHOOD 76 148-150
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1998) POSTURAL DRAINAGE IN CYSTIC FIBROSIS IS THERE A LINK WITH GASTRO-OESOPHAGEAL REFLUX JOURNAL OF PAEDIATRIC CHILD HEALTH 34 330-334
bull CECINS NM JENKINS SC PENGELLEY J ET AL (1999) THE ACTIVE CYCLE OF BREATHING TECHNIQUES-TO TIP OR NOT TO TIP RESPIRATORY MEDICINE 93 660-665
bull CONSTANTINI D BRIVIO A BRUSA D ET AL (2001) PEP MASK VERSUS POSTURAL DRAINAGE IN INFANTS A LONG-TERM COMPARATIVE TRIAL PEADIATRIC PULMONOLOGY
bull HOUGH A (2001) PHYSIOTHERAPY IN RESPIRATORY CARE AN EVIDENCE-BASED APPROACH TO RESPIRATORY AND CARDIAC MANAGEMENT CENGAGE LEARNING EMEA
bull INTERNATIONAL PHYSIOTHERAPY GROUP FOR CYSTIC FIBROSIS PHYSIOTHERAPY IN THE TREATMENT OF CYSTIC FIBROSIS (2009) HTTPSWWWECFSEUIPG_CFBOOKLET INTERNATIONAL PHYSIOTHERAPY GROUP ndash THE BLUE BOOKLET
bull KONSTAN MW STERN RC DOERSHUK CF (1994) EFFICACY OF THE FLUTTER DEVICE FOR AIRWAY MUCUS CLEARANCE IN PATIENTS WITH CYSTIC FIBROSIS JOURNAL OF PEDIATRICS 124 (5 (PT 1) 689-693
bull MCILWAINE M BUTTON B AND DWAN K (2015) POSITIVE EXPIRATORY PRESSURE PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 6 ART NO CD003147 DOI 10100214651858CD003147PUB4
bull MESTRINER RG FERNANDES RO STAFFEN LC ET AL (2009) OPTIMUM DESIGN PARAMETERS FOR A THERAPIST-CONSTRUCTED POSITIVE-EXPIRATORY-PRESSURE THERAPY BOTTLE DEVICE RESPIRATORY CARE 54 504-8
bull MORRISON L AND AGNEW J (2014) OSCILLATING DEVICES FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 7 ART NO CD006842 DOI 10100214651858CD006842PUB
bull OERMANN CM SOCKRIDER MM GILES D ET AL (2001) COMPARISON OF HIGH-FREQUENCY CHEST WALL OSCILLATION AND OSCILLATING POSITIVE EXPIRATORY PRESSURE IN THE HOME MANAGEMENT OF CYSTIC FIBROSIS A PILOT STUDY PEDIATRIC PULMONOLOGY 32 (5) 372-7
bull PRASAD SA AND HUSSEY J (1995) PAEDIATRIC RESPIRATORY CARE A GUIDE FOR PHYSIOTHERAPISTS AND HEALTH PROFESSIONALS CHAPMAN amp HALL
bull PRYOR J (1999) PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN ADULTS EUROPEAN RESPIRATORY JOURNAL 14 (6) 1418-1424
bull PRYOR JA amp PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS CHURCHILL LIVINGSTONE
bull PRYOR JA WEBBER BA HODSON ME ET AL (1994) THE FLUTTER VRP1 AS AN ADJUNCT TO CHEST PHYSIOTHERAPY IN CYSTIC FIBROSIS RESPIRATORY MEDICINE 88677-81
bull WEST K WALLEN M FOLLETT J (2010) ACAPELLA VS PEP MASK THERAPY A RANDOMISED TRIAL IN CHILDREN WITH CYSTIC FIBROSIS DURING RESPIRATORY EXACERBATION PHYSIOTHERAPY THEORY PRACTICE 26143-9
bull WILSONLM AGNEW J MORRISON L ET AL (2014) AIRWAY CLEARANCE TECHNIQUES FOR CYSTIC FIBROSIS AN OVERVIEW OF COCHRANE SYSTEMATIC REVIEWS COCHRANE DATABASE OF SYSTEMATIC REVIEWS DOI 10100214651858CD011231
bull VOLSKO TA DIFIORE JM CHATBURN RL (2003) PERFORMANCE COMPARISON OF TWO OSCILLATORY POSITIVE PRESSURE DEVICES ACAPELLA VERSUS FLUTTER RESPIRATORY CARE 48 (2) 124- 130
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SEDDON PC KHAN Y RESPIRATORY PROBLEMS IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT ARCHIVES OF DISEASE IN CHILDHOOD 2003 01 JAN88(1)75-8
bull MARKS JH PULMONARY CARE OF CHILDREN AND ADOLESCENTS WITH DEVELOPMENTAL DISABILITIES PEDIATR CLIN NORTH AM 2008 DECEMBER55(6)1299-314
bull ARENS R MUZUMDAR H SLEEP SLEEP DISORDERED BREATHING AND NOCTURNAL HYPOVENTILATION IN CHILDREN WITH NEUROMUSCULAR DISEASES PAEDIATRIC RESPIRATORY REVIEWS 2010 MAR11(1)24-30
bull FITZGERALD DA FOLLETT J VAN ASPEREN PP ASSESSING AND MANAGING LUNG DISEASE AND SLEEP DISORDERED BREATHING IN CHILDREN WITH CEREBRAL PALSY PAEDIATRIC RESPIRATORY REVIEWS 2009 MARCH10(1)18-24
bull HSIAO KH NIXON GM THE EFFECT OF TREATMENT OF OBSTRUCTIVE SLEEP APNEA ON QUALITY OF LIFE IN CHILDREN WITH CEREBRAL PALSY RES DEV DISABIL 2008 MAR-APR29(2)133-40
bull LUNDBERG A OXYGEN CONSUMPTION IN RELATION TO WORKLOAD IN STUDENTS WITH CEREBRAL PALSY J APPL PHYSIO 197640873-5
bull SULLIVAN PB ROSENBLOOM L FEEDING THE DISABLED CHILD CLINICS IN DEVELOPMENTAL MEDICINE MACKEITH PRESS 1999140
bull MARTIN TR THE RELATIONSHIP BETWEEN MALNUTRITION AND LUNG INFECTIONS CLIN CHEST MED 19878359
bull MOSTAFA SM BHANDARI S RITCHIE G ET AL CONSTIPATION AND ITS IMPLICATIONS IN THE CRITICALLY ILL PATIENT BR J ANAESTH 200391815-9 3
bull GACOUIN A CAMUS C GROS A ET AL CONSTIPATION IN LONGTERM VENTILATED PATIENTS ASSOCIATED FACTORS AND IMPACT ON INTENSIVE CARE UNIT OUTCOMES CRIT CARE MED 2010381933- 8
bull NGUYEN T FRENETTE AJ JOHANSON C ET AL IMPAIRED GASTROINTESTINAL TRANSIT AND ITS ASSOCIATED MORBIDITY IN THE INTENSIVE CARE UNIT J CRIT CARE 201328537
bull ASAI T CONSTIPATION DOES IT INCREASE MORBIDITY AND MORTALITY IN CRITICALLY ILL PATIENTS CRIT CARE MED 2007352861-2
bull UNDERSTANDING THE PHYSIOLOGICAL EFFECTS OF UNTREATED PAIN NURSING TIMES VOL 99 ISSUE 37 PAGE NO 28
bull WINFIELD ET AL NON-PHARMACEUTICAL MANAGEMENT OF RESPIRATORY MORBIDITY IN CHILDREN WITH SEVERE GLOBAL DEVELOPMENTAL DELAY THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014
bull OLOUGHLIN EV SOMERVILLE HM SOMERVILLE ER DEALING WITH MULTISYSTEM DISEASE IN PEOPLE WITH A DEVELOPMENTAL DISABILITY MEDICAL JOURNAL OF AUSTRALIA 2009 JUN 1190(11)616-7
bull MESTROVIC J KARDUM G POLIC B MESTROVIC M MARKIC J SUSTIC A ET AL THE INFLUENCE OF CHRONIC HEALTH CONDITIONS ON SUSCEPTIBILITY TO SEVERE ACUTE ILLNESS OF CHILDREN TREATED IN PICU EUROPEAN JOURNAL OF PEDIATRICS 2006 AUG165(8)526-
9
bull HEALY F PANITCH HB PULMONARY COMPLICATIONS OF PEDIATRIC NEUROLOGICAL DISEASES PEDIATR ANN 2010 APR39(4)216-24
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SRIVASTAVA R JACKSON WD BARNHART DC DYSPHAGIA AND GASTROESOPHAGEAL REFLUX DISEASE DILEMMAS IN DIAGNOSIS AND MANAGEMENT IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT PEDIATR ANN 2010 APR39(4)225-31
bull SULLIVAN PB JUSZCZAK E BACHLET AME LAMBERT B VERNON-ROBERTS A GRANT HW ET AL GASTROSTOMY TUBE FEEDING IN CHILDREN WITH CEREBRAL PALSY A PROSPECTIVE LONGITUDINAL STUDY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 2005
FEBRUARY47(2)77-85
bull SOMERVILLE H TZANNES G WOOD J SHUN A HILL C ARROWSMITH F ET AL GASTROINTESTINAL AND NUTRITIONAL PROBLEMS IN SEVERE DEVELOPMENTAL DISABILITY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 200850(9)712-6
bull TODER DS RESPIRATORY PROBLEMS IN THE ADOLESCENT WITH DEVELOPMENTAL DELAY ADOLESCENT MEDICINE 2000 3 OCTOBER 200011(3)617-31
bull LEVIN K COLON A DIPALMA J FITZPATRICK S USING THE RADIONUCLIDE SALIVAGRAM TO DETECT PULMONARY ASPIRATION AND ESOPHAGEAL DYSMOTILITY CLIN NUCL MED 1993 FEB18(2)110-4
bull SCHROEDER AS KLING T HUSS K BORGGRAEFE I KOERTE IK BLASCHEK A ET AL BOTULINUM TOXIN TYPE A AND B FOR THE REDUCTION OF HYPERSALIVATION IN CHILDREN WITH NEUROLOGICAL DISORDERS A FOCUS ON EFFECTIVENESS AND THERAPY ADHERENCE
NEUROPEDIATRICS 201243(1)27-36
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull GOEMINNE P AND DUPONT L (2010) NON-CYSTIC FIBROSIS BRONCHIECTASIS DIAGNOSIS AND MANAGEMENT IN 21ST CENTURY POSTGRADUATE MEDICAL JOURNAL 86(1018) PP493-501
bull LEE A BUTTON B AND TANNENBAUM E (2017) AIRWAY-CLEARANCE TECHNIQUES IN CHILDREN AND ADOLESCENTS WITH CHRONIC SUPPURATIVE LUNG DISEASE AND BRONCHIECTASIS FRONTIERS IN PEDIATRICS 5
bull MANDAL P SIDHU M KOPE L POLLOCK W STEVENSON L PENTLAND J TURNBULL K MAC QUARRIE S AND HILL A (2012) A PILOT STUDY OF PULMONARY REHABILITATION AND CHEST PHYSIOTHERAPY VERSUS CHEST PHYSIOTHERAPY ALONE IN
BRONCHIECTASIS RESPIRATORY MEDICINE 106(12) PP1647-1654
bull MURRAY M PENTLAND J AND HILL A (2009) A RANDOMISED CROSSOVER TRIAL OF CHEST PHYSIOTHERAPY IN NON-CYSTIC FIBROSIS BRONCHIECTASIS EUROPEAN RESPIRATORY JOURNAL 34(5) PP1086-1092
bull NEWALL C STOCKLEY R AND HILL S (2005) EXERCISE TRAINING AND INSPIRATORY MUSCLE TRAINING IN PATIENTS WITH BRONCHIECTASIS THORAX 60(11) PP943-948
bull ONG H LEE A HILL C HOLLAND A AND DENEHY L (2011) EFFECTS OF PULMONARY REHABILITATION IN BRONCHIECTASIS A RETROSPECTIVE STUDY CHRONIC RESPIRATORY DISEASE 8(1) PP21-30
bull QUINT J MILLETT E JOSHI M NAVARATNAM V THOMAS S HURST J SMEETH L AND BROWN J (2015) CHANGES IN THE INCIDENCE PREVALENCE AND MORTALITY OF BRONCHIECTASIS IN THE UK FROM 2004 TO 2013 A POPULATION-BASED COHORT
STUDY EUROPEAN RESPIRATORY JOURNAL 47(1) PP186-193
bull SNIJDERS D FERNANDEZ DOMINGUEZ B CALGARO S BERTOZZI I ESCRIBANO MONTANER A PERILONGO G AND BARBATO A (2015) MUCOCILIARY CLEARANCE TECHNIQUES FOR TREATING NON-CYSTIC FIBROSIS BRONCHIECTASIS IS THERE
EVIDENCE INTERNATIONAL JOURNAL OF IMMUNOPATHOLOGY AND PHARMACOLOGY 28(2) PP150-159
bull BEFORE OR AT LEAST 1 HR AFTER A FEED
bull START WITH THE SMALLEST HOLERESISTOR THAT BABY CAN TOLERATE
bull USE A MANOMETER
bull HOLD THE BABY IN ARMS OR ON PARENTS LAP SIT ON GYM BALL
bull PLACE THE MASK OVER THE BABYrsquoS MOUTH amp NOSE
bull AIM FOR FEW BREATHS 30-60 SECONDS WHICH CAN BE BUILT UP TO 1-2 MINUTES AS TOLERATED
bull AIM TO REACH PRESSURES BETWEEN 5-15 CM H2O
bull REST FOR 30-60 SECONDS THEN REPEAT FOR ABOUT 5-10 MINUTES
bull COMBINE THIS WITH OTHER TREATMENTS
BABY PEP TREATMENT
OSCILLATING PEP
OSCILLATING PEP
bull DEVICES CAN BE INTRA-THORACIC OR EXTRA-THORACIC
bull INTRA-THORACIC DEVICES ARE PLACED IN THE MOUTH AND PROVIDE RESISTANCE DURING EXHALATION
bull ALTERS EXPIRATORY AIRFLOW
bull VIBRATIONS ON THE AIRWAY SURFACE
bull REDUCES MUCOUS VISCOSITY
bull ACCELERATION OF THE EXPIRATORY FLOW
bull PREVENTS AND TREATS AIRWAY COMPRESSION ATELECTASIS
bull IMPROVES AIRWAY PATENCY amp VENTILATION
bull DECREASES HYPERINFLATION
bull IMPROVES LUNG FUNCTION PARAMETERS
bull INCLUDES EXERCISE
OSCILLATING PEP TREATMENT
bull SIMILAR TO PEP
bull GOOD POSITION
bull PLACE MOUTHPIECE BETWEEN LIPS AND TEETH OR USE MASK
bull SLOW INHALE JUST A LITTLE LARGER THAN A NORMAL BREATH IN
bull HOLD FOR 3 SECONDS
bull STEADY ACTIVE amp FULL EXHALATION
bull ADJUST THE RESISTANCE AS REQUIRED
bull REPEAT 12-15 TIMES FOLLOWED BY FET amp COUGH
bull COMPLETE FOR 5-10 MINS
bull COMBINE WITH OTHER TREATMENTS
ACAPELLA
bull DETACHABLE MOUTHPIECEFACEMASK
bull ONE-WAY INSPIRATORY VALVE
bull EXPIRATORY RESISTANCEFREQUENCY ADJUSTMENT DIAL
bull COUNTERWEIGHTED PLUG amp MAGNET
bull MAINTAINS A RAISED FRC LEVEL
TREATMENT
bull EASY TO USE IN DIFFERENT POSITIONS
bull INHALE amp EXHALE THROUGH THE ACAPELLA
bull ROTATE THE FREQUENCY RESISTANCE DIAL UNTIL MAXIMUM VIBRATIONS ARE FELT WITHIN THE CHEST WALL
AEROBIKA bull COMBINES PEP WITH HIGH FREQUENCY OSCILLATIONS
bull CAN BE USED WITH A MANOMETER
bull NEBULISER CAN BE ENTRAINED INTO THE SYSTEM
bull POSSIBLE INCREASE IN TREATMENT COMPLIANCE BY DECREASING
TREATMENT TIMES
TECHNIQUE AS OSCILLATING PEP
BUBBLE PEP
Suction tubing (~1cm diameter) The end MUST sit at the bottom of the bottle
Plastic bottle Any widthshapediameter must be gt20cm tall 15cm fresh tapsterile water
(depth of water determines the amount of pressure ie cm H20
Washing up bowl
INDICATIONS
bull REDUCED LUNG VOLUME (FVClt50)
bull WEAK COUGH (PCFlt270)
bull SECRETIONS RETENTION
bull ATELECTASIS
bull REDUCED MECHANICAL COMPLIANCE
bull CHILD ABLE TO COMPLY
BENEFITS
bull INCREASE LUNG VOLUME = IMPROVES PCF
bull SECRETION CLEARANCE
bull MAY REVERSE ATELECTASIS
bull IMPROVE MECHANICAL COMPLIANCE = LUNG AND CHEST WALL MOBILITY
bull IMPROVE VOICE STRENGTH
LUNG VOLUME RECRUITMENT
bull LABEL NOT FOR RESUSCITATION
bull BEST IN SITTING
bull SUCTION READY
bull AGREE SIGNAL WITH CHILD WHEN MIC ACHIEVED
bull ASK TO BREATH OUT
bull PLACE MOUTHPIECE +- NOSE CLIP OR MASK
bull ASK TO BREATH IN AND HOLD WHILE GENTLY SQUEEZING BAG
bull WITHOUT LETTING AIR OUT ASK CHILD TO TAKE ANOTHER BREATH IN ON TOP OF THE FIRST BREATH AND SQUEEZE BAG IN TIME WITH BREATH
bull REPEAT UNTIL LUNGS ARE FULL (NORMALLY 3-5 BREATHS) OR SIGNAL
bull REMOVE MASK OR MOUTHPIECE ASK TO HOLD FOR 3-5 SECONDS
bull EXHALE OR IF SECRETIONS ARE PRESENT ENCOURAGE TO HAVE A COUGH OR MAC
bull REPEATED X3-5 X2-4 DAY
LVR TREATMENT
bull AIRWAY CLEARANCE OR THORACIC MOBILITY
bull AMBU RESUS BAG
bull GREEN ldquoPHYSIOrdquo BAG
bull MANUAL TECHNIQUES WITH BAGGING
bull MHI AT HOME
bull MANOMETERS
MHI
PHYSIO WITH NIV
bull PHYSIO SETTINGS
bull SECRETIONS
bull THORACIC MOBILITY
bull ALLOWS REST PERIOD PRE ACT
bull HUMIDIFICATION
bull INFLATABLE VEST CONNECTED BY TUBES TO AN AIR PULSE GENERATOR WHICH RAPIDLY INFLATES AND DEFLATES THE VEST PRODUCING OSCILLATIONS TO THE CHEST WALL
bull RAPID CHEST MOVEMENT MIMICS A COUGH-LIKE EXPIRATORY FLOW THAT SHEARS MUCUS AWAY FROM THE AIRWAY WALLS AND HELPS TO MOVE IT ALONG TO THE CENTRAL AIRWAYS
bull PASSIVE TREATMENT amp NOT POSITION DEPENDANT
bull COMBINATION OF RX
bull CONTRAINDICATIONS
bull HEAD ANDOR NECK INJURY THAT HAS NOT BEEN STABILISED
bull ACTIVE HAEMORRHAGE WITH HEMODYNAMIC INSTABILITY
HFCWO
HFCWO INDICATIONS
bull CHRONIC MUCUS HYPERSECRETION OR RETENTION ASSOCIATED WITH A CHRONIC PULMONARY OR NEUROMUSCULAR CONDITION
bull LRT SECRETIONS AND FREQUENT LRTI REQUIRING HOSPITAL ADMISSION
bull INEFFECTIVE COUGH OR INABILITY TO REMOVE MUCUS BY COUGHING
bull TENACIOUS SECRETIONS THAT ARE NOT EASILY MOBILISED WITH STANDARD CPT
bull MECHANICALLY VENTILATED WITH EVIDENCE OF SECRETION RETENTION
bull ALTERNATIVE AIRWAY CLEARANCE THERAPY PROVEN INEFFECTIVE OR CONTRAINDICATEDDO NOT TOLERATE STANDARD CPT
bull CONSTANT FATIGUE LACK OF STRENGTH OR ABILITY TO PERFORM ACTIVE TREATMENT
bull SYMPTOMATIC
bull POOR COMPLIANCE WITH OTHER AIRWAY CLEARANCE METHODS
bull HIGH BURDEN OF CARE
bull PATIENT UNABLE TO TOLERATE THE INCREASED WORK OF BREATHING bull ACTIVE HAEMOPTYSIS bull UNTREATED PNEUMOTHORAX bull INTRACRANIAL PRESSURE (ICP) gt 20 MMHG bull HAEMODYNAMIC INSTABILITY bull SEVERE CARDIOVASCULAR INSULTDISEASE bull RECENT FACIAL ORAL OR SKULL SURGERY OR TRAUMA bull ACUTE SINUSITIS bull EPISTAXIS bull POST OESOPHAGEAL amp LUNG SURGERY bull KNOWN OR SUSPECTED TYMPANIC MEMBRANE RUPTURE OR OTHER MIDDLE EAR
PATHOLOGY
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
POSSIBLE HAZARDSCOMPLICATIONS
bull INCREASED WORK OF BREATHING THAT MAY LEAD TO HYPOVENTILATION AND
HYPERCARBIA
bull INCREASED INTRACRANIAL PRESSURE
bull CARDIOVASCULAR COMPROMISE
bull NAUSEA
bull MYOCARDIAL ISCHEMIA
bull DECREASED VENOUS RETURN
bull AIR SWALLOWING WITH INCREASED LIKELIHOOD OF VOMITING AND
ASPIRATION
bull CLAUSTROPHOBIA
bull SKIN BREAK DOWN AND DISCOMFORT FROM MASK
bull PULMONARY BAROTRAUMA
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
MI-E
bull USED WITH CHILDREN WHO HAVE DECREASED INSPIRATORY EFFORT DUE TO EITHER SPINAL CORD INJURY OR NMW AND WHO HAVE AN IMPAIRED OR INEFFECTIVE COUGH WITH APPROPRIATE RESPIRATORY SYMPTOMS
bull CONSIDERED WHEN CONVENTIONAL COUGH ASSISTANCE TECHNIQUES BECOME INEFFECTIVE
bull ACCEPTED AS THE CORE STANDARD FOR CHILD WITH NMW
bull MIE WORKS BY
bull INFLATING THE LUNGS WITH GRADUAL POSITIVE AIRWAY PRESSURE ASSISTING INSPIRATION CALLED INSUFFLATION
bull FOLLOWED BY A RAPID SWITCH TO NEGATIVE PRESSURE WHICH SIMULATES THE FLOW CHANGES THAT OCCUR DURING A COUGH THEREBY ENHANCING EXPIRATORY FLOW CALLED EXSUFFLATION AND ASSISTING EXPECTORATION OF SECRETIONS
bull MOVEMENT AND EXERCISE BEST FUNCTIONAL METHOD OF AIRWAY CLEARANCE
bull CPET BETTER CORRELATION THAN LUNG FUNCTION IN SURVIVAL RATES IN PEOPLE WITH
CYSTIC FIBROSIS
bull RUNNINGWALKING BETTER FOR SECRETION CLEARANCE THAN BIKE DURING TO SHEARING
MECHANISM
bull CONSIDER ADDING IN HUFFS (DYER)
bull CONSIDER USE OF AD BELT
EXERCISE
bull APCP SUCTION GUIDELINES
bull TYPESNASOPHARANGEAL OROPHARANGEAL AND TRACHEOSTOMY
bull MAIN VARIABLES SUCTION TYPE AND SIZE DEPTH OF SUCTION
PRESSURE TECHNIQUE
SUCTION
SPUTUM
bull SPUTUM bull 95 WATER bull COLOUR bull VOLUME bull CONSISTENCY bull ODOUR
bull PURPOSE bull HUMIDIFICATION bull WATERPROOFING bull PROTECTION OF EPITHELIUM
HUMIDIFICATION
bull METABOLIC AND VENTILATORY REQUIREMENTS ARE X2-3 OF ADULTS
IMPLICATION
bull HEAT AND MOISTURE LOSSES FROM RESPIRATION WILL INCREASE BY X2-3
bull CONSUME GREATER AMOUNTS OF ENERGY AND WATER
HUMIDIFICATION INHALATION
THERAPY
bull TRACHEOSTOMY HME
bull WET DRY CIRCUIT
bull NEBULISERS INHALERS MUCOLYTICS
bull HUMIDIFIERS WITH NIV
bull OXYGEN
bull SYSTEMIC HYDRATION ENVIRONMENT
NEBULISERS
bull NEBULISER CHAMBER CONVERTS LIQUID INTO
RESPIRABLE PARTICLES
bull MOISTURE DESCENDS THROUGH THE HOLES IN THE SUPERFICIAL GEL LAYER
bull INCREASES THE SOL LAYER SO THE CILIARY BEAT IS OPTIMAL FOR MUCUS TRANSPORT
bull SHORT TERM HUMIDIFICATION
bull DAILY WASHING OF NEBULISER SYSTEM
TIMING OF DRUG AND PHYSIOTHERAPY
BEFORE TREATMENT
bull DNASE (PULMOZYME)
bull SALBUTAMOL
(VENTOLIN BLUE)
bull SALINE NEBS
AFTER TREATMENT
bull SERETIDE (PURPLE)
bull BECLOMETHASONE (BECOTIDE BROWN)
bull COLISTIN (COLOMYCIN PROMIXIN)
bull TOBRAMYCIN
CONCLUSION
bull BE AWARE OF CHILDrsquoS RESPIRATORY FUNCTION
bull CHOSE ACT BEST FOR THEM bull TYPE OF KETCHUP BOTTLE bull LV SECRETION RETENTION WOB
bull EARLY RESPIRATORY REFERRAL
bull RESPIRATORY CARE COMPETENCIES
bull EFFECTIVE SECRETION CLEARANCE AT HOMERESPITESCHOOL
bull USE OF PEAK COUGH FLOWS TO AID CHOICE OF ADJUNCT
0
50
100
150
200
250
300
350
400
0
50
100
150
200
250
300
350
400
Green
Key
Additional info
(please comment) Please refer to BTSACPRC Guideline
Lothian University Hospitals NHS Trust
n PCF
gt270lmin
Breathstack
ing tri-
flow
blowing
REFERENCES bull BTSACPRC GUIDELINE IS PUBLISHED IN THORAX VOL 67 SUPPLEMENT 1
bull AVAILABLE ONLINE AT HTTPTHORAXBMJCOMCONTENTVOL64ISSUESUPPLI
bull HTTPWWWBRIT-THORACICORGUKPHYSIOGUIDE
bull BRITISH THORACIC SOCIETY REPORTS VOL 1 NO 1 2009
bull ADAPTED PRYOR AJ AND PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS3RD ED
bull HOUGH A PHYSIOTHERAPY IN RESPIRATORY CARE LONDON CHAPMAN AND HALL 1993
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1997) POSTURAL DRAINAGE AND GASTRO-OESOPHAGEAL REFLUX IN INFANTS WITH CYSTIC FIBROSIS ARCHIVES OF DISEASE IN CHILDHOOD 76 148-150
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1998) POSTURAL DRAINAGE IN CYSTIC FIBROSIS IS THERE A LINK WITH GASTRO-OESOPHAGEAL REFLUX JOURNAL OF PAEDIATRIC CHILD HEALTH 34 330-334
bull CECINS NM JENKINS SC PENGELLEY J ET AL (1999) THE ACTIVE CYCLE OF BREATHING TECHNIQUES-TO TIP OR NOT TO TIP RESPIRATORY MEDICINE 93 660-665
bull CONSTANTINI D BRIVIO A BRUSA D ET AL (2001) PEP MASK VERSUS POSTURAL DRAINAGE IN INFANTS A LONG-TERM COMPARATIVE TRIAL PEADIATRIC PULMONOLOGY
bull HOUGH A (2001) PHYSIOTHERAPY IN RESPIRATORY CARE AN EVIDENCE-BASED APPROACH TO RESPIRATORY AND CARDIAC MANAGEMENT CENGAGE LEARNING EMEA
bull INTERNATIONAL PHYSIOTHERAPY GROUP FOR CYSTIC FIBROSIS PHYSIOTHERAPY IN THE TREATMENT OF CYSTIC FIBROSIS (2009) HTTPSWWWECFSEUIPG_CFBOOKLET INTERNATIONAL PHYSIOTHERAPY GROUP ndash THE BLUE BOOKLET
bull KONSTAN MW STERN RC DOERSHUK CF (1994) EFFICACY OF THE FLUTTER DEVICE FOR AIRWAY MUCUS CLEARANCE IN PATIENTS WITH CYSTIC FIBROSIS JOURNAL OF PEDIATRICS 124 (5 (PT 1) 689-693
bull MCILWAINE M BUTTON B AND DWAN K (2015) POSITIVE EXPIRATORY PRESSURE PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 6 ART NO CD003147 DOI 10100214651858CD003147PUB4
bull MESTRINER RG FERNANDES RO STAFFEN LC ET AL (2009) OPTIMUM DESIGN PARAMETERS FOR A THERAPIST-CONSTRUCTED POSITIVE-EXPIRATORY-PRESSURE THERAPY BOTTLE DEVICE RESPIRATORY CARE 54 504-8
bull MORRISON L AND AGNEW J (2014) OSCILLATING DEVICES FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 7 ART NO CD006842 DOI 10100214651858CD006842PUB
bull OERMANN CM SOCKRIDER MM GILES D ET AL (2001) COMPARISON OF HIGH-FREQUENCY CHEST WALL OSCILLATION AND OSCILLATING POSITIVE EXPIRATORY PRESSURE IN THE HOME MANAGEMENT OF CYSTIC FIBROSIS A PILOT STUDY PEDIATRIC PULMONOLOGY 32 (5) 372-7
bull PRASAD SA AND HUSSEY J (1995) PAEDIATRIC RESPIRATORY CARE A GUIDE FOR PHYSIOTHERAPISTS AND HEALTH PROFESSIONALS CHAPMAN amp HALL
bull PRYOR J (1999) PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN ADULTS EUROPEAN RESPIRATORY JOURNAL 14 (6) 1418-1424
bull PRYOR JA amp PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS CHURCHILL LIVINGSTONE
bull PRYOR JA WEBBER BA HODSON ME ET AL (1994) THE FLUTTER VRP1 AS AN ADJUNCT TO CHEST PHYSIOTHERAPY IN CYSTIC FIBROSIS RESPIRATORY MEDICINE 88677-81
bull WEST K WALLEN M FOLLETT J (2010) ACAPELLA VS PEP MASK THERAPY A RANDOMISED TRIAL IN CHILDREN WITH CYSTIC FIBROSIS DURING RESPIRATORY EXACERBATION PHYSIOTHERAPY THEORY PRACTICE 26143-9
bull WILSONLM AGNEW J MORRISON L ET AL (2014) AIRWAY CLEARANCE TECHNIQUES FOR CYSTIC FIBROSIS AN OVERVIEW OF COCHRANE SYSTEMATIC REVIEWS COCHRANE DATABASE OF SYSTEMATIC REVIEWS DOI 10100214651858CD011231
bull VOLSKO TA DIFIORE JM CHATBURN RL (2003) PERFORMANCE COMPARISON OF TWO OSCILLATORY POSITIVE PRESSURE DEVICES ACAPELLA VERSUS FLUTTER RESPIRATORY CARE 48 (2) 124- 130
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SEDDON PC KHAN Y RESPIRATORY PROBLEMS IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT ARCHIVES OF DISEASE IN CHILDHOOD 2003 01 JAN88(1)75-8
bull MARKS JH PULMONARY CARE OF CHILDREN AND ADOLESCENTS WITH DEVELOPMENTAL DISABILITIES PEDIATR CLIN NORTH AM 2008 DECEMBER55(6)1299-314
bull ARENS R MUZUMDAR H SLEEP SLEEP DISORDERED BREATHING AND NOCTURNAL HYPOVENTILATION IN CHILDREN WITH NEUROMUSCULAR DISEASES PAEDIATRIC RESPIRATORY REVIEWS 2010 MAR11(1)24-30
bull FITZGERALD DA FOLLETT J VAN ASPEREN PP ASSESSING AND MANAGING LUNG DISEASE AND SLEEP DISORDERED BREATHING IN CHILDREN WITH CEREBRAL PALSY PAEDIATRIC RESPIRATORY REVIEWS 2009 MARCH10(1)18-24
bull HSIAO KH NIXON GM THE EFFECT OF TREATMENT OF OBSTRUCTIVE SLEEP APNEA ON QUALITY OF LIFE IN CHILDREN WITH CEREBRAL PALSY RES DEV DISABIL 2008 MAR-APR29(2)133-40
bull LUNDBERG A OXYGEN CONSUMPTION IN RELATION TO WORKLOAD IN STUDENTS WITH CEREBRAL PALSY J APPL PHYSIO 197640873-5
bull SULLIVAN PB ROSENBLOOM L FEEDING THE DISABLED CHILD CLINICS IN DEVELOPMENTAL MEDICINE MACKEITH PRESS 1999140
bull MARTIN TR THE RELATIONSHIP BETWEEN MALNUTRITION AND LUNG INFECTIONS CLIN CHEST MED 19878359
bull MOSTAFA SM BHANDARI S RITCHIE G ET AL CONSTIPATION AND ITS IMPLICATIONS IN THE CRITICALLY ILL PATIENT BR J ANAESTH 200391815-9 3
bull GACOUIN A CAMUS C GROS A ET AL CONSTIPATION IN LONGTERM VENTILATED PATIENTS ASSOCIATED FACTORS AND IMPACT ON INTENSIVE CARE UNIT OUTCOMES CRIT CARE MED 2010381933- 8
bull NGUYEN T FRENETTE AJ JOHANSON C ET AL IMPAIRED GASTROINTESTINAL TRANSIT AND ITS ASSOCIATED MORBIDITY IN THE INTENSIVE CARE UNIT J CRIT CARE 201328537
bull ASAI T CONSTIPATION DOES IT INCREASE MORBIDITY AND MORTALITY IN CRITICALLY ILL PATIENTS CRIT CARE MED 2007352861-2
bull UNDERSTANDING THE PHYSIOLOGICAL EFFECTS OF UNTREATED PAIN NURSING TIMES VOL 99 ISSUE 37 PAGE NO 28
bull WINFIELD ET AL NON-PHARMACEUTICAL MANAGEMENT OF RESPIRATORY MORBIDITY IN CHILDREN WITH SEVERE GLOBAL DEVELOPMENTAL DELAY THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014
bull OLOUGHLIN EV SOMERVILLE HM SOMERVILLE ER DEALING WITH MULTISYSTEM DISEASE IN PEOPLE WITH A DEVELOPMENTAL DISABILITY MEDICAL JOURNAL OF AUSTRALIA 2009 JUN 1190(11)616-7
bull MESTROVIC J KARDUM G POLIC B MESTROVIC M MARKIC J SUSTIC A ET AL THE INFLUENCE OF CHRONIC HEALTH CONDITIONS ON SUSCEPTIBILITY TO SEVERE ACUTE ILLNESS OF CHILDREN TREATED IN PICU EUROPEAN JOURNAL OF PEDIATRICS 2006 AUG165(8)526-
9
bull HEALY F PANITCH HB PULMONARY COMPLICATIONS OF PEDIATRIC NEUROLOGICAL DISEASES PEDIATR ANN 2010 APR39(4)216-24
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SRIVASTAVA R JACKSON WD BARNHART DC DYSPHAGIA AND GASTROESOPHAGEAL REFLUX DISEASE DILEMMAS IN DIAGNOSIS AND MANAGEMENT IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT PEDIATR ANN 2010 APR39(4)225-31
bull SULLIVAN PB JUSZCZAK E BACHLET AME LAMBERT B VERNON-ROBERTS A GRANT HW ET AL GASTROSTOMY TUBE FEEDING IN CHILDREN WITH CEREBRAL PALSY A PROSPECTIVE LONGITUDINAL STUDY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 2005
FEBRUARY47(2)77-85
bull SOMERVILLE H TZANNES G WOOD J SHUN A HILL C ARROWSMITH F ET AL GASTROINTESTINAL AND NUTRITIONAL PROBLEMS IN SEVERE DEVELOPMENTAL DISABILITY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 200850(9)712-6
bull TODER DS RESPIRATORY PROBLEMS IN THE ADOLESCENT WITH DEVELOPMENTAL DELAY ADOLESCENT MEDICINE 2000 3 OCTOBER 200011(3)617-31
bull LEVIN K COLON A DIPALMA J FITZPATRICK S USING THE RADIONUCLIDE SALIVAGRAM TO DETECT PULMONARY ASPIRATION AND ESOPHAGEAL DYSMOTILITY CLIN NUCL MED 1993 FEB18(2)110-4
bull SCHROEDER AS KLING T HUSS K BORGGRAEFE I KOERTE IK BLASCHEK A ET AL BOTULINUM TOXIN TYPE A AND B FOR THE REDUCTION OF HYPERSALIVATION IN CHILDREN WITH NEUROLOGICAL DISORDERS A FOCUS ON EFFECTIVENESS AND THERAPY ADHERENCE
NEUROPEDIATRICS 201243(1)27-36
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull GOEMINNE P AND DUPONT L (2010) NON-CYSTIC FIBROSIS BRONCHIECTASIS DIAGNOSIS AND MANAGEMENT IN 21ST CENTURY POSTGRADUATE MEDICAL JOURNAL 86(1018) PP493-501
bull LEE A BUTTON B AND TANNENBAUM E (2017) AIRWAY-CLEARANCE TECHNIQUES IN CHILDREN AND ADOLESCENTS WITH CHRONIC SUPPURATIVE LUNG DISEASE AND BRONCHIECTASIS FRONTIERS IN PEDIATRICS 5
bull MANDAL P SIDHU M KOPE L POLLOCK W STEVENSON L PENTLAND J TURNBULL K MAC QUARRIE S AND HILL A (2012) A PILOT STUDY OF PULMONARY REHABILITATION AND CHEST PHYSIOTHERAPY VERSUS CHEST PHYSIOTHERAPY ALONE IN
BRONCHIECTASIS RESPIRATORY MEDICINE 106(12) PP1647-1654
bull MURRAY M PENTLAND J AND HILL A (2009) A RANDOMISED CROSSOVER TRIAL OF CHEST PHYSIOTHERAPY IN NON-CYSTIC FIBROSIS BRONCHIECTASIS EUROPEAN RESPIRATORY JOURNAL 34(5) PP1086-1092
bull NEWALL C STOCKLEY R AND HILL S (2005) EXERCISE TRAINING AND INSPIRATORY MUSCLE TRAINING IN PATIENTS WITH BRONCHIECTASIS THORAX 60(11) PP943-948
bull ONG H LEE A HILL C HOLLAND A AND DENEHY L (2011) EFFECTS OF PULMONARY REHABILITATION IN BRONCHIECTASIS A RETROSPECTIVE STUDY CHRONIC RESPIRATORY DISEASE 8(1) PP21-30
bull QUINT J MILLETT E JOSHI M NAVARATNAM V THOMAS S HURST J SMEETH L AND BROWN J (2015) CHANGES IN THE INCIDENCE PREVALENCE AND MORTALITY OF BRONCHIECTASIS IN THE UK FROM 2004 TO 2013 A POPULATION-BASED COHORT
STUDY EUROPEAN RESPIRATORY JOURNAL 47(1) PP186-193
bull SNIJDERS D FERNANDEZ DOMINGUEZ B CALGARO S BERTOZZI I ESCRIBANO MONTANER A PERILONGO G AND BARBATO A (2015) MUCOCILIARY CLEARANCE TECHNIQUES FOR TREATING NON-CYSTIC FIBROSIS BRONCHIECTASIS IS THERE
EVIDENCE INTERNATIONAL JOURNAL OF IMMUNOPATHOLOGY AND PHARMACOLOGY 28(2) PP150-159
OSCILLATING PEP
OSCILLATING PEP
bull DEVICES CAN BE INTRA-THORACIC OR EXTRA-THORACIC
bull INTRA-THORACIC DEVICES ARE PLACED IN THE MOUTH AND PROVIDE RESISTANCE DURING EXHALATION
bull ALTERS EXPIRATORY AIRFLOW
bull VIBRATIONS ON THE AIRWAY SURFACE
bull REDUCES MUCOUS VISCOSITY
bull ACCELERATION OF THE EXPIRATORY FLOW
bull PREVENTS AND TREATS AIRWAY COMPRESSION ATELECTASIS
bull IMPROVES AIRWAY PATENCY amp VENTILATION
bull DECREASES HYPERINFLATION
bull IMPROVES LUNG FUNCTION PARAMETERS
bull INCLUDES EXERCISE
OSCILLATING PEP TREATMENT
bull SIMILAR TO PEP
bull GOOD POSITION
bull PLACE MOUTHPIECE BETWEEN LIPS AND TEETH OR USE MASK
bull SLOW INHALE JUST A LITTLE LARGER THAN A NORMAL BREATH IN
bull HOLD FOR 3 SECONDS
bull STEADY ACTIVE amp FULL EXHALATION
bull ADJUST THE RESISTANCE AS REQUIRED
bull REPEAT 12-15 TIMES FOLLOWED BY FET amp COUGH
bull COMPLETE FOR 5-10 MINS
bull COMBINE WITH OTHER TREATMENTS
ACAPELLA
bull DETACHABLE MOUTHPIECEFACEMASK
bull ONE-WAY INSPIRATORY VALVE
bull EXPIRATORY RESISTANCEFREQUENCY ADJUSTMENT DIAL
bull COUNTERWEIGHTED PLUG amp MAGNET
bull MAINTAINS A RAISED FRC LEVEL
TREATMENT
bull EASY TO USE IN DIFFERENT POSITIONS
bull INHALE amp EXHALE THROUGH THE ACAPELLA
bull ROTATE THE FREQUENCY RESISTANCE DIAL UNTIL MAXIMUM VIBRATIONS ARE FELT WITHIN THE CHEST WALL
AEROBIKA bull COMBINES PEP WITH HIGH FREQUENCY OSCILLATIONS
bull CAN BE USED WITH A MANOMETER
bull NEBULISER CAN BE ENTRAINED INTO THE SYSTEM
bull POSSIBLE INCREASE IN TREATMENT COMPLIANCE BY DECREASING
TREATMENT TIMES
TECHNIQUE AS OSCILLATING PEP
BUBBLE PEP
Suction tubing (~1cm diameter) The end MUST sit at the bottom of the bottle
Plastic bottle Any widthshapediameter must be gt20cm tall 15cm fresh tapsterile water
(depth of water determines the amount of pressure ie cm H20
Washing up bowl
INDICATIONS
bull REDUCED LUNG VOLUME (FVClt50)
bull WEAK COUGH (PCFlt270)
bull SECRETIONS RETENTION
bull ATELECTASIS
bull REDUCED MECHANICAL COMPLIANCE
bull CHILD ABLE TO COMPLY
BENEFITS
bull INCREASE LUNG VOLUME = IMPROVES PCF
bull SECRETION CLEARANCE
bull MAY REVERSE ATELECTASIS
bull IMPROVE MECHANICAL COMPLIANCE = LUNG AND CHEST WALL MOBILITY
bull IMPROVE VOICE STRENGTH
LUNG VOLUME RECRUITMENT
bull LABEL NOT FOR RESUSCITATION
bull BEST IN SITTING
bull SUCTION READY
bull AGREE SIGNAL WITH CHILD WHEN MIC ACHIEVED
bull ASK TO BREATH OUT
bull PLACE MOUTHPIECE +- NOSE CLIP OR MASK
bull ASK TO BREATH IN AND HOLD WHILE GENTLY SQUEEZING BAG
bull WITHOUT LETTING AIR OUT ASK CHILD TO TAKE ANOTHER BREATH IN ON TOP OF THE FIRST BREATH AND SQUEEZE BAG IN TIME WITH BREATH
bull REPEAT UNTIL LUNGS ARE FULL (NORMALLY 3-5 BREATHS) OR SIGNAL
bull REMOVE MASK OR MOUTHPIECE ASK TO HOLD FOR 3-5 SECONDS
bull EXHALE OR IF SECRETIONS ARE PRESENT ENCOURAGE TO HAVE A COUGH OR MAC
bull REPEATED X3-5 X2-4 DAY
LVR TREATMENT
bull AIRWAY CLEARANCE OR THORACIC MOBILITY
bull AMBU RESUS BAG
bull GREEN ldquoPHYSIOrdquo BAG
bull MANUAL TECHNIQUES WITH BAGGING
bull MHI AT HOME
bull MANOMETERS
MHI
PHYSIO WITH NIV
bull PHYSIO SETTINGS
bull SECRETIONS
bull THORACIC MOBILITY
bull ALLOWS REST PERIOD PRE ACT
bull HUMIDIFICATION
bull INFLATABLE VEST CONNECTED BY TUBES TO AN AIR PULSE GENERATOR WHICH RAPIDLY INFLATES AND DEFLATES THE VEST PRODUCING OSCILLATIONS TO THE CHEST WALL
bull RAPID CHEST MOVEMENT MIMICS A COUGH-LIKE EXPIRATORY FLOW THAT SHEARS MUCUS AWAY FROM THE AIRWAY WALLS AND HELPS TO MOVE IT ALONG TO THE CENTRAL AIRWAYS
bull PASSIVE TREATMENT amp NOT POSITION DEPENDANT
bull COMBINATION OF RX
bull CONTRAINDICATIONS
bull HEAD ANDOR NECK INJURY THAT HAS NOT BEEN STABILISED
bull ACTIVE HAEMORRHAGE WITH HEMODYNAMIC INSTABILITY
HFCWO
HFCWO INDICATIONS
bull CHRONIC MUCUS HYPERSECRETION OR RETENTION ASSOCIATED WITH A CHRONIC PULMONARY OR NEUROMUSCULAR CONDITION
bull LRT SECRETIONS AND FREQUENT LRTI REQUIRING HOSPITAL ADMISSION
bull INEFFECTIVE COUGH OR INABILITY TO REMOVE MUCUS BY COUGHING
bull TENACIOUS SECRETIONS THAT ARE NOT EASILY MOBILISED WITH STANDARD CPT
bull MECHANICALLY VENTILATED WITH EVIDENCE OF SECRETION RETENTION
bull ALTERNATIVE AIRWAY CLEARANCE THERAPY PROVEN INEFFECTIVE OR CONTRAINDICATEDDO NOT TOLERATE STANDARD CPT
bull CONSTANT FATIGUE LACK OF STRENGTH OR ABILITY TO PERFORM ACTIVE TREATMENT
bull SYMPTOMATIC
bull POOR COMPLIANCE WITH OTHER AIRWAY CLEARANCE METHODS
bull HIGH BURDEN OF CARE
bull PATIENT UNABLE TO TOLERATE THE INCREASED WORK OF BREATHING bull ACTIVE HAEMOPTYSIS bull UNTREATED PNEUMOTHORAX bull INTRACRANIAL PRESSURE (ICP) gt 20 MMHG bull HAEMODYNAMIC INSTABILITY bull SEVERE CARDIOVASCULAR INSULTDISEASE bull RECENT FACIAL ORAL OR SKULL SURGERY OR TRAUMA bull ACUTE SINUSITIS bull EPISTAXIS bull POST OESOPHAGEAL amp LUNG SURGERY bull KNOWN OR SUSPECTED TYMPANIC MEMBRANE RUPTURE OR OTHER MIDDLE EAR
PATHOLOGY
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
POSSIBLE HAZARDSCOMPLICATIONS
bull INCREASED WORK OF BREATHING THAT MAY LEAD TO HYPOVENTILATION AND
HYPERCARBIA
bull INCREASED INTRACRANIAL PRESSURE
bull CARDIOVASCULAR COMPROMISE
bull NAUSEA
bull MYOCARDIAL ISCHEMIA
bull DECREASED VENOUS RETURN
bull AIR SWALLOWING WITH INCREASED LIKELIHOOD OF VOMITING AND
ASPIRATION
bull CLAUSTROPHOBIA
bull SKIN BREAK DOWN AND DISCOMFORT FROM MASK
bull PULMONARY BAROTRAUMA
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
MI-E
bull USED WITH CHILDREN WHO HAVE DECREASED INSPIRATORY EFFORT DUE TO EITHER SPINAL CORD INJURY OR NMW AND WHO HAVE AN IMPAIRED OR INEFFECTIVE COUGH WITH APPROPRIATE RESPIRATORY SYMPTOMS
bull CONSIDERED WHEN CONVENTIONAL COUGH ASSISTANCE TECHNIQUES BECOME INEFFECTIVE
bull ACCEPTED AS THE CORE STANDARD FOR CHILD WITH NMW
bull MIE WORKS BY
bull INFLATING THE LUNGS WITH GRADUAL POSITIVE AIRWAY PRESSURE ASSISTING INSPIRATION CALLED INSUFFLATION
bull FOLLOWED BY A RAPID SWITCH TO NEGATIVE PRESSURE WHICH SIMULATES THE FLOW CHANGES THAT OCCUR DURING A COUGH THEREBY ENHANCING EXPIRATORY FLOW CALLED EXSUFFLATION AND ASSISTING EXPECTORATION OF SECRETIONS
bull MOVEMENT AND EXERCISE BEST FUNCTIONAL METHOD OF AIRWAY CLEARANCE
bull CPET BETTER CORRELATION THAN LUNG FUNCTION IN SURVIVAL RATES IN PEOPLE WITH
CYSTIC FIBROSIS
bull RUNNINGWALKING BETTER FOR SECRETION CLEARANCE THAN BIKE DURING TO SHEARING
MECHANISM
bull CONSIDER ADDING IN HUFFS (DYER)
bull CONSIDER USE OF AD BELT
EXERCISE
bull APCP SUCTION GUIDELINES
bull TYPESNASOPHARANGEAL OROPHARANGEAL AND TRACHEOSTOMY
bull MAIN VARIABLES SUCTION TYPE AND SIZE DEPTH OF SUCTION
PRESSURE TECHNIQUE
SUCTION
SPUTUM
bull SPUTUM bull 95 WATER bull COLOUR bull VOLUME bull CONSISTENCY bull ODOUR
bull PURPOSE bull HUMIDIFICATION bull WATERPROOFING bull PROTECTION OF EPITHELIUM
HUMIDIFICATION
bull METABOLIC AND VENTILATORY REQUIREMENTS ARE X2-3 OF ADULTS
IMPLICATION
bull HEAT AND MOISTURE LOSSES FROM RESPIRATION WILL INCREASE BY X2-3
bull CONSUME GREATER AMOUNTS OF ENERGY AND WATER
HUMIDIFICATION INHALATION
THERAPY
bull TRACHEOSTOMY HME
bull WET DRY CIRCUIT
bull NEBULISERS INHALERS MUCOLYTICS
bull HUMIDIFIERS WITH NIV
bull OXYGEN
bull SYSTEMIC HYDRATION ENVIRONMENT
NEBULISERS
bull NEBULISER CHAMBER CONVERTS LIQUID INTO
RESPIRABLE PARTICLES
bull MOISTURE DESCENDS THROUGH THE HOLES IN THE SUPERFICIAL GEL LAYER
bull INCREASES THE SOL LAYER SO THE CILIARY BEAT IS OPTIMAL FOR MUCUS TRANSPORT
bull SHORT TERM HUMIDIFICATION
bull DAILY WASHING OF NEBULISER SYSTEM
TIMING OF DRUG AND PHYSIOTHERAPY
BEFORE TREATMENT
bull DNASE (PULMOZYME)
bull SALBUTAMOL
(VENTOLIN BLUE)
bull SALINE NEBS
AFTER TREATMENT
bull SERETIDE (PURPLE)
bull BECLOMETHASONE (BECOTIDE BROWN)
bull COLISTIN (COLOMYCIN PROMIXIN)
bull TOBRAMYCIN
CONCLUSION
bull BE AWARE OF CHILDrsquoS RESPIRATORY FUNCTION
bull CHOSE ACT BEST FOR THEM bull TYPE OF KETCHUP BOTTLE bull LV SECRETION RETENTION WOB
bull EARLY RESPIRATORY REFERRAL
bull RESPIRATORY CARE COMPETENCIES
bull EFFECTIVE SECRETION CLEARANCE AT HOMERESPITESCHOOL
bull USE OF PEAK COUGH FLOWS TO AID CHOICE OF ADJUNCT
0
50
100
150
200
250
300
350
400
0
50
100
150
200
250
300
350
400
Green
Key
Additional info
(please comment) Please refer to BTSACPRC Guideline
Lothian University Hospitals NHS Trust
n PCF
gt270lmin
Breathstack
ing tri-
flow
blowing
REFERENCES bull BTSACPRC GUIDELINE IS PUBLISHED IN THORAX VOL 67 SUPPLEMENT 1
bull AVAILABLE ONLINE AT HTTPTHORAXBMJCOMCONTENTVOL64ISSUESUPPLI
bull HTTPWWWBRIT-THORACICORGUKPHYSIOGUIDE
bull BRITISH THORACIC SOCIETY REPORTS VOL 1 NO 1 2009
bull ADAPTED PRYOR AJ AND PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS3RD ED
bull HOUGH A PHYSIOTHERAPY IN RESPIRATORY CARE LONDON CHAPMAN AND HALL 1993
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1997) POSTURAL DRAINAGE AND GASTRO-OESOPHAGEAL REFLUX IN INFANTS WITH CYSTIC FIBROSIS ARCHIVES OF DISEASE IN CHILDHOOD 76 148-150
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1998) POSTURAL DRAINAGE IN CYSTIC FIBROSIS IS THERE A LINK WITH GASTRO-OESOPHAGEAL REFLUX JOURNAL OF PAEDIATRIC CHILD HEALTH 34 330-334
bull CECINS NM JENKINS SC PENGELLEY J ET AL (1999) THE ACTIVE CYCLE OF BREATHING TECHNIQUES-TO TIP OR NOT TO TIP RESPIRATORY MEDICINE 93 660-665
bull CONSTANTINI D BRIVIO A BRUSA D ET AL (2001) PEP MASK VERSUS POSTURAL DRAINAGE IN INFANTS A LONG-TERM COMPARATIVE TRIAL PEADIATRIC PULMONOLOGY
bull HOUGH A (2001) PHYSIOTHERAPY IN RESPIRATORY CARE AN EVIDENCE-BASED APPROACH TO RESPIRATORY AND CARDIAC MANAGEMENT CENGAGE LEARNING EMEA
bull INTERNATIONAL PHYSIOTHERAPY GROUP FOR CYSTIC FIBROSIS PHYSIOTHERAPY IN THE TREATMENT OF CYSTIC FIBROSIS (2009) HTTPSWWWECFSEUIPG_CFBOOKLET INTERNATIONAL PHYSIOTHERAPY GROUP ndash THE BLUE BOOKLET
bull KONSTAN MW STERN RC DOERSHUK CF (1994) EFFICACY OF THE FLUTTER DEVICE FOR AIRWAY MUCUS CLEARANCE IN PATIENTS WITH CYSTIC FIBROSIS JOURNAL OF PEDIATRICS 124 (5 (PT 1) 689-693
bull MCILWAINE M BUTTON B AND DWAN K (2015) POSITIVE EXPIRATORY PRESSURE PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 6 ART NO CD003147 DOI 10100214651858CD003147PUB4
bull MESTRINER RG FERNANDES RO STAFFEN LC ET AL (2009) OPTIMUM DESIGN PARAMETERS FOR A THERAPIST-CONSTRUCTED POSITIVE-EXPIRATORY-PRESSURE THERAPY BOTTLE DEVICE RESPIRATORY CARE 54 504-8
bull MORRISON L AND AGNEW J (2014) OSCILLATING DEVICES FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 7 ART NO CD006842 DOI 10100214651858CD006842PUB
bull OERMANN CM SOCKRIDER MM GILES D ET AL (2001) COMPARISON OF HIGH-FREQUENCY CHEST WALL OSCILLATION AND OSCILLATING POSITIVE EXPIRATORY PRESSURE IN THE HOME MANAGEMENT OF CYSTIC FIBROSIS A PILOT STUDY PEDIATRIC PULMONOLOGY 32 (5) 372-7
bull PRASAD SA AND HUSSEY J (1995) PAEDIATRIC RESPIRATORY CARE A GUIDE FOR PHYSIOTHERAPISTS AND HEALTH PROFESSIONALS CHAPMAN amp HALL
bull PRYOR J (1999) PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN ADULTS EUROPEAN RESPIRATORY JOURNAL 14 (6) 1418-1424
bull PRYOR JA amp PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS CHURCHILL LIVINGSTONE
bull PRYOR JA WEBBER BA HODSON ME ET AL (1994) THE FLUTTER VRP1 AS AN ADJUNCT TO CHEST PHYSIOTHERAPY IN CYSTIC FIBROSIS RESPIRATORY MEDICINE 88677-81
bull WEST K WALLEN M FOLLETT J (2010) ACAPELLA VS PEP MASK THERAPY A RANDOMISED TRIAL IN CHILDREN WITH CYSTIC FIBROSIS DURING RESPIRATORY EXACERBATION PHYSIOTHERAPY THEORY PRACTICE 26143-9
bull WILSONLM AGNEW J MORRISON L ET AL (2014) AIRWAY CLEARANCE TECHNIQUES FOR CYSTIC FIBROSIS AN OVERVIEW OF COCHRANE SYSTEMATIC REVIEWS COCHRANE DATABASE OF SYSTEMATIC REVIEWS DOI 10100214651858CD011231
bull VOLSKO TA DIFIORE JM CHATBURN RL (2003) PERFORMANCE COMPARISON OF TWO OSCILLATORY POSITIVE PRESSURE DEVICES ACAPELLA VERSUS FLUTTER RESPIRATORY CARE 48 (2) 124- 130
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SEDDON PC KHAN Y RESPIRATORY PROBLEMS IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT ARCHIVES OF DISEASE IN CHILDHOOD 2003 01 JAN88(1)75-8
bull MARKS JH PULMONARY CARE OF CHILDREN AND ADOLESCENTS WITH DEVELOPMENTAL DISABILITIES PEDIATR CLIN NORTH AM 2008 DECEMBER55(6)1299-314
bull ARENS R MUZUMDAR H SLEEP SLEEP DISORDERED BREATHING AND NOCTURNAL HYPOVENTILATION IN CHILDREN WITH NEUROMUSCULAR DISEASES PAEDIATRIC RESPIRATORY REVIEWS 2010 MAR11(1)24-30
bull FITZGERALD DA FOLLETT J VAN ASPEREN PP ASSESSING AND MANAGING LUNG DISEASE AND SLEEP DISORDERED BREATHING IN CHILDREN WITH CEREBRAL PALSY PAEDIATRIC RESPIRATORY REVIEWS 2009 MARCH10(1)18-24
bull HSIAO KH NIXON GM THE EFFECT OF TREATMENT OF OBSTRUCTIVE SLEEP APNEA ON QUALITY OF LIFE IN CHILDREN WITH CEREBRAL PALSY RES DEV DISABIL 2008 MAR-APR29(2)133-40
bull LUNDBERG A OXYGEN CONSUMPTION IN RELATION TO WORKLOAD IN STUDENTS WITH CEREBRAL PALSY J APPL PHYSIO 197640873-5
bull SULLIVAN PB ROSENBLOOM L FEEDING THE DISABLED CHILD CLINICS IN DEVELOPMENTAL MEDICINE MACKEITH PRESS 1999140
bull MARTIN TR THE RELATIONSHIP BETWEEN MALNUTRITION AND LUNG INFECTIONS CLIN CHEST MED 19878359
bull MOSTAFA SM BHANDARI S RITCHIE G ET AL CONSTIPATION AND ITS IMPLICATIONS IN THE CRITICALLY ILL PATIENT BR J ANAESTH 200391815-9 3
bull GACOUIN A CAMUS C GROS A ET AL CONSTIPATION IN LONGTERM VENTILATED PATIENTS ASSOCIATED FACTORS AND IMPACT ON INTENSIVE CARE UNIT OUTCOMES CRIT CARE MED 2010381933- 8
bull NGUYEN T FRENETTE AJ JOHANSON C ET AL IMPAIRED GASTROINTESTINAL TRANSIT AND ITS ASSOCIATED MORBIDITY IN THE INTENSIVE CARE UNIT J CRIT CARE 201328537
bull ASAI T CONSTIPATION DOES IT INCREASE MORBIDITY AND MORTALITY IN CRITICALLY ILL PATIENTS CRIT CARE MED 2007352861-2
bull UNDERSTANDING THE PHYSIOLOGICAL EFFECTS OF UNTREATED PAIN NURSING TIMES VOL 99 ISSUE 37 PAGE NO 28
bull WINFIELD ET AL NON-PHARMACEUTICAL MANAGEMENT OF RESPIRATORY MORBIDITY IN CHILDREN WITH SEVERE GLOBAL DEVELOPMENTAL DELAY THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014
bull OLOUGHLIN EV SOMERVILLE HM SOMERVILLE ER DEALING WITH MULTISYSTEM DISEASE IN PEOPLE WITH A DEVELOPMENTAL DISABILITY MEDICAL JOURNAL OF AUSTRALIA 2009 JUN 1190(11)616-7
bull MESTROVIC J KARDUM G POLIC B MESTROVIC M MARKIC J SUSTIC A ET AL THE INFLUENCE OF CHRONIC HEALTH CONDITIONS ON SUSCEPTIBILITY TO SEVERE ACUTE ILLNESS OF CHILDREN TREATED IN PICU EUROPEAN JOURNAL OF PEDIATRICS 2006 AUG165(8)526-
9
bull HEALY F PANITCH HB PULMONARY COMPLICATIONS OF PEDIATRIC NEUROLOGICAL DISEASES PEDIATR ANN 2010 APR39(4)216-24
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SRIVASTAVA R JACKSON WD BARNHART DC DYSPHAGIA AND GASTROESOPHAGEAL REFLUX DISEASE DILEMMAS IN DIAGNOSIS AND MANAGEMENT IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT PEDIATR ANN 2010 APR39(4)225-31
bull SULLIVAN PB JUSZCZAK E BACHLET AME LAMBERT B VERNON-ROBERTS A GRANT HW ET AL GASTROSTOMY TUBE FEEDING IN CHILDREN WITH CEREBRAL PALSY A PROSPECTIVE LONGITUDINAL STUDY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 2005
FEBRUARY47(2)77-85
bull SOMERVILLE H TZANNES G WOOD J SHUN A HILL C ARROWSMITH F ET AL GASTROINTESTINAL AND NUTRITIONAL PROBLEMS IN SEVERE DEVELOPMENTAL DISABILITY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 200850(9)712-6
bull TODER DS RESPIRATORY PROBLEMS IN THE ADOLESCENT WITH DEVELOPMENTAL DELAY ADOLESCENT MEDICINE 2000 3 OCTOBER 200011(3)617-31
bull LEVIN K COLON A DIPALMA J FITZPATRICK S USING THE RADIONUCLIDE SALIVAGRAM TO DETECT PULMONARY ASPIRATION AND ESOPHAGEAL DYSMOTILITY CLIN NUCL MED 1993 FEB18(2)110-4
bull SCHROEDER AS KLING T HUSS K BORGGRAEFE I KOERTE IK BLASCHEK A ET AL BOTULINUM TOXIN TYPE A AND B FOR THE REDUCTION OF HYPERSALIVATION IN CHILDREN WITH NEUROLOGICAL DISORDERS A FOCUS ON EFFECTIVENESS AND THERAPY ADHERENCE
NEUROPEDIATRICS 201243(1)27-36
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull GOEMINNE P AND DUPONT L (2010) NON-CYSTIC FIBROSIS BRONCHIECTASIS DIAGNOSIS AND MANAGEMENT IN 21ST CENTURY POSTGRADUATE MEDICAL JOURNAL 86(1018) PP493-501
bull LEE A BUTTON B AND TANNENBAUM E (2017) AIRWAY-CLEARANCE TECHNIQUES IN CHILDREN AND ADOLESCENTS WITH CHRONIC SUPPURATIVE LUNG DISEASE AND BRONCHIECTASIS FRONTIERS IN PEDIATRICS 5
bull MANDAL P SIDHU M KOPE L POLLOCK W STEVENSON L PENTLAND J TURNBULL K MAC QUARRIE S AND HILL A (2012) A PILOT STUDY OF PULMONARY REHABILITATION AND CHEST PHYSIOTHERAPY VERSUS CHEST PHYSIOTHERAPY ALONE IN
BRONCHIECTASIS RESPIRATORY MEDICINE 106(12) PP1647-1654
bull MURRAY M PENTLAND J AND HILL A (2009) A RANDOMISED CROSSOVER TRIAL OF CHEST PHYSIOTHERAPY IN NON-CYSTIC FIBROSIS BRONCHIECTASIS EUROPEAN RESPIRATORY JOURNAL 34(5) PP1086-1092
bull NEWALL C STOCKLEY R AND HILL S (2005) EXERCISE TRAINING AND INSPIRATORY MUSCLE TRAINING IN PATIENTS WITH BRONCHIECTASIS THORAX 60(11) PP943-948
bull ONG H LEE A HILL C HOLLAND A AND DENEHY L (2011) EFFECTS OF PULMONARY REHABILITATION IN BRONCHIECTASIS A RETROSPECTIVE STUDY CHRONIC RESPIRATORY DISEASE 8(1) PP21-30
bull QUINT J MILLETT E JOSHI M NAVARATNAM V THOMAS S HURST J SMEETH L AND BROWN J (2015) CHANGES IN THE INCIDENCE PREVALENCE AND MORTALITY OF BRONCHIECTASIS IN THE UK FROM 2004 TO 2013 A POPULATION-BASED COHORT
STUDY EUROPEAN RESPIRATORY JOURNAL 47(1) PP186-193
bull SNIJDERS D FERNANDEZ DOMINGUEZ B CALGARO S BERTOZZI I ESCRIBANO MONTANER A PERILONGO G AND BARBATO A (2015) MUCOCILIARY CLEARANCE TECHNIQUES FOR TREATING NON-CYSTIC FIBROSIS BRONCHIECTASIS IS THERE
EVIDENCE INTERNATIONAL JOURNAL OF IMMUNOPATHOLOGY AND PHARMACOLOGY 28(2) PP150-159
OSCILLATING PEP
bull DEVICES CAN BE INTRA-THORACIC OR EXTRA-THORACIC
bull INTRA-THORACIC DEVICES ARE PLACED IN THE MOUTH AND PROVIDE RESISTANCE DURING EXHALATION
bull ALTERS EXPIRATORY AIRFLOW
bull VIBRATIONS ON THE AIRWAY SURFACE
bull REDUCES MUCOUS VISCOSITY
bull ACCELERATION OF THE EXPIRATORY FLOW
bull PREVENTS AND TREATS AIRWAY COMPRESSION ATELECTASIS
bull IMPROVES AIRWAY PATENCY amp VENTILATION
bull DECREASES HYPERINFLATION
bull IMPROVES LUNG FUNCTION PARAMETERS
bull INCLUDES EXERCISE
OSCILLATING PEP TREATMENT
bull SIMILAR TO PEP
bull GOOD POSITION
bull PLACE MOUTHPIECE BETWEEN LIPS AND TEETH OR USE MASK
bull SLOW INHALE JUST A LITTLE LARGER THAN A NORMAL BREATH IN
bull HOLD FOR 3 SECONDS
bull STEADY ACTIVE amp FULL EXHALATION
bull ADJUST THE RESISTANCE AS REQUIRED
bull REPEAT 12-15 TIMES FOLLOWED BY FET amp COUGH
bull COMPLETE FOR 5-10 MINS
bull COMBINE WITH OTHER TREATMENTS
ACAPELLA
bull DETACHABLE MOUTHPIECEFACEMASK
bull ONE-WAY INSPIRATORY VALVE
bull EXPIRATORY RESISTANCEFREQUENCY ADJUSTMENT DIAL
bull COUNTERWEIGHTED PLUG amp MAGNET
bull MAINTAINS A RAISED FRC LEVEL
TREATMENT
bull EASY TO USE IN DIFFERENT POSITIONS
bull INHALE amp EXHALE THROUGH THE ACAPELLA
bull ROTATE THE FREQUENCY RESISTANCE DIAL UNTIL MAXIMUM VIBRATIONS ARE FELT WITHIN THE CHEST WALL
AEROBIKA bull COMBINES PEP WITH HIGH FREQUENCY OSCILLATIONS
bull CAN BE USED WITH A MANOMETER
bull NEBULISER CAN BE ENTRAINED INTO THE SYSTEM
bull POSSIBLE INCREASE IN TREATMENT COMPLIANCE BY DECREASING
TREATMENT TIMES
TECHNIQUE AS OSCILLATING PEP
BUBBLE PEP
Suction tubing (~1cm diameter) The end MUST sit at the bottom of the bottle
Plastic bottle Any widthshapediameter must be gt20cm tall 15cm fresh tapsterile water
(depth of water determines the amount of pressure ie cm H20
Washing up bowl
INDICATIONS
bull REDUCED LUNG VOLUME (FVClt50)
bull WEAK COUGH (PCFlt270)
bull SECRETIONS RETENTION
bull ATELECTASIS
bull REDUCED MECHANICAL COMPLIANCE
bull CHILD ABLE TO COMPLY
BENEFITS
bull INCREASE LUNG VOLUME = IMPROVES PCF
bull SECRETION CLEARANCE
bull MAY REVERSE ATELECTASIS
bull IMPROVE MECHANICAL COMPLIANCE = LUNG AND CHEST WALL MOBILITY
bull IMPROVE VOICE STRENGTH
LUNG VOLUME RECRUITMENT
bull LABEL NOT FOR RESUSCITATION
bull BEST IN SITTING
bull SUCTION READY
bull AGREE SIGNAL WITH CHILD WHEN MIC ACHIEVED
bull ASK TO BREATH OUT
bull PLACE MOUTHPIECE +- NOSE CLIP OR MASK
bull ASK TO BREATH IN AND HOLD WHILE GENTLY SQUEEZING BAG
bull WITHOUT LETTING AIR OUT ASK CHILD TO TAKE ANOTHER BREATH IN ON TOP OF THE FIRST BREATH AND SQUEEZE BAG IN TIME WITH BREATH
bull REPEAT UNTIL LUNGS ARE FULL (NORMALLY 3-5 BREATHS) OR SIGNAL
bull REMOVE MASK OR MOUTHPIECE ASK TO HOLD FOR 3-5 SECONDS
bull EXHALE OR IF SECRETIONS ARE PRESENT ENCOURAGE TO HAVE A COUGH OR MAC
bull REPEATED X3-5 X2-4 DAY
LVR TREATMENT
bull AIRWAY CLEARANCE OR THORACIC MOBILITY
bull AMBU RESUS BAG
bull GREEN ldquoPHYSIOrdquo BAG
bull MANUAL TECHNIQUES WITH BAGGING
bull MHI AT HOME
bull MANOMETERS
MHI
PHYSIO WITH NIV
bull PHYSIO SETTINGS
bull SECRETIONS
bull THORACIC MOBILITY
bull ALLOWS REST PERIOD PRE ACT
bull HUMIDIFICATION
bull INFLATABLE VEST CONNECTED BY TUBES TO AN AIR PULSE GENERATOR WHICH RAPIDLY INFLATES AND DEFLATES THE VEST PRODUCING OSCILLATIONS TO THE CHEST WALL
bull RAPID CHEST MOVEMENT MIMICS A COUGH-LIKE EXPIRATORY FLOW THAT SHEARS MUCUS AWAY FROM THE AIRWAY WALLS AND HELPS TO MOVE IT ALONG TO THE CENTRAL AIRWAYS
bull PASSIVE TREATMENT amp NOT POSITION DEPENDANT
bull COMBINATION OF RX
bull CONTRAINDICATIONS
bull HEAD ANDOR NECK INJURY THAT HAS NOT BEEN STABILISED
bull ACTIVE HAEMORRHAGE WITH HEMODYNAMIC INSTABILITY
HFCWO
HFCWO INDICATIONS
bull CHRONIC MUCUS HYPERSECRETION OR RETENTION ASSOCIATED WITH A CHRONIC PULMONARY OR NEUROMUSCULAR CONDITION
bull LRT SECRETIONS AND FREQUENT LRTI REQUIRING HOSPITAL ADMISSION
bull INEFFECTIVE COUGH OR INABILITY TO REMOVE MUCUS BY COUGHING
bull TENACIOUS SECRETIONS THAT ARE NOT EASILY MOBILISED WITH STANDARD CPT
bull MECHANICALLY VENTILATED WITH EVIDENCE OF SECRETION RETENTION
bull ALTERNATIVE AIRWAY CLEARANCE THERAPY PROVEN INEFFECTIVE OR CONTRAINDICATEDDO NOT TOLERATE STANDARD CPT
bull CONSTANT FATIGUE LACK OF STRENGTH OR ABILITY TO PERFORM ACTIVE TREATMENT
bull SYMPTOMATIC
bull POOR COMPLIANCE WITH OTHER AIRWAY CLEARANCE METHODS
bull HIGH BURDEN OF CARE
bull PATIENT UNABLE TO TOLERATE THE INCREASED WORK OF BREATHING bull ACTIVE HAEMOPTYSIS bull UNTREATED PNEUMOTHORAX bull INTRACRANIAL PRESSURE (ICP) gt 20 MMHG bull HAEMODYNAMIC INSTABILITY bull SEVERE CARDIOVASCULAR INSULTDISEASE bull RECENT FACIAL ORAL OR SKULL SURGERY OR TRAUMA bull ACUTE SINUSITIS bull EPISTAXIS bull POST OESOPHAGEAL amp LUNG SURGERY bull KNOWN OR SUSPECTED TYMPANIC MEMBRANE RUPTURE OR OTHER MIDDLE EAR
PATHOLOGY
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
POSSIBLE HAZARDSCOMPLICATIONS
bull INCREASED WORK OF BREATHING THAT MAY LEAD TO HYPOVENTILATION AND
HYPERCARBIA
bull INCREASED INTRACRANIAL PRESSURE
bull CARDIOVASCULAR COMPROMISE
bull NAUSEA
bull MYOCARDIAL ISCHEMIA
bull DECREASED VENOUS RETURN
bull AIR SWALLOWING WITH INCREASED LIKELIHOOD OF VOMITING AND
ASPIRATION
bull CLAUSTROPHOBIA
bull SKIN BREAK DOWN AND DISCOMFORT FROM MASK
bull PULMONARY BAROTRAUMA
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
MI-E
bull USED WITH CHILDREN WHO HAVE DECREASED INSPIRATORY EFFORT DUE TO EITHER SPINAL CORD INJURY OR NMW AND WHO HAVE AN IMPAIRED OR INEFFECTIVE COUGH WITH APPROPRIATE RESPIRATORY SYMPTOMS
bull CONSIDERED WHEN CONVENTIONAL COUGH ASSISTANCE TECHNIQUES BECOME INEFFECTIVE
bull ACCEPTED AS THE CORE STANDARD FOR CHILD WITH NMW
bull MIE WORKS BY
bull INFLATING THE LUNGS WITH GRADUAL POSITIVE AIRWAY PRESSURE ASSISTING INSPIRATION CALLED INSUFFLATION
bull FOLLOWED BY A RAPID SWITCH TO NEGATIVE PRESSURE WHICH SIMULATES THE FLOW CHANGES THAT OCCUR DURING A COUGH THEREBY ENHANCING EXPIRATORY FLOW CALLED EXSUFFLATION AND ASSISTING EXPECTORATION OF SECRETIONS
bull MOVEMENT AND EXERCISE BEST FUNCTIONAL METHOD OF AIRWAY CLEARANCE
bull CPET BETTER CORRELATION THAN LUNG FUNCTION IN SURVIVAL RATES IN PEOPLE WITH
CYSTIC FIBROSIS
bull RUNNINGWALKING BETTER FOR SECRETION CLEARANCE THAN BIKE DURING TO SHEARING
MECHANISM
bull CONSIDER ADDING IN HUFFS (DYER)
bull CONSIDER USE OF AD BELT
EXERCISE
bull APCP SUCTION GUIDELINES
bull TYPESNASOPHARANGEAL OROPHARANGEAL AND TRACHEOSTOMY
bull MAIN VARIABLES SUCTION TYPE AND SIZE DEPTH OF SUCTION
PRESSURE TECHNIQUE
SUCTION
SPUTUM
bull SPUTUM bull 95 WATER bull COLOUR bull VOLUME bull CONSISTENCY bull ODOUR
bull PURPOSE bull HUMIDIFICATION bull WATERPROOFING bull PROTECTION OF EPITHELIUM
HUMIDIFICATION
bull METABOLIC AND VENTILATORY REQUIREMENTS ARE X2-3 OF ADULTS
IMPLICATION
bull HEAT AND MOISTURE LOSSES FROM RESPIRATION WILL INCREASE BY X2-3
bull CONSUME GREATER AMOUNTS OF ENERGY AND WATER
HUMIDIFICATION INHALATION
THERAPY
bull TRACHEOSTOMY HME
bull WET DRY CIRCUIT
bull NEBULISERS INHALERS MUCOLYTICS
bull HUMIDIFIERS WITH NIV
bull OXYGEN
bull SYSTEMIC HYDRATION ENVIRONMENT
NEBULISERS
bull NEBULISER CHAMBER CONVERTS LIQUID INTO
RESPIRABLE PARTICLES
bull MOISTURE DESCENDS THROUGH THE HOLES IN THE SUPERFICIAL GEL LAYER
bull INCREASES THE SOL LAYER SO THE CILIARY BEAT IS OPTIMAL FOR MUCUS TRANSPORT
bull SHORT TERM HUMIDIFICATION
bull DAILY WASHING OF NEBULISER SYSTEM
TIMING OF DRUG AND PHYSIOTHERAPY
BEFORE TREATMENT
bull DNASE (PULMOZYME)
bull SALBUTAMOL
(VENTOLIN BLUE)
bull SALINE NEBS
AFTER TREATMENT
bull SERETIDE (PURPLE)
bull BECLOMETHASONE (BECOTIDE BROWN)
bull COLISTIN (COLOMYCIN PROMIXIN)
bull TOBRAMYCIN
CONCLUSION
bull BE AWARE OF CHILDrsquoS RESPIRATORY FUNCTION
bull CHOSE ACT BEST FOR THEM bull TYPE OF KETCHUP BOTTLE bull LV SECRETION RETENTION WOB
bull EARLY RESPIRATORY REFERRAL
bull RESPIRATORY CARE COMPETENCIES
bull EFFECTIVE SECRETION CLEARANCE AT HOMERESPITESCHOOL
bull USE OF PEAK COUGH FLOWS TO AID CHOICE OF ADJUNCT
0
50
100
150
200
250
300
350
400
0
50
100
150
200
250
300
350
400
Green
Key
Additional info
(please comment) Please refer to BTSACPRC Guideline
Lothian University Hospitals NHS Trust
n PCF
gt270lmin
Breathstack
ing tri-
flow
blowing
REFERENCES bull BTSACPRC GUIDELINE IS PUBLISHED IN THORAX VOL 67 SUPPLEMENT 1
bull AVAILABLE ONLINE AT HTTPTHORAXBMJCOMCONTENTVOL64ISSUESUPPLI
bull HTTPWWWBRIT-THORACICORGUKPHYSIOGUIDE
bull BRITISH THORACIC SOCIETY REPORTS VOL 1 NO 1 2009
bull ADAPTED PRYOR AJ AND PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS3RD ED
bull HOUGH A PHYSIOTHERAPY IN RESPIRATORY CARE LONDON CHAPMAN AND HALL 1993
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1997) POSTURAL DRAINAGE AND GASTRO-OESOPHAGEAL REFLUX IN INFANTS WITH CYSTIC FIBROSIS ARCHIVES OF DISEASE IN CHILDHOOD 76 148-150
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1998) POSTURAL DRAINAGE IN CYSTIC FIBROSIS IS THERE A LINK WITH GASTRO-OESOPHAGEAL REFLUX JOURNAL OF PAEDIATRIC CHILD HEALTH 34 330-334
bull CECINS NM JENKINS SC PENGELLEY J ET AL (1999) THE ACTIVE CYCLE OF BREATHING TECHNIQUES-TO TIP OR NOT TO TIP RESPIRATORY MEDICINE 93 660-665
bull CONSTANTINI D BRIVIO A BRUSA D ET AL (2001) PEP MASK VERSUS POSTURAL DRAINAGE IN INFANTS A LONG-TERM COMPARATIVE TRIAL PEADIATRIC PULMONOLOGY
bull HOUGH A (2001) PHYSIOTHERAPY IN RESPIRATORY CARE AN EVIDENCE-BASED APPROACH TO RESPIRATORY AND CARDIAC MANAGEMENT CENGAGE LEARNING EMEA
bull INTERNATIONAL PHYSIOTHERAPY GROUP FOR CYSTIC FIBROSIS PHYSIOTHERAPY IN THE TREATMENT OF CYSTIC FIBROSIS (2009) HTTPSWWWECFSEUIPG_CFBOOKLET INTERNATIONAL PHYSIOTHERAPY GROUP ndash THE BLUE BOOKLET
bull KONSTAN MW STERN RC DOERSHUK CF (1994) EFFICACY OF THE FLUTTER DEVICE FOR AIRWAY MUCUS CLEARANCE IN PATIENTS WITH CYSTIC FIBROSIS JOURNAL OF PEDIATRICS 124 (5 (PT 1) 689-693
bull MCILWAINE M BUTTON B AND DWAN K (2015) POSITIVE EXPIRATORY PRESSURE PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 6 ART NO CD003147 DOI 10100214651858CD003147PUB4
bull MESTRINER RG FERNANDES RO STAFFEN LC ET AL (2009) OPTIMUM DESIGN PARAMETERS FOR A THERAPIST-CONSTRUCTED POSITIVE-EXPIRATORY-PRESSURE THERAPY BOTTLE DEVICE RESPIRATORY CARE 54 504-8
bull MORRISON L AND AGNEW J (2014) OSCILLATING DEVICES FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 7 ART NO CD006842 DOI 10100214651858CD006842PUB
bull OERMANN CM SOCKRIDER MM GILES D ET AL (2001) COMPARISON OF HIGH-FREQUENCY CHEST WALL OSCILLATION AND OSCILLATING POSITIVE EXPIRATORY PRESSURE IN THE HOME MANAGEMENT OF CYSTIC FIBROSIS A PILOT STUDY PEDIATRIC PULMONOLOGY 32 (5) 372-7
bull PRASAD SA AND HUSSEY J (1995) PAEDIATRIC RESPIRATORY CARE A GUIDE FOR PHYSIOTHERAPISTS AND HEALTH PROFESSIONALS CHAPMAN amp HALL
bull PRYOR J (1999) PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN ADULTS EUROPEAN RESPIRATORY JOURNAL 14 (6) 1418-1424
bull PRYOR JA amp PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS CHURCHILL LIVINGSTONE
bull PRYOR JA WEBBER BA HODSON ME ET AL (1994) THE FLUTTER VRP1 AS AN ADJUNCT TO CHEST PHYSIOTHERAPY IN CYSTIC FIBROSIS RESPIRATORY MEDICINE 88677-81
bull WEST K WALLEN M FOLLETT J (2010) ACAPELLA VS PEP MASK THERAPY A RANDOMISED TRIAL IN CHILDREN WITH CYSTIC FIBROSIS DURING RESPIRATORY EXACERBATION PHYSIOTHERAPY THEORY PRACTICE 26143-9
bull WILSONLM AGNEW J MORRISON L ET AL (2014) AIRWAY CLEARANCE TECHNIQUES FOR CYSTIC FIBROSIS AN OVERVIEW OF COCHRANE SYSTEMATIC REVIEWS COCHRANE DATABASE OF SYSTEMATIC REVIEWS DOI 10100214651858CD011231
bull VOLSKO TA DIFIORE JM CHATBURN RL (2003) PERFORMANCE COMPARISON OF TWO OSCILLATORY POSITIVE PRESSURE DEVICES ACAPELLA VERSUS FLUTTER RESPIRATORY CARE 48 (2) 124- 130
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SEDDON PC KHAN Y RESPIRATORY PROBLEMS IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT ARCHIVES OF DISEASE IN CHILDHOOD 2003 01 JAN88(1)75-8
bull MARKS JH PULMONARY CARE OF CHILDREN AND ADOLESCENTS WITH DEVELOPMENTAL DISABILITIES PEDIATR CLIN NORTH AM 2008 DECEMBER55(6)1299-314
bull ARENS R MUZUMDAR H SLEEP SLEEP DISORDERED BREATHING AND NOCTURNAL HYPOVENTILATION IN CHILDREN WITH NEUROMUSCULAR DISEASES PAEDIATRIC RESPIRATORY REVIEWS 2010 MAR11(1)24-30
bull FITZGERALD DA FOLLETT J VAN ASPEREN PP ASSESSING AND MANAGING LUNG DISEASE AND SLEEP DISORDERED BREATHING IN CHILDREN WITH CEREBRAL PALSY PAEDIATRIC RESPIRATORY REVIEWS 2009 MARCH10(1)18-24
bull HSIAO KH NIXON GM THE EFFECT OF TREATMENT OF OBSTRUCTIVE SLEEP APNEA ON QUALITY OF LIFE IN CHILDREN WITH CEREBRAL PALSY RES DEV DISABIL 2008 MAR-APR29(2)133-40
bull LUNDBERG A OXYGEN CONSUMPTION IN RELATION TO WORKLOAD IN STUDENTS WITH CEREBRAL PALSY J APPL PHYSIO 197640873-5
bull SULLIVAN PB ROSENBLOOM L FEEDING THE DISABLED CHILD CLINICS IN DEVELOPMENTAL MEDICINE MACKEITH PRESS 1999140
bull MARTIN TR THE RELATIONSHIP BETWEEN MALNUTRITION AND LUNG INFECTIONS CLIN CHEST MED 19878359
bull MOSTAFA SM BHANDARI S RITCHIE G ET AL CONSTIPATION AND ITS IMPLICATIONS IN THE CRITICALLY ILL PATIENT BR J ANAESTH 200391815-9 3
bull GACOUIN A CAMUS C GROS A ET AL CONSTIPATION IN LONGTERM VENTILATED PATIENTS ASSOCIATED FACTORS AND IMPACT ON INTENSIVE CARE UNIT OUTCOMES CRIT CARE MED 2010381933- 8
bull NGUYEN T FRENETTE AJ JOHANSON C ET AL IMPAIRED GASTROINTESTINAL TRANSIT AND ITS ASSOCIATED MORBIDITY IN THE INTENSIVE CARE UNIT J CRIT CARE 201328537
bull ASAI T CONSTIPATION DOES IT INCREASE MORBIDITY AND MORTALITY IN CRITICALLY ILL PATIENTS CRIT CARE MED 2007352861-2
bull UNDERSTANDING THE PHYSIOLOGICAL EFFECTS OF UNTREATED PAIN NURSING TIMES VOL 99 ISSUE 37 PAGE NO 28
bull WINFIELD ET AL NON-PHARMACEUTICAL MANAGEMENT OF RESPIRATORY MORBIDITY IN CHILDREN WITH SEVERE GLOBAL DEVELOPMENTAL DELAY THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014
bull OLOUGHLIN EV SOMERVILLE HM SOMERVILLE ER DEALING WITH MULTISYSTEM DISEASE IN PEOPLE WITH A DEVELOPMENTAL DISABILITY MEDICAL JOURNAL OF AUSTRALIA 2009 JUN 1190(11)616-7
bull MESTROVIC J KARDUM G POLIC B MESTROVIC M MARKIC J SUSTIC A ET AL THE INFLUENCE OF CHRONIC HEALTH CONDITIONS ON SUSCEPTIBILITY TO SEVERE ACUTE ILLNESS OF CHILDREN TREATED IN PICU EUROPEAN JOURNAL OF PEDIATRICS 2006 AUG165(8)526-
9
bull HEALY F PANITCH HB PULMONARY COMPLICATIONS OF PEDIATRIC NEUROLOGICAL DISEASES PEDIATR ANN 2010 APR39(4)216-24
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SRIVASTAVA R JACKSON WD BARNHART DC DYSPHAGIA AND GASTROESOPHAGEAL REFLUX DISEASE DILEMMAS IN DIAGNOSIS AND MANAGEMENT IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT PEDIATR ANN 2010 APR39(4)225-31
bull SULLIVAN PB JUSZCZAK E BACHLET AME LAMBERT B VERNON-ROBERTS A GRANT HW ET AL GASTROSTOMY TUBE FEEDING IN CHILDREN WITH CEREBRAL PALSY A PROSPECTIVE LONGITUDINAL STUDY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 2005
FEBRUARY47(2)77-85
bull SOMERVILLE H TZANNES G WOOD J SHUN A HILL C ARROWSMITH F ET AL GASTROINTESTINAL AND NUTRITIONAL PROBLEMS IN SEVERE DEVELOPMENTAL DISABILITY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 200850(9)712-6
bull TODER DS RESPIRATORY PROBLEMS IN THE ADOLESCENT WITH DEVELOPMENTAL DELAY ADOLESCENT MEDICINE 2000 3 OCTOBER 200011(3)617-31
bull LEVIN K COLON A DIPALMA J FITZPATRICK S USING THE RADIONUCLIDE SALIVAGRAM TO DETECT PULMONARY ASPIRATION AND ESOPHAGEAL DYSMOTILITY CLIN NUCL MED 1993 FEB18(2)110-4
bull SCHROEDER AS KLING T HUSS K BORGGRAEFE I KOERTE IK BLASCHEK A ET AL BOTULINUM TOXIN TYPE A AND B FOR THE REDUCTION OF HYPERSALIVATION IN CHILDREN WITH NEUROLOGICAL DISORDERS A FOCUS ON EFFECTIVENESS AND THERAPY ADHERENCE
NEUROPEDIATRICS 201243(1)27-36
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull GOEMINNE P AND DUPONT L (2010) NON-CYSTIC FIBROSIS BRONCHIECTASIS DIAGNOSIS AND MANAGEMENT IN 21ST CENTURY POSTGRADUATE MEDICAL JOURNAL 86(1018) PP493-501
bull LEE A BUTTON B AND TANNENBAUM E (2017) AIRWAY-CLEARANCE TECHNIQUES IN CHILDREN AND ADOLESCENTS WITH CHRONIC SUPPURATIVE LUNG DISEASE AND BRONCHIECTASIS FRONTIERS IN PEDIATRICS 5
bull MANDAL P SIDHU M KOPE L POLLOCK W STEVENSON L PENTLAND J TURNBULL K MAC QUARRIE S AND HILL A (2012) A PILOT STUDY OF PULMONARY REHABILITATION AND CHEST PHYSIOTHERAPY VERSUS CHEST PHYSIOTHERAPY ALONE IN
BRONCHIECTASIS RESPIRATORY MEDICINE 106(12) PP1647-1654
bull MURRAY M PENTLAND J AND HILL A (2009) A RANDOMISED CROSSOVER TRIAL OF CHEST PHYSIOTHERAPY IN NON-CYSTIC FIBROSIS BRONCHIECTASIS EUROPEAN RESPIRATORY JOURNAL 34(5) PP1086-1092
bull NEWALL C STOCKLEY R AND HILL S (2005) EXERCISE TRAINING AND INSPIRATORY MUSCLE TRAINING IN PATIENTS WITH BRONCHIECTASIS THORAX 60(11) PP943-948
bull ONG H LEE A HILL C HOLLAND A AND DENEHY L (2011) EFFECTS OF PULMONARY REHABILITATION IN BRONCHIECTASIS A RETROSPECTIVE STUDY CHRONIC RESPIRATORY DISEASE 8(1) PP21-30
bull QUINT J MILLETT E JOSHI M NAVARATNAM V THOMAS S HURST J SMEETH L AND BROWN J (2015) CHANGES IN THE INCIDENCE PREVALENCE AND MORTALITY OF BRONCHIECTASIS IN THE UK FROM 2004 TO 2013 A POPULATION-BASED COHORT
STUDY EUROPEAN RESPIRATORY JOURNAL 47(1) PP186-193
bull SNIJDERS D FERNANDEZ DOMINGUEZ B CALGARO S BERTOZZI I ESCRIBANO MONTANER A PERILONGO G AND BARBATO A (2015) MUCOCILIARY CLEARANCE TECHNIQUES FOR TREATING NON-CYSTIC FIBROSIS BRONCHIECTASIS IS THERE
EVIDENCE INTERNATIONAL JOURNAL OF IMMUNOPATHOLOGY AND PHARMACOLOGY 28(2) PP150-159
OSCILLATING PEP TREATMENT
bull SIMILAR TO PEP
bull GOOD POSITION
bull PLACE MOUTHPIECE BETWEEN LIPS AND TEETH OR USE MASK
bull SLOW INHALE JUST A LITTLE LARGER THAN A NORMAL BREATH IN
bull HOLD FOR 3 SECONDS
bull STEADY ACTIVE amp FULL EXHALATION
bull ADJUST THE RESISTANCE AS REQUIRED
bull REPEAT 12-15 TIMES FOLLOWED BY FET amp COUGH
bull COMPLETE FOR 5-10 MINS
bull COMBINE WITH OTHER TREATMENTS
ACAPELLA
bull DETACHABLE MOUTHPIECEFACEMASK
bull ONE-WAY INSPIRATORY VALVE
bull EXPIRATORY RESISTANCEFREQUENCY ADJUSTMENT DIAL
bull COUNTERWEIGHTED PLUG amp MAGNET
bull MAINTAINS A RAISED FRC LEVEL
TREATMENT
bull EASY TO USE IN DIFFERENT POSITIONS
bull INHALE amp EXHALE THROUGH THE ACAPELLA
bull ROTATE THE FREQUENCY RESISTANCE DIAL UNTIL MAXIMUM VIBRATIONS ARE FELT WITHIN THE CHEST WALL
AEROBIKA bull COMBINES PEP WITH HIGH FREQUENCY OSCILLATIONS
bull CAN BE USED WITH A MANOMETER
bull NEBULISER CAN BE ENTRAINED INTO THE SYSTEM
bull POSSIBLE INCREASE IN TREATMENT COMPLIANCE BY DECREASING
TREATMENT TIMES
TECHNIQUE AS OSCILLATING PEP
BUBBLE PEP
Suction tubing (~1cm diameter) The end MUST sit at the bottom of the bottle
Plastic bottle Any widthshapediameter must be gt20cm tall 15cm fresh tapsterile water
(depth of water determines the amount of pressure ie cm H20
Washing up bowl
INDICATIONS
bull REDUCED LUNG VOLUME (FVClt50)
bull WEAK COUGH (PCFlt270)
bull SECRETIONS RETENTION
bull ATELECTASIS
bull REDUCED MECHANICAL COMPLIANCE
bull CHILD ABLE TO COMPLY
BENEFITS
bull INCREASE LUNG VOLUME = IMPROVES PCF
bull SECRETION CLEARANCE
bull MAY REVERSE ATELECTASIS
bull IMPROVE MECHANICAL COMPLIANCE = LUNG AND CHEST WALL MOBILITY
bull IMPROVE VOICE STRENGTH
LUNG VOLUME RECRUITMENT
bull LABEL NOT FOR RESUSCITATION
bull BEST IN SITTING
bull SUCTION READY
bull AGREE SIGNAL WITH CHILD WHEN MIC ACHIEVED
bull ASK TO BREATH OUT
bull PLACE MOUTHPIECE +- NOSE CLIP OR MASK
bull ASK TO BREATH IN AND HOLD WHILE GENTLY SQUEEZING BAG
bull WITHOUT LETTING AIR OUT ASK CHILD TO TAKE ANOTHER BREATH IN ON TOP OF THE FIRST BREATH AND SQUEEZE BAG IN TIME WITH BREATH
bull REPEAT UNTIL LUNGS ARE FULL (NORMALLY 3-5 BREATHS) OR SIGNAL
bull REMOVE MASK OR MOUTHPIECE ASK TO HOLD FOR 3-5 SECONDS
bull EXHALE OR IF SECRETIONS ARE PRESENT ENCOURAGE TO HAVE A COUGH OR MAC
bull REPEATED X3-5 X2-4 DAY
LVR TREATMENT
bull AIRWAY CLEARANCE OR THORACIC MOBILITY
bull AMBU RESUS BAG
bull GREEN ldquoPHYSIOrdquo BAG
bull MANUAL TECHNIQUES WITH BAGGING
bull MHI AT HOME
bull MANOMETERS
MHI
PHYSIO WITH NIV
bull PHYSIO SETTINGS
bull SECRETIONS
bull THORACIC MOBILITY
bull ALLOWS REST PERIOD PRE ACT
bull HUMIDIFICATION
bull INFLATABLE VEST CONNECTED BY TUBES TO AN AIR PULSE GENERATOR WHICH RAPIDLY INFLATES AND DEFLATES THE VEST PRODUCING OSCILLATIONS TO THE CHEST WALL
bull RAPID CHEST MOVEMENT MIMICS A COUGH-LIKE EXPIRATORY FLOW THAT SHEARS MUCUS AWAY FROM THE AIRWAY WALLS AND HELPS TO MOVE IT ALONG TO THE CENTRAL AIRWAYS
bull PASSIVE TREATMENT amp NOT POSITION DEPENDANT
bull COMBINATION OF RX
bull CONTRAINDICATIONS
bull HEAD ANDOR NECK INJURY THAT HAS NOT BEEN STABILISED
bull ACTIVE HAEMORRHAGE WITH HEMODYNAMIC INSTABILITY
HFCWO
HFCWO INDICATIONS
bull CHRONIC MUCUS HYPERSECRETION OR RETENTION ASSOCIATED WITH A CHRONIC PULMONARY OR NEUROMUSCULAR CONDITION
bull LRT SECRETIONS AND FREQUENT LRTI REQUIRING HOSPITAL ADMISSION
bull INEFFECTIVE COUGH OR INABILITY TO REMOVE MUCUS BY COUGHING
bull TENACIOUS SECRETIONS THAT ARE NOT EASILY MOBILISED WITH STANDARD CPT
bull MECHANICALLY VENTILATED WITH EVIDENCE OF SECRETION RETENTION
bull ALTERNATIVE AIRWAY CLEARANCE THERAPY PROVEN INEFFECTIVE OR CONTRAINDICATEDDO NOT TOLERATE STANDARD CPT
bull CONSTANT FATIGUE LACK OF STRENGTH OR ABILITY TO PERFORM ACTIVE TREATMENT
bull SYMPTOMATIC
bull POOR COMPLIANCE WITH OTHER AIRWAY CLEARANCE METHODS
bull HIGH BURDEN OF CARE
bull PATIENT UNABLE TO TOLERATE THE INCREASED WORK OF BREATHING bull ACTIVE HAEMOPTYSIS bull UNTREATED PNEUMOTHORAX bull INTRACRANIAL PRESSURE (ICP) gt 20 MMHG bull HAEMODYNAMIC INSTABILITY bull SEVERE CARDIOVASCULAR INSULTDISEASE bull RECENT FACIAL ORAL OR SKULL SURGERY OR TRAUMA bull ACUTE SINUSITIS bull EPISTAXIS bull POST OESOPHAGEAL amp LUNG SURGERY bull KNOWN OR SUSPECTED TYMPANIC MEMBRANE RUPTURE OR OTHER MIDDLE EAR
PATHOLOGY
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
POSSIBLE HAZARDSCOMPLICATIONS
bull INCREASED WORK OF BREATHING THAT MAY LEAD TO HYPOVENTILATION AND
HYPERCARBIA
bull INCREASED INTRACRANIAL PRESSURE
bull CARDIOVASCULAR COMPROMISE
bull NAUSEA
bull MYOCARDIAL ISCHEMIA
bull DECREASED VENOUS RETURN
bull AIR SWALLOWING WITH INCREASED LIKELIHOOD OF VOMITING AND
ASPIRATION
bull CLAUSTROPHOBIA
bull SKIN BREAK DOWN AND DISCOMFORT FROM MASK
bull PULMONARY BAROTRAUMA
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
MI-E
bull USED WITH CHILDREN WHO HAVE DECREASED INSPIRATORY EFFORT DUE TO EITHER SPINAL CORD INJURY OR NMW AND WHO HAVE AN IMPAIRED OR INEFFECTIVE COUGH WITH APPROPRIATE RESPIRATORY SYMPTOMS
bull CONSIDERED WHEN CONVENTIONAL COUGH ASSISTANCE TECHNIQUES BECOME INEFFECTIVE
bull ACCEPTED AS THE CORE STANDARD FOR CHILD WITH NMW
bull MIE WORKS BY
bull INFLATING THE LUNGS WITH GRADUAL POSITIVE AIRWAY PRESSURE ASSISTING INSPIRATION CALLED INSUFFLATION
bull FOLLOWED BY A RAPID SWITCH TO NEGATIVE PRESSURE WHICH SIMULATES THE FLOW CHANGES THAT OCCUR DURING A COUGH THEREBY ENHANCING EXPIRATORY FLOW CALLED EXSUFFLATION AND ASSISTING EXPECTORATION OF SECRETIONS
bull MOVEMENT AND EXERCISE BEST FUNCTIONAL METHOD OF AIRWAY CLEARANCE
bull CPET BETTER CORRELATION THAN LUNG FUNCTION IN SURVIVAL RATES IN PEOPLE WITH
CYSTIC FIBROSIS
bull RUNNINGWALKING BETTER FOR SECRETION CLEARANCE THAN BIKE DURING TO SHEARING
MECHANISM
bull CONSIDER ADDING IN HUFFS (DYER)
bull CONSIDER USE OF AD BELT
EXERCISE
bull APCP SUCTION GUIDELINES
bull TYPESNASOPHARANGEAL OROPHARANGEAL AND TRACHEOSTOMY
bull MAIN VARIABLES SUCTION TYPE AND SIZE DEPTH OF SUCTION
PRESSURE TECHNIQUE
SUCTION
SPUTUM
bull SPUTUM bull 95 WATER bull COLOUR bull VOLUME bull CONSISTENCY bull ODOUR
bull PURPOSE bull HUMIDIFICATION bull WATERPROOFING bull PROTECTION OF EPITHELIUM
HUMIDIFICATION
bull METABOLIC AND VENTILATORY REQUIREMENTS ARE X2-3 OF ADULTS
IMPLICATION
bull HEAT AND MOISTURE LOSSES FROM RESPIRATION WILL INCREASE BY X2-3
bull CONSUME GREATER AMOUNTS OF ENERGY AND WATER
HUMIDIFICATION INHALATION
THERAPY
bull TRACHEOSTOMY HME
bull WET DRY CIRCUIT
bull NEBULISERS INHALERS MUCOLYTICS
bull HUMIDIFIERS WITH NIV
bull OXYGEN
bull SYSTEMIC HYDRATION ENVIRONMENT
NEBULISERS
bull NEBULISER CHAMBER CONVERTS LIQUID INTO
RESPIRABLE PARTICLES
bull MOISTURE DESCENDS THROUGH THE HOLES IN THE SUPERFICIAL GEL LAYER
bull INCREASES THE SOL LAYER SO THE CILIARY BEAT IS OPTIMAL FOR MUCUS TRANSPORT
bull SHORT TERM HUMIDIFICATION
bull DAILY WASHING OF NEBULISER SYSTEM
TIMING OF DRUG AND PHYSIOTHERAPY
BEFORE TREATMENT
bull DNASE (PULMOZYME)
bull SALBUTAMOL
(VENTOLIN BLUE)
bull SALINE NEBS
AFTER TREATMENT
bull SERETIDE (PURPLE)
bull BECLOMETHASONE (BECOTIDE BROWN)
bull COLISTIN (COLOMYCIN PROMIXIN)
bull TOBRAMYCIN
CONCLUSION
bull BE AWARE OF CHILDrsquoS RESPIRATORY FUNCTION
bull CHOSE ACT BEST FOR THEM bull TYPE OF KETCHUP BOTTLE bull LV SECRETION RETENTION WOB
bull EARLY RESPIRATORY REFERRAL
bull RESPIRATORY CARE COMPETENCIES
bull EFFECTIVE SECRETION CLEARANCE AT HOMERESPITESCHOOL
bull USE OF PEAK COUGH FLOWS TO AID CHOICE OF ADJUNCT
0
50
100
150
200
250
300
350
400
0
50
100
150
200
250
300
350
400
Green
Key
Additional info
(please comment) Please refer to BTSACPRC Guideline
Lothian University Hospitals NHS Trust
n PCF
gt270lmin
Breathstack
ing tri-
flow
blowing
REFERENCES bull BTSACPRC GUIDELINE IS PUBLISHED IN THORAX VOL 67 SUPPLEMENT 1
bull AVAILABLE ONLINE AT HTTPTHORAXBMJCOMCONTENTVOL64ISSUESUPPLI
bull HTTPWWWBRIT-THORACICORGUKPHYSIOGUIDE
bull BRITISH THORACIC SOCIETY REPORTS VOL 1 NO 1 2009
bull ADAPTED PRYOR AJ AND PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS3RD ED
bull HOUGH A PHYSIOTHERAPY IN RESPIRATORY CARE LONDON CHAPMAN AND HALL 1993
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1997) POSTURAL DRAINAGE AND GASTRO-OESOPHAGEAL REFLUX IN INFANTS WITH CYSTIC FIBROSIS ARCHIVES OF DISEASE IN CHILDHOOD 76 148-150
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1998) POSTURAL DRAINAGE IN CYSTIC FIBROSIS IS THERE A LINK WITH GASTRO-OESOPHAGEAL REFLUX JOURNAL OF PAEDIATRIC CHILD HEALTH 34 330-334
bull CECINS NM JENKINS SC PENGELLEY J ET AL (1999) THE ACTIVE CYCLE OF BREATHING TECHNIQUES-TO TIP OR NOT TO TIP RESPIRATORY MEDICINE 93 660-665
bull CONSTANTINI D BRIVIO A BRUSA D ET AL (2001) PEP MASK VERSUS POSTURAL DRAINAGE IN INFANTS A LONG-TERM COMPARATIVE TRIAL PEADIATRIC PULMONOLOGY
bull HOUGH A (2001) PHYSIOTHERAPY IN RESPIRATORY CARE AN EVIDENCE-BASED APPROACH TO RESPIRATORY AND CARDIAC MANAGEMENT CENGAGE LEARNING EMEA
bull INTERNATIONAL PHYSIOTHERAPY GROUP FOR CYSTIC FIBROSIS PHYSIOTHERAPY IN THE TREATMENT OF CYSTIC FIBROSIS (2009) HTTPSWWWECFSEUIPG_CFBOOKLET INTERNATIONAL PHYSIOTHERAPY GROUP ndash THE BLUE BOOKLET
bull KONSTAN MW STERN RC DOERSHUK CF (1994) EFFICACY OF THE FLUTTER DEVICE FOR AIRWAY MUCUS CLEARANCE IN PATIENTS WITH CYSTIC FIBROSIS JOURNAL OF PEDIATRICS 124 (5 (PT 1) 689-693
bull MCILWAINE M BUTTON B AND DWAN K (2015) POSITIVE EXPIRATORY PRESSURE PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 6 ART NO CD003147 DOI 10100214651858CD003147PUB4
bull MESTRINER RG FERNANDES RO STAFFEN LC ET AL (2009) OPTIMUM DESIGN PARAMETERS FOR A THERAPIST-CONSTRUCTED POSITIVE-EXPIRATORY-PRESSURE THERAPY BOTTLE DEVICE RESPIRATORY CARE 54 504-8
bull MORRISON L AND AGNEW J (2014) OSCILLATING DEVICES FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 7 ART NO CD006842 DOI 10100214651858CD006842PUB
bull OERMANN CM SOCKRIDER MM GILES D ET AL (2001) COMPARISON OF HIGH-FREQUENCY CHEST WALL OSCILLATION AND OSCILLATING POSITIVE EXPIRATORY PRESSURE IN THE HOME MANAGEMENT OF CYSTIC FIBROSIS A PILOT STUDY PEDIATRIC PULMONOLOGY 32 (5) 372-7
bull PRASAD SA AND HUSSEY J (1995) PAEDIATRIC RESPIRATORY CARE A GUIDE FOR PHYSIOTHERAPISTS AND HEALTH PROFESSIONALS CHAPMAN amp HALL
bull PRYOR J (1999) PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN ADULTS EUROPEAN RESPIRATORY JOURNAL 14 (6) 1418-1424
bull PRYOR JA amp PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS CHURCHILL LIVINGSTONE
bull PRYOR JA WEBBER BA HODSON ME ET AL (1994) THE FLUTTER VRP1 AS AN ADJUNCT TO CHEST PHYSIOTHERAPY IN CYSTIC FIBROSIS RESPIRATORY MEDICINE 88677-81
bull WEST K WALLEN M FOLLETT J (2010) ACAPELLA VS PEP MASK THERAPY A RANDOMISED TRIAL IN CHILDREN WITH CYSTIC FIBROSIS DURING RESPIRATORY EXACERBATION PHYSIOTHERAPY THEORY PRACTICE 26143-9
bull WILSONLM AGNEW J MORRISON L ET AL (2014) AIRWAY CLEARANCE TECHNIQUES FOR CYSTIC FIBROSIS AN OVERVIEW OF COCHRANE SYSTEMATIC REVIEWS COCHRANE DATABASE OF SYSTEMATIC REVIEWS DOI 10100214651858CD011231
bull VOLSKO TA DIFIORE JM CHATBURN RL (2003) PERFORMANCE COMPARISON OF TWO OSCILLATORY POSITIVE PRESSURE DEVICES ACAPELLA VERSUS FLUTTER RESPIRATORY CARE 48 (2) 124- 130
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SEDDON PC KHAN Y RESPIRATORY PROBLEMS IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT ARCHIVES OF DISEASE IN CHILDHOOD 2003 01 JAN88(1)75-8
bull MARKS JH PULMONARY CARE OF CHILDREN AND ADOLESCENTS WITH DEVELOPMENTAL DISABILITIES PEDIATR CLIN NORTH AM 2008 DECEMBER55(6)1299-314
bull ARENS R MUZUMDAR H SLEEP SLEEP DISORDERED BREATHING AND NOCTURNAL HYPOVENTILATION IN CHILDREN WITH NEUROMUSCULAR DISEASES PAEDIATRIC RESPIRATORY REVIEWS 2010 MAR11(1)24-30
bull FITZGERALD DA FOLLETT J VAN ASPEREN PP ASSESSING AND MANAGING LUNG DISEASE AND SLEEP DISORDERED BREATHING IN CHILDREN WITH CEREBRAL PALSY PAEDIATRIC RESPIRATORY REVIEWS 2009 MARCH10(1)18-24
bull HSIAO KH NIXON GM THE EFFECT OF TREATMENT OF OBSTRUCTIVE SLEEP APNEA ON QUALITY OF LIFE IN CHILDREN WITH CEREBRAL PALSY RES DEV DISABIL 2008 MAR-APR29(2)133-40
bull LUNDBERG A OXYGEN CONSUMPTION IN RELATION TO WORKLOAD IN STUDENTS WITH CEREBRAL PALSY J APPL PHYSIO 197640873-5
bull SULLIVAN PB ROSENBLOOM L FEEDING THE DISABLED CHILD CLINICS IN DEVELOPMENTAL MEDICINE MACKEITH PRESS 1999140
bull MARTIN TR THE RELATIONSHIP BETWEEN MALNUTRITION AND LUNG INFECTIONS CLIN CHEST MED 19878359
bull MOSTAFA SM BHANDARI S RITCHIE G ET AL CONSTIPATION AND ITS IMPLICATIONS IN THE CRITICALLY ILL PATIENT BR J ANAESTH 200391815-9 3
bull GACOUIN A CAMUS C GROS A ET AL CONSTIPATION IN LONGTERM VENTILATED PATIENTS ASSOCIATED FACTORS AND IMPACT ON INTENSIVE CARE UNIT OUTCOMES CRIT CARE MED 2010381933- 8
bull NGUYEN T FRENETTE AJ JOHANSON C ET AL IMPAIRED GASTROINTESTINAL TRANSIT AND ITS ASSOCIATED MORBIDITY IN THE INTENSIVE CARE UNIT J CRIT CARE 201328537
bull ASAI T CONSTIPATION DOES IT INCREASE MORBIDITY AND MORTALITY IN CRITICALLY ILL PATIENTS CRIT CARE MED 2007352861-2
bull UNDERSTANDING THE PHYSIOLOGICAL EFFECTS OF UNTREATED PAIN NURSING TIMES VOL 99 ISSUE 37 PAGE NO 28
bull WINFIELD ET AL NON-PHARMACEUTICAL MANAGEMENT OF RESPIRATORY MORBIDITY IN CHILDREN WITH SEVERE GLOBAL DEVELOPMENTAL DELAY THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014
bull OLOUGHLIN EV SOMERVILLE HM SOMERVILLE ER DEALING WITH MULTISYSTEM DISEASE IN PEOPLE WITH A DEVELOPMENTAL DISABILITY MEDICAL JOURNAL OF AUSTRALIA 2009 JUN 1190(11)616-7
bull MESTROVIC J KARDUM G POLIC B MESTROVIC M MARKIC J SUSTIC A ET AL THE INFLUENCE OF CHRONIC HEALTH CONDITIONS ON SUSCEPTIBILITY TO SEVERE ACUTE ILLNESS OF CHILDREN TREATED IN PICU EUROPEAN JOURNAL OF PEDIATRICS 2006 AUG165(8)526-
9
bull HEALY F PANITCH HB PULMONARY COMPLICATIONS OF PEDIATRIC NEUROLOGICAL DISEASES PEDIATR ANN 2010 APR39(4)216-24
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SRIVASTAVA R JACKSON WD BARNHART DC DYSPHAGIA AND GASTROESOPHAGEAL REFLUX DISEASE DILEMMAS IN DIAGNOSIS AND MANAGEMENT IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT PEDIATR ANN 2010 APR39(4)225-31
bull SULLIVAN PB JUSZCZAK E BACHLET AME LAMBERT B VERNON-ROBERTS A GRANT HW ET AL GASTROSTOMY TUBE FEEDING IN CHILDREN WITH CEREBRAL PALSY A PROSPECTIVE LONGITUDINAL STUDY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 2005
FEBRUARY47(2)77-85
bull SOMERVILLE H TZANNES G WOOD J SHUN A HILL C ARROWSMITH F ET AL GASTROINTESTINAL AND NUTRITIONAL PROBLEMS IN SEVERE DEVELOPMENTAL DISABILITY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 200850(9)712-6
bull TODER DS RESPIRATORY PROBLEMS IN THE ADOLESCENT WITH DEVELOPMENTAL DELAY ADOLESCENT MEDICINE 2000 3 OCTOBER 200011(3)617-31
bull LEVIN K COLON A DIPALMA J FITZPATRICK S USING THE RADIONUCLIDE SALIVAGRAM TO DETECT PULMONARY ASPIRATION AND ESOPHAGEAL DYSMOTILITY CLIN NUCL MED 1993 FEB18(2)110-4
bull SCHROEDER AS KLING T HUSS K BORGGRAEFE I KOERTE IK BLASCHEK A ET AL BOTULINUM TOXIN TYPE A AND B FOR THE REDUCTION OF HYPERSALIVATION IN CHILDREN WITH NEUROLOGICAL DISORDERS A FOCUS ON EFFECTIVENESS AND THERAPY ADHERENCE
NEUROPEDIATRICS 201243(1)27-36
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull GOEMINNE P AND DUPONT L (2010) NON-CYSTIC FIBROSIS BRONCHIECTASIS DIAGNOSIS AND MANAGEMENT IN 21ST CENTURY POSTGRADUATE MEDICAL JOURNAL 86(1018) PP493-501
bull LEE A BUTTON B AND TANNENBAUM E (2017) AIRWAY-CLEARANCE TECHNIQUES IN CHILDREN AND ADOLESCENTS WITH CHRONIC SUPPURATIVE LUNG DISEASE AND BRONCHIECTASIS FRONTIERS IN PEDIATRICS 5
bull MANDAL P SIDHU M KOPE L POLLOCK W STEVENSON L PENTLAND J TURNBULL K MAC QUARRIE S AND HILL A (2012) A PILOT STUDY OF PULMONARY REHABILITATION AND CHEST PHYSIOTHERAPY VERSUS CHEST PHYSIOTHERAPY ALONE IN
BRONCHIECTASIS RESPIRATORY MEDICINE 106(12) PP1647-1654
bull MURRAY M PENTLAND J AND HILL A (2009) A RANDOMISED CROSSOVER TRIAL OF CHEST PHYSIOTHERAPY IN NON-CYSTIC FIBROSIS BRONCHIECTASIS EUROPEAN RESPIRATORY JOURNAL 34(5) PP1086-1092
bull NEWALL C STOCKLEY R AND HILL S (2005) EXERCISE TRAINING AND INSPIRATORY MUSCLE TRAINING IN PATIENTS WITH BRONCHIECTASIS THORAX 60(11) PP943-948
bull ONG H LEE A HILL C HOLLAND A AND DENEHY L (2011) EFFECTS OF PULMONARY REHABILITATION IN BRONCHIECTASIS A RETROSPECTIVE STUDY CHRONIC RESPIRATORY DISEASE 8(1) PP21-30
bull QUINT J MILLETT E JOSHI M NAVARATNAM V THOMAS S HURST J SMEETH L AND BROWN J (2015) CHANGES IN THE INCIDENCE PREVALENCE AND MORTALITY OF BRONCHIECTASIS IN THE UK FROM 2004 TO 2013 A POPULATION-BASED COHORT
STUDY EUROPEAN RESPIRATORY JOURNAL 47(1) PP186-193
bull SNIJDERS D FERNANDEZ DOMINGUEZ B CALGARO S BERTOZZI I ESCRIBANO MONTANER A PERILONGO G AND BARBATO A (2015) MUCOCILIARY CLEARANCE TECHNIQUES FOR TREATING NON-CYSTIC FIBROSIS BRONCHIECTASIS IS THERE
EVIDENCE INTERNATIONAL JOURNAL OF IMMUNOPATHOLOGY AND PHARMACOLOGY 28(2) PP150-159
ACAPELLA
bull DETACHABLE MOUTHPIECEFACEMASK
bull ONE-WAY INSPIRATORY VALVE
bull EXPIRATORY RESISTANCEFREQUENCY ADJUSTMENT DIAL
bull COUNTERWEIGHTED PLUG amp MAGNET
bull MAINTAINS A RAISED FRC LEVEL
TREATMENT
bull EASY TO USE IN DIFFERENT POSITIONS
bull INHALE amp EXHALE THROUGH THE ACAPELLA
bull ROTATE THE FREQUENCY RESISTANCE DIAL UNTIL MAXIMUM VIBRATIONS ARE FELT WITHIN THE CHEST WALL
AEROBIKA bull COMBINES PEP WITH HIGH FREQUENCY OSCILLATIONS
bull CAN BE USED WITH A MANOMETER
bull NEBULISER CAN BE ENTRAINED INTO THE SYSTEM
bull POSSIBLE INCREASE IN TREATMENT COMPLIANCE BY DECREASING
TREATMENT TIMES
TECHNIQUE AS OSCILLATING PEP
BUBBLE PEP
Suction tubing (~1cm diameter) The end MUST sit at the bottom of the bottle
Plastic bottle Any widthshapediameter must be gt20cm tall 15cm fresh tapsterile water
(depth of water determines the amount of pressure ie cm H20
Washing up bowl
INDICATIONS
bull REDUCED LUNG VOLUME (FVClt50)
bull WEAK COUGH (PCFlt270)
bull SECRETIONS RETENTION
bull ATELECTASIS
bull REDUCED MECHANICAL COMPLIANCE
bull CHILD ABLE TO COMPLY
BENEFITS
bull INCREASE LUNG VOLUME = IMPROVES PCF
bull SECRETION CLEARANCE
bull MAY REVERSE ATELECTASIS
bull IMPROVE MECHANICAL COMPLIANCE = LUNG AND CHEST WALL MOBILITY
bull IMPROVE VOICE STRENGTH
LUNG VOLUME RECRUITMENT
bull LABEL NOT FOR RESUSCITATION
bull BEST IN SITTING
bull SUCTION READY
bull AGREE SIGNAL WITH CHILD WHEN MIC ACHIEVED
bull ASK TO BREATH OUT
bull PLACE MOUTHPIECE +- NOSE CLIP OR MASK
bull ASK TO BREATH IN AND HOLD WHILE GENTLY SQUEEZING BAG
bull WITHOUT LETTING AIR OUT ASK CHILD TO TAKE ANOTHER BREATH IN ON TOP OF THE FIRST BREATH AND SQUEEZE BAG IN TIME WITH BREATH
bull REPEAT UNTIL LUNGS ARE FULL (NORMALLY 3-5 BREATHS) OR SIGNAL
bull REMOVE MASK OR MOUTHPIECE ASK TO HOLD FOR 3-5 SECONDS
bull EXHALE OR IF SECRETIONS ARE PRESENT ENCOURAGE TO HAVE A COUGH OR MAC
bull REPEATED X3-5 X2-4 DAY
LVR TREATMENT
bull AIRWAY CLEARANCE OR THORACIC MOBILITY
bull AMBU RESUS BAG
bull GREEN ldquoPHYSIOrdquo BAG
bull MANUAL TECHNIQUES WITH BAGGING
bull MHI AT HOME
bull MANOMETERS
MHI
PHYSIO WITH NIV
bull PHYSIO SETTINGS
bull SECRETIONS
bull THORACIC MOBILITY
bull ALLOWS REST PERIOD PRE ACT
bull HUMIDIFICATION
bull INFLATABLE VEST CONNECTED BY TUBES TO AN AIR PULSE GENERATOR WHICH RAPIDLY INFLATES AND DEFLATES THE VEST PRODUCING OSCILLATIONS TO THE CHEST WALL
bull RAPID CHEST MOVEMENT MIMICS A COUGH-LIKE EXPIRATORY FLOW THAT SHEARS MUCUS AWAY FROM THE AIRWAY WALLS AND HELPS TO MOVE IT ALONG TO THE CENTRAL AIRWAYS
bull PASSIVE TREATMENT amp NOT POSITION DEPENDANT
bull COMBINATION OF RX
bull CONTRAINDICATIONS
bull HEAD ANDOR NECK INJURY THAT HAS NOT BEEN STABILISED
bull ACTIVE HAEMORRHAGE WITH HEMODYNAMIC INSTABILITY
HFCWO
HFCWO INDICATIONS
bull CHRONIC MUCUS HYPERSECRETION OR RETENTION ASSOCIATED WITH A CHRONIC PULMONARY OR NEUROMUSCULAR CONDITION
bull LRT SECRETIONS AND FREQUENT LRTI REQUIRING HOSPITAL ADMISSION
bull INEFFECTIVE COUGH OR INABILITY TO REMOVE MUCUS BY COUGHING
bull TENACIOUS SECRETIONS THAT ARE NOT EASILY MOBILISED WITH STANDARD CPT
bull MECHANICALLY VENTILATED WITH EVIDENCE OF SECRETION RETENTION
bull ALTERNATIVE AIRWAY CLEARANCE THERAPY PROVEN INEFFECTIVE OR CONTRAINDICATEDDO NOT TOLERATE STANDARD CPT
bull CONSTANT FATIGUE LACK OF STRENGTH OR ABILITY TO PERFORM ACTIVE TREATMENT
bull SYMPTOMATIC
bull POOR COMPLIANCE WITH OTHER AIRWAY CLEARANCE METHODS
bull HIGH BURDEN OF CARE
bull PATIENT UNABLE TO TOLERATE THE INCREASED WORK OF BREATHING bull ACTIVE HAEMOPTYSIS bull UNTREATED PNEUMOTHORAX bull INTRACRANIAL PRESSURE (ICP) gt 20 MMHG bull HAEMODYNAMIC INSTABILITY bull SEVERE CARDIOVASCULAR INSULTDISEASE bull RECENT FACIAL ORAL OR SKULL SURGERY OR TRAUMA bull ACUTE SINUSITIS bull EPISTAXIS bull POST OESOPHAGEAL amp LUNG SURGERY bull KNOWN OR SUSPECTED TYMPANIC MEMBRANE RUPTURE OR OTHER MIDDLE EAR
PATHOLOGY
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
POSSIBLE HAZARDSCOMPLICATIONS
bull INCREASED WORK OF BREATHING THAT MAY LEAD TO HYPOVENTILATION AND
HYPERCARBIA
bull INCREASED INTRACRANIAL PRESSURE
bull CARDIOVASCULAR COMPROMISE
bull NAUSEA
bull MYOCARDIAL ISCHEMIA
bull DECREASED VENOUS RETURN
bull AIR SWALLOWING WITH INCREASED LIKELIHOOD OF VOMITING AND
ASPIRATION
bull CLAUSTROPHOBIA
bull SKIN BREAK DOWN AND DISCOMFORT FROM MASK
bull PULMONARY BAROTRAUMA
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
MI-E
bull USED WITH CHILDREN WHO HAVE DECREASED INSPIRATORY EFFORT DUE TO EITHER SPINAL CORD INJURY OR NMW AND WHO HAVE AN IMPAIRED OR INEFFECTIVE COUGH WITH APPROPRIATE RESPIRATORY SYMPTOMS
bull CONSIDERED WHEN CONVENTIONAL COUGH ASSISTANCE TECHNIQUES BECOME INEFFECTIVE
bull ACCEPTED AS THE CORE STANDARD FOR CHILD WITH NMW
bull MIE WORKS BY
bull INFLATING THE LUNGS WITH GRADUAL POSITIVE AIRWAY PRESSURE ASSISTING INSPIRATION CALLED INSUFFLATION
bull FOLLOWED BY A RAPID SWITCH TO NEGATIVE PRESSURE WHICH SIMULATES THE FLOW CHANGES THAT OCCUR DURING A COUGH THEREBY ENHANCING EXPIRATORY FLOW CALLED EXSUFFLATION AND ASSISTING EXPECTORATION OF SECRETIONS
bull MOVEMENT AND EXERCISE BEST FUNCTIONAL METHOD OF AIRWAY CLEARANCE
bull CPET BETTER CORRELATION THAN LUNG FUNCTION IN SURVIVAL RATES IN PEOPLE WITH
CYSTIC FIBROSIS
bull RUNNINGWALKING BETTER FOR SECRETION CLEARANCE THAN BIKE DURING TO SHEARING
MECHANISM
bull CONSIDER ADDING IN HUFFS (DYER)
bull CONSIDER USE OF AD BELT
EXERCISE
bull APCP SUCTION GUIDELINES
bull TYPESNASOPHARANGEAL OROPHARANGEAL AND TRACHEOSTOMY
bull MAIN VARIABLES SUCTION TYPE AND SIZE DEPTH OF SUCTION
PRESSURE TECHNIQUE
SUCTION
SPUTUM
bull SPUTUM bull 95 WATER bull COLOUR bull VOLUME bull CONSISTENCY bull ODOUR
bull PURPOSE bull HUMIDIFICATION bull WATERPROOFING bull PROTECTION OF EPITHELIUM
HUMIDIFICATION
bull METABOLIC AND VENTILATORY REQUIREMENTS ARE X2-3 OF ADULTS
IMPLICATION
bull HEAT AND MOISTURE LOSSES FROM RESPIRATION WILL INCREASE BY X2-3
bull CONSUME GREATER AMOUNTS OF ENERGY AND WATER
HUMIDIFICATION INHALATION
THERAPY
bull TRACHEOSTOMY HME
bull WET DRY CIRCUIT
bull NEBULISERS INHALERS MUCOLYTICS
bull HUMIDIFIERS WITH NIV
bull OXYGEN
bull SYSTEMIC HYDRATION ENVIRONMENT
NEBULISERS
bull NEBULISER CHAMBER CONVERTS LIQUID INTO
RESPIRABLE PARTICLES
bull MOISTURE DESCENDS THROUGH THE HOLES IN THE SUPERFICIAL GEL LAYER
bull INCREASES THE SOL LAYER SO THE CILIARY BEAT IS OPTIMAL FOR MUCUS TRANSPORT
bull SHORT TERM HUMIDIFICATION
bull DAILY WASHING OF NEBULISER SYSTEM
TIMING OF DRUG AND PHYSIOTHERAPY
BEFORE TREATMENT
bull DNASE (PULMOZYME)
bull SALBUTAMOL
(VENTOLIN BLUE)
bull SALINE NEBS
AFTER TREATMENT
bull SERETIDE (PURPLE)
bull BECLOMETHASONE (BECOTIDE BROWN)
bull COLISTIN (COLOMYCIN PROMIXIN)
bull TOBRAMYCIN
CONCLUSION
bull BE AWARE OF CHILDrsquoS RESPIRATORY FUNCTION
bull CHOSE ACT BEST FOR THEM bull TYPE OF KETCHUP BOTTLE bull LV SECRETION RETENTION WOB
bull EARLY RESPIRATORY REFERRAL
bull RESPIRATORY CARE COMPETENCIES
bull EFFECTIVE SECRETION CLEARANCE AT HOMERESPITESCHOOL
bull USE OF PEAK COUGH FLOWS TO AID CHOICE OF ADJUNCT
0
50
100
150
200
250
300
350
400
0
50
100
150
200
250
300
350
400
Green
Key
Additional info
(please comment) Please refer to BTSACPRC Guideline
Lothian University Hospitals NHS Trust
n PCF
gt270lmin
Breathstack
ing tri-
flow
blowing
REFERENCES bull BTSACPRC GUIDELINE IS PUBLISHED IN THORAX VOL 67 SUPPLEMENT 1
bull AVAILABLE ONLINE AT HTTPTHORAXBMJCOMCONTENTVOL64ISSUESUPPLI
bull HTTPWWWBRIT-THORACICORGUKPHYSIOGUIDE
bull BRITISH THORACIC SOCIETY REPORTS VOL 1 NO 1 2009
bull ADAPTED PRYOR AJ AND PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS3RD ED
bull HOUGH A PHYSIOTHERAPY IN RESPIRATORY CARE LONDON CHAPMAN AND HALL 1993
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1997) POSTURAL DRAINAGE AND GASTRO-OESOPHAGEAL REFLUX IN INFANTS WITH CYSTIC FIBROSIS ARCHIVES OF DISEASE IN CHILDHOOD 76 148-150
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1998) POSTURAL DRAINAGE IN CYSTIC FIBROSIS IS THERE A LINK WITH GASTRO-OESOPHAGEAL REFLUX JOURNAL OF PAEDIATRIC CHILD HEALTH 34 330-334
bull CECINS NM JENKINS SC PENGELLEY J ET AL (1999) THE ACTIVE CYCLE OF BREATHING TECHNIQUES-TO TIP OR NOT TO TIP RESPIRATORY MEDICINE 93 660-665
bull CONSTANTINI D BRIVIO A BRUSA D ET AL (2001) PEP MASK VERSUS POSTURAL DRAINAGE IN INFANTS A LONG-TERM COMPARATIVE TRIAL PEADIATRIC PULMONOLOGY
bull HOUGH A (2001) PHYSIOTHERAPY IN RESPIRATORY CARE AN EVIDENCE-BASED APPROACH TO RESPIRATORY AND CARDIAC MANAGEMENT CENGAGE LEARNING EMEA
bull INTERNATIONAL PHYSIOTHERAPY GROUP FOR CYSTIC FIBROSIS PHYSIOTHERAPY IN THE TREATMENT OF CYSTIC FIBROSIS (2009) HTTPSWWWECFSEUIPG_CFBOOKLET INTERNATIONAL PHYSIOTHERAPY GROUP ndash THE BLUE BOOKLET
bull KONSTAN MW STERN RC DOERSHUK CF (1994) EFFICACY OF THE FLUTTER DEVICE FOR AIRWAY MUCUS CLEARANCE IN PATIENTS WITH CYSTIC FIBROSIS JOURNAL OF PEDIATRICS 124 (5 (PT 1) 689-693
bull MCILWAINE M BUTTON B AND DWAN K (2015) POSITIVE EXPIRATORY PRESSURE PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 6 ART NO CD003147 DOI 10100214651858CD003147PUB4
bull MESTRINER RG FERNANDES RO STAFFEN LC ET AL (2009) OPTIMUM DESIGN PARAMETERS FOR A THERAPIST-CONSTRUCTED POSITIVE-EXPIRATORY-PRESSURE THERAPY BOTTLE DEVICE RESPIRATORY CARE 54 504-8
bull MORRISON L AND AGNEW J (2014) OSCILLATING DEVICES FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 7 ART NO CD006842 DOI 10100214651858CD006842PUB
bull OERMANN CM SOCKRIDER MM GILES D ET AL (2001) COMPARISON OF HIGH-FREQUENCY CHEST WALL OSCILLATION AND OSCILLATING POSITIVE EXPIRATORY PRESSURE IN THE HOME MANAGEMENT OF CYSTIC FIBROSIS A PILOT STUDY PEDIATRIC PULMONOLOGY 32 (5) 372-7
bull PRASAD SA AND HUSSEY J (1995) PAEDIATRIC RESPIRATORY CARE A GUIDE FOR PHYSIOTHERAPISTS AND HEALTH PROFESSIONALS CHAPMAN amp HALL
bull PRYOR J (1999) PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN ADULTS EUROPEAN RESPIRATORY JOURNAL 14 (6) 1418-1424
bull PRYOR JA amp PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS CHURCHILL LIVINGSTONE
bull PRYOR JA WEBBER BA HODSON ME ET AL (1994) THE FLUTTER VRP1 AS AN ADJUNCT TO CHEST PHYSIOTHERAPY IN CYSTIC FIBROSIS RESPIRATORY MEDICINE 88677-81
bull WEST K WALLEN M FOLLETT J (2010) ACAPELLA VS PEP MASK THERAPY A RANDOMISED TRIAL IN CHILDREN WITH CYSTIC FIBROSIS DURING RESPIRATORY EXACERBATION PHYSIOTHERAPY THEORY PRACTICE 26143-9
bull WILSONLM AGNEW J MORRISON L ET AL (2014) AIRWAY CLEARANCE TECHNIQUES FOR CYSTIC FIBROSIS AN OVERVIEW OF COCHRANE SYSTEMATIC REVIEWS COCHRANE DATABASE OF SYSTEMATIC REVIEWS DOI 10100214651858CD011231
bull VOLSKO TA DIFIORE JM CHATBURN RL (2003) PERFORMANCE COMPARISON OF TWO OSCILLATORY POSITIVE PRESSURE DEVICES ACAPELLA VERSUS FLUTTER RESPIRATORY CARE 48 (2) 124- 130
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SEDDON PC KHAN Y RESPIRATORY PROBLEMS IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT ARCHIVES OF DISEASE IN CHILDHOOD 2003 01 JAN88(1)75-8
bull MARKS JH PULMONARY CARE OF CHILDREN AND ADOLESCENTS WITH DEVELOPMENTAL DISABILITIES PEDIATR CLIN NORTH AM 2008 DECEMBER55(6)1299-314
bull ARENS R MUZUMDAR H SLEEP SLEEP DISORDERED BREATHING AND NOCTURNAL HYPOVENTILATION IN CHILDREN WITH NEUROMUSCULAR DISEASES PAEDIATRIC RESPIRATORY REVIEWS 2010 MAR11(1)24-30
bull FITZGERALD DA FOLLETT J VAN ASPEREN PP ASSESSING AND MANAGING LUNG DISEASE AND SLEEP DISORDERED BREATHING IN CHILDREN WITH CEREBRAL PALSY PAEDIATRIC RESPIRATORY REVIEWS 2009 MARCH10(1)18-24
bull HSIAO KH NIXON GM THE EFFECT OF TREATMENT OF OBSTRUCTIVE SLEEP APNEA ON QUALITY OF LIFE IN CHILDREN WITH CEREBRAL PALSY RES DEV DISABIL 2008 MAR-APR29(2)133-40
bull LUNDBERG A OXYGEN CONSUMPTION IN RELATION TO WORKLOAD IN STUDENTS WITH CEREBRAL PALSY J APPL PHYSIO 197640873-5
bull SULLIVAN PB ROSENBLOOM L FEEDING THE DISABLED CHILD CLINICS IN DEVELOPMENTAL MEDICINE MACKEITH PRESS 1999140
bull MARTIN TR THE RELATIONSHIP BETWEEN MALNUTRITION AND LUNG INFECTIONS CLIN CHEST MED 19878359
bull MOSTAFA SM BHANDARI S RITCHIE G ET AL CONSTIPATION AND ITS IMPLICATIONS IN THE CRITICALLY ILL PATIENT BR J ANAESTH 200391815-9 3
bull GACOUIN A CAMUS C GROS A ET AL CONSTIPATION IN LONGTERM VENTILATED PATIENTS ASSOCIATED FACTORS AND IMPACT ON INTENSIVE CARE UNIT OUTCOMES CRIT CARE MED 2010381933- 8
bull NGUYEN T FRENETTE AJ JOHANSON C ET AL IMPAIRED GASTROINTESTINAL TRANSIT AND ITS ASSOCIATED MORBIDITY IN THE INTENSIVE CARE UNIT J CRIT CARE 201328537
bull ASAI T CONSTIPATION DOES IT INCREASE MORBIDITY AND MORTALITY IN CRITICALLY ILL PATIENTS CRIT CARE MED 2007352861-2
bull UNDERSTANDING THE PHYSIOLOGICAL EFFECTS OF UNTREATED PAIN NURSING TIMES VOL 99 ISSUE 37 PAGE NO 28
bull WINFIELD ET AL NON-PHARMACEUTICAL MANAGEMENT OF RESPIRATORY MORBIDITY IN CHILDREN WITH SEVERE GLOBAL DEVELOPMENTAL DELAY THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014
bull OLOUGHLIN EV SOMERVILLE HM SOMERVILLE ER DEALING WITH MULTISYSTEM DISEASE IN PEOPLE WITH A DEVELOPMENTAL DISABILITY MEDICAL JOURNAL OF AUSTRALIA 2009 JUN 1190(11)616-7
bull MESTROVIC J KARDUM G POLIC B MESTROVIC M MARKIC J SUSTIC A ET AL THE INFLUENCE OF CHRONIC HEALTH CONDITIONS ON SUSCEPTIBILITY TO SEVERE ACUTE ILLNESS OF CHILDREN TREATED IN PICU EUROPEAN JOURNAL OF PEDIATRICS 2006 AUG165(8)526-
9
bull HEALY F PANITCH HB PULMONARY COMPLICATIONS OF PEDIATRIC NEUROLOGICAL DISEASES PEDIATR ANN 2010 APR39(4)216-24
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SRIVASTAVA R JACKSON WD BARNHART DC DYSPHAGIA AND GASTROESOPHAGEAL REFLUX DISEASE DILEMMAS IN DIAGNOSIS AND MANAGEMENT IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT PEDIATR ANN 2010 APR39(4)225-31
bull SULLIVAN PB JUSZCZAK E BACHLET AME LAMBERT B VERNON-ROBERTS A GRANT HW ET AL GASTROSTOMY TUBE FEEDING IN CHILDREN WITH CEREBRAL PALSY A PROSPECTIVE LONGITUDINAL STUDY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 2005
FEBRUARY47(2)77-85
bull SOMERVILLE H TZANNES G WOOD J SHUN A HILL C ARROWSMITH F ET AL GASTROINTESTINAL AND NUTRITIONAL PROBLEMS IN SEVERE DEVELOPMENTAL DISABILITY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 200850(9)712-6
bull TODER DS RESPIRATORY PROBLEMS IN THE ADOLESCENT WITH DEVELOPMENTAL DELAY ADOLESCENT MEDICINE 2000 3 OCTOBER 200011(3)617-31
bull LEVIN K COLON A DIPALMA J FITZPATRICK S USING THE RADIONUCLIDE SALIVAGRAM TO DETECT PULMONARY ASPIRATION AND ESOPHAGEAL DYSMOTILITY CLIN NUCL MED 1993 FEB18(2)110-4
bull SCHROEDER AS KLING T HUSS K BORGGRAEFE I KOERTE IK BLASCHEK A ET AL BOTULINUM TOXIN TYPE A AND B FOR THE REDUCTION OF HYPERSALIVATION IN CHILDREN WITH NEUROLOGICAL DISORDERS A FOCUS ON EFFECTIVENESS AND THERAPY ADHERENCE
NEUROPEDIATRICS 201243(1)27-36
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull GOEMINNE P AND DUPONT L (2010) NON-CYSTIC FIBROSIS BRONCHIECTASIS DIAGNOSIS AND MANAGEMENT IN 21ST CENTURY POSTGRADUATE MEDICAL JOURNAL 86(1018) PP493-501
bull LEE A BUTTON B AND TANNENBAUM E (2017) AIRWAY-CLEARANCE TECHNIQUES IN CHILDREN AND ADOLESCENTS WITH CHRONIC SUPPURATIVE LUNG DISEASE AND BRONCHIECTASIS FRONTIERS IN PEDIATRICS 5
bull MANDAL P SIDHU M KOPE L POLLOCK W STEVENSON L PENTLAND J TURNBULL K MAC QUARRIE S AND HILL A (2012) A PILOT STUDY OF PULMONARY REHABILITATION AND CHEST PHYSIOTHERAPY VERSUS CHEST PHYSIOTHERAPY ALONE IN
BRONCHIECTASIS RESPIRATORY MEDICINE 106(12) PP1647-1654
bull MURRAY M PENTLAND J AND HILL A (2009) A RANDOMISED CROSSOVER TRIAL OF CHEST PHYSIOTHERAPY IN NON-CYSTIC FIBROSIS BRONCHIECTASIS EUROPEAN RESPIRATORY JOURNAL 34(5) PP1086-1092
bull NEWALL C STOCKLEY R AND HILL S (2005) EXERCISE TRAINING AND INSPIRATORY MUSCLE TRAINING IN PATIENTS WITH BRONCHIECTASIS THORAX 60(11) PP943-948
bull ONG H LEE A HILL C HOLLAND A AND DENEHY L (2011) EFFECTS OF PULMONARY REHABILITATION IN BRONCHIECTASIS A RETROSPECTIVE STUDY CHRONIC RESPIRATORY DISEASE 8(1) PP21-30
bull QUINT J MILLETT E JOSHI M NAVARATNAM V THOMAS S HURST J SMEETH L AND BROWN J (2015) CHANGES IN THE INCIDENCE PREVALENCE AND MORTALITY OF BRONCHIECTASIS IN THE UK FROM 2004 TO 2013 A POPULATION-BASED COHORT
STUDY EUROPEAN RESPIRATORY JOURNAL 47(1) PP186-193
bull SNIJDERS D FERNANDEZ DOMINGUEZ B CALGARO S BERTOZZI I ESCRIBANO MONTANER A PERILONGO G AND BARBATO A (2015) MUCOCILIARY CLEARANCE TECHNIQUES FOR TREATING NON-CYSTIC FIBROSIS BRONCHIECTASIS IS THERE
EVIDENCE INTERNATIONAL JOURNAL OF IMMUNOPATHOLOGY AND PHARMACOLOGY 28(2) PP150-159
AEROBIKA bull COMBINES PEP WITH HIGH FREQUENCY OSCILLATIONS
bull CAN BE USED WITH A MANOMETER
bull NEBULISER CAN BE ENTRAINED INTO THE SYSTEM
bull POSSIBLE INCREASE IN TREATMENT COMPLIANCE BY DECREASING
TREATMENT TIMES
TECHNIQUE AS OSCILLATING PEP
BUBBLE PEP
Suction tubing (~1cm diameter) The end MUST sit at the bottom of the bottle
Plastic bottle Any widthshapediameter must be gt20cm tall 15cm fresh tapsterile water
(depth of water determines the amount of pressure ie cm H20
Washing up bowl
INDICATIONS
bull REDUCED LUNG VOLUME (FVClt50)
bull WEAK COUGH (PCFlt270)
bull SECRETIONS RETENTION
bull ATELECTASIS
bull REDUCED MECHANICAL COMPLIANCE
bull CHILD ABLE TO COMPLY
BENEFITS
bull INCREASE LUNG VOLUME = IMPROVES PCF
bull SECRETION CLEARANCE
bull MAY REVERSE ATELECTASIS
bull IMPROVE MECHANICAL COMPLIANCE = LUNG AND CHEST WALL MOBILITY
bull IMPROVE VOICE STRENGTH
LUNG VOLUME RECRUITMENT
bull LABEL NOT FOR RESUSCITATION
bull BEST IN SITTING
bull SUCTION READY
bull AGREE SIGNAL WITH CHILD WHEN MIC ACHIEVED
bull ASK TO BREATH OUT
bull PLACE MOUTHPIECE +- NOSE CLIP OR MASK
bull ASK TO BREATH IN AND HOLD WHILE GENTLY SQUEEZING BAG
bull WITHOUT LETTING AIR OUT ASK CHILD TO TAKE ANOTHER BREATH IN ON TOP OF THE FIRST BREATH AND SQUEEZE BAG IN TIME WITH BREATH
bull REPEAT UNTIL LUNGS ARE FULL (NORMALLY 3-5 BREATHS) OR SIGNAL
bull REMOVE MASK OR MOUTHPIECE ASK TO HOLD FOR 3-5 SECONDS
bull EXHALE OR IF SECRETIONS ARE PRESENT ENCOURAGE TO HAVE A COUGH OR MAC
bull REPEATED X3-5 X2-4 DAY
LVR TREATMENT
bull AIRWAY CLEARANCE OR THORACIC MOBILITY
bull AMBU RESUS BAG
bull GREEN ldquoPHYSIOrdquo BAG
bull MANUAL TECHNIQUES WITH BAGGING
bull MHI AT HOME
bull MANOMETERS
MHI
PHYSIO WITH NIV
bull PHYSIO SETTINGS
bull SECRETIONS
bull THORACIC MOBILITY
bull ALLOWS REST PERIOD PRE ACT
bull HUMIDIFICATION
bull INFLATABLE VEST CONNECTED BY TUBES TO AN AIR PULSE GENERATOR WHICH RAPIDLY INFLATES AND DEFLATES THE VEST PRODUCING OSCILLATIONS TO THE CHEST WALL
bull RAPID CHEST MOVEMENT MIMICS A COUGH-LIKE EXPIRATORY FLOW THAT SHEARS MUCUS AWAY FROM THE AIRWAY WALLS AND HELPS TO MOVE IT ALONG TO THE CENTRAL AIRWAYS
bull PASSIVE TREATMENT amp NOT POSITION DEPENDANT
bull COMBINATION OF RX
bull CONTRAINDICATIONS
bull HEAD ANDOR NECK INJURY THAT HAS NOT BEEN STABILISED
bull ACTIVE HAEMORRHAGE WITH HEMODYNAMIC INSTABILITY
HFCWO
HFCWO INDICATIONS
bull CHRONIC MUCUS HYPERSECRETION OR RETENTION ASSOCIATED WITH A CHRONIC PULMONARY OR NEUROMUSCULAR CONDITION
bull LRT SECRETIONS AND FREQUENT LRTI REQUIRING HOSPITAL ADMISSION
bull INEFFECTIVE COUGH OR INABILITY TO REMOVE MUCUS BY COUGHING
bull TENACIOUS SECRETIONS THAT ARE NOT EASILY MOBILISED WITH STANDARD CPT
bull MECHANICALLY VENTILATED WITH EVIDENCE OF SECRETION RETENTION
bull ALTERNATIVE AIRWAY CLEARANCE THERAPY PROVEN INEFFECTIVE OR CONTRAINDICATEDDO NOT TOLERATE STANDARD CPT
bull CONSTANT FATIGUE LACK OF STRENGTH OR ABILITY TO PERFORM ACTIVE TREATMENT
bull SYMPTOMATIC
bull POOR COMPLIANCE WITH OTHER AIRWAY CLEARANCE METHODS
bull HIGH BURDEN OF CARE
bull PATIENT UNABLE TO TOLERATE THE INCREASED WORK OF BREATHING bull ACTIVE HAEMOPTYSIS bull UNTREATED PNEUMOTHORAX bull INTRACRANIAL PRESSURE (ICP) gt 20 MMHG bull HAEMODYNAMIC INSTABILITY bull SEVERE CARDIOVASCULAR INSULTDISEASE bull RECENT FACIAL ORAL OR SKULL SURGERY OR TRAUMA bull ACUTE SINUSITIS bull EPISTAXIS bull POST OESOPHAGEAL amp LUNG SURGERY bull KNOWN OR SUSPECTED TYMPANIC MEMBRANE RUPTURE OR OTHER MIDDLE EAR
PATHOLOGY
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
POSSIBLE HAZARDSCOMPLICATIONS
bull INCREASED WORK OF BREATHING THAT MAY LEAD TO HYPOVENTILATION AND
HYPERCARBIA
bull INCREASED INTRACRANIAL PRESSURE
bull CARDIOVASCULAR COMPROMISE
bull NAUSEA
bull MYOCARDIAL ISCHEMIA
bull DECREASED VENOUS RETURN
bull AIR SWALLOWING WITH INCREASED LIKELIHOOD OF VOMITING AND
ASPIRATION
bull CLAUSTROPHOBIA
bull SKIN BREAK DOWN AND DISCOMFORT FROM MASK
bull PULMONARY BAROTRAUMA
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
MI-E
bull USED WITH CHILDREN WHO HAVE DECREASED INSPIRATORY EFFORT DUE TO EITHER SPINAL CORD INJURY OR NMW AND WHO HAVE AN IMPAIRED OR INEFFECTIVE COUGH WITH APPROPRIATE RESPIRATORY SYMPTOMS
bull CONSIDERED WHEN CONVENTIONAL COUGH ASSISTANCE TECHNIQUES BECOME INEFFECTIVE
bull ACCEPTED AS THE CORE STANDARD FOR CHILD WITH NMW
bull MIE WORKS BY
bull INFLATING THE LUNGS WITH GRADUAL POSITIVE AIRWAY PRESSURE ASSISTING INSPIRATION CALLED INSUFFLATION
bull FOLLOWED BY A RAPID SWITCH TO NEGATIVE PRESSURE WHICH SIMULATES THE FLOW CHANGES THAT OCCUR DURING A COUGH THEREBY ENHANCING EXPIRATORY FLOW CALLED EXSUFFLATION AND ASSISTING EXPECTORATION OF SECRETIONS
bull MOVEMENT AND EXERCISE BEST FUNCTIONAL METHOD OF AIRWAY CLEARANCE
bull CPET BETTER CORRELATION THAN LUNG FUNCTION IN SURVIVAL RATES IN PEOPLE WITH
CYSTIC FIBROSIS
bull RUNNINGWALKING BETTER FOR SECRETION CLEARANCE THAN BIKE DURING TO SHEARING
MECHANISM
bull CONSIDER ADDING IN HUFFS (DYER)
bull CONSIDER USE OF AD BELT
EXERCISE
bull APCP SUCTION GUIDELINES
bull TYPESNASOPHARANGEAL OROPHARANGEAL AND TRACHEOSTOMY
bull MAIN VARIABLES SUCTION TYPE AND SIZE DEPTH OF SUCTION
PRESSURE TECHNIQUE
SUCTION
SPUTUM
bull SPUTUM bull 95 WATER bull COLOUR bull VOLUME bull CONSISTENCY bull ODOUR
bull PURPOSE bull HUMIDIFICATION bull WATERPROOFING bull PROTECTION OF EPITHELIUM
HUMIDIFICATION
bull METABOLIC AND VENTILATORY REQUIREMENTS ARE X2-3 OF ADULTS
IMPLICATION
bull HEAT AND MOISTURE LOSSES FROM RESPIRATION WILL INCREASE BY X2-3
bull CONSUME GREATER AMOUNTS OF ENERGY AND WATER
HUMIDIFICATION INHALATION
THERAPY
bull TRACHEOSTOMY HME
bull WET DRY CIRCUIT
bull NEBULISERS INHALERS MUCOLYTICS
bull HUMIDIFIERS WITH NIV
bull OXYGEN
bull SYSTEMIC HYDRATION ENVIRONMENT
NEBULISERS
bull NEBULISER CHAMBER CONVERTS LIQUID INTO
RESPIRABLE PARTICLES
bull MOISTURE DESCENDS THROUGH THE HOLES IN THE SUPERFICIAL GEL LAYER
bull INCREASES THE SOL LAYER SO THE CILIARY BEAT IS OPTIMAL FOR MUCUS TRANSPORT
bull SHORT TERM HUMIDIFICATION
bull DAILY WASHING OF NEBULISER SYSTEM
TIMING OF DRUG AND PHYSIOTHERAPY
BEFORE TREATMENT
bull DNASE (PULMOZYME)
bull SALBUTAMOL
(VENTOLIN BLUE)
bull SALINE NEBS
AFTER TREATMENT
bull SERETIDE (PURPLE)
bull BECLOMETHASONE (BECOTIDE BROWN)
bull COLISTIN (COLOMYCIN PROMIXIN)
bull TOBRAMYCIN
CONCLUSION
bull BE AWARE OF CHILDrsquoS RESPIRATORY FUNCTION
bull CHOSE ACT BEST FOR THEM bull TYPE OF KETCHUP BOTTLE bull LV SECRETION RETENTION WOB
bull EARLY RESPIRATORY REFERRAL
bull RESPIRATORY CARE COMPETENCIES
bull EFFECTIVE SECRETION CLEARANCE AT HOMERESPITESCHOOL
bull USE OF PEAK COUGH FLOWS TO AID CHOICE OF ADJUNCT
0
50
100
150
200
250
300
350
400
0
50
100
150
200
250
300
350
400
Green
Key
Additional info
(please comment) Please refer to BTSACPRC Guideline
Lothian University Hospitals NHS Trust
n PCF
gt270lmin
Breathstack
ing tri-
flow
blowing
REFERENCES bull BTSACPRC GUIDELINE IS PUBLISHED IN THORAX VOL 67 SUPPLEMENT 1
bull AVAILABLE ONLINE AT HTTPTHORAXBMJCOMCONTENTVOL64ISSUESUPPLI
bull HTTPWWWBRIT-THORACICORGUKPHYSIOGUIDE
bull BRITISH THORACIC SOCIETY REPORTS VOL 1 NO 1 2009
bull ADAPTED PRYOR AJ AND PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS3RD ED
bull HOUGH A PHYSIOTHERAPY IN RESPIRATORY CARE LONDON CHAPMAN AND HALL 1993
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1997) POSTURAL DRAINAGE AND GASTRO-OESOPHAGEAL REFLUX IN INFANTS WITH CYSTIC FIBROSIS ARCHIVES OF DISEASE IN CHILDHOOD 76 148-150
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1998) POSTURAL DRAINAGE IN CYSTIC FIBROSIS IS THERE A LINK WITH GASTRO-OESOPHAGEAL REFLUX JOURNAL OF PAEDIATRIC CHILD HEALTH 34 330-334
bull CECINS NM JENKINS SC PENGELLEY J ET AL (1999) THE ACTIVE CYCLE OF BREATHING TECHNIQUES-TO TIP OR NOT TO TIP RESPIRATORY MEDICINE 93 660-665
bull CONSTANTINI D BRIVIO A BRUSA D ET AL (2001) PEP MASK VERSUS POSTURAL DRAINAGE IN INFANTS A LONG-TERM COMPARATIVE TRIAL PEADIATRIC PULMONOLOGY
bull HOUGH A (2001) PHYSIOTHERAPY IN RESPIRATORY CARE AN EVIDENCE-BASED APPROACH TO RESPIRATORY AND CARDIAC MANAGEMENT CENGAGE LEARNING EMEA
bull INTERNATIONAL PHYSIOTHERAPY GROUP FOR CYSTIC FIBROSIS PHYSIOTHERAPY IN THE TREATMENT OF CYSTIC FIBROSIS (2009) HTTPSWWWECFSEUIPG_CFBOOKLET INTERNATIONAL PHYSIOTHERAPY GROUP ndash THE BLUE BOOKLET
bull KONSTAN MW STERN RC DOERSHUK CF (1994) EFFICACY OF THE FLUTTER DEVICE FOR AIRWAY MUCUS CLEARANCE IN PATIENTS WITH CYSTIC FIBROSIS JOURNAL OF PEDIATRICS 124 (5 (PT 1) 689-693
bull MCILWAINE M BUTTON B AND DWAN K (2015) POSITIVE EXPIRATORY PRESSURE PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 6 ART NO CD003147 DOI 10100214651858CD003147PUB4
bull MESTRINER RG FERNANDES RO STAFFEN LC ET AL (2009) OPTIMUM DESIGN PARAMETERS FOR A THERAPIST-CONSTRUCTED POSITIVE-EXPIRATORY-PRESSURE THERAPY BOTTLE DEVICE RESPIRATORY CARE 54 504-8
bull MORRISON L AND AGNEW J (2014) OSCILLATING DEVICES FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 7 ART NO CD006842 DOI 10100214651858CD006842PUB
bull OERMANN CM SOCKRIDER MM GILES D ET AL (2001) COMPARISON OF HIGH-FREQUENCY CHEST WALL OSCILLATION AND OSCILLATING POSITIVE EXPIRATORY PRESSURE IN THE HOME MANAGEMENT OF CYSTIC FIBROSIS A PILOT STUDY PEDIATRIC PULMONOLOGY 32 (5) 372-7
bull PRASAD SA AND HUSSEY J (1995) PAEDIATRIC RESPIRATORY CARE A GUIDE FOR PHYSIOTHERAPISTS AND HEALTH PROFESSIONALS CHAPMAN amp HALL
bull PRYOR J (1999) PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN ADULTS EUROPEAN RESPIRATORY JOURNAL 14 (6) 1418-1424
bull PRYOR JA amp PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS CHURCHILL LIVINGSTONE
bull PRYOR JA WEBBER BA HODSON ME ET AL (1994) THE FLUTTER VRP1 AS AN ADJUNCT TO CHEST PHYSIOTHERAPY IN CYSTIC FIBROSIS RESPIRATORY MEDICINE 88677-81
bull WEST K WALLEN M FOLLETT J (2010) ACAPELLA VS PEP MASK THERAPY A RANDOMISED TRIAL IN CHILDREN WITH CYSTIC FIBROSIS DURING RESPIRATORY EXACERBATION PHYSIOTHERAPY THEORY PRACTICE 26143-9
bull WILSONLM AGNEW J MORRISON L ET AL (2014) AIRWAY CLEARANCE TECHNIQUES FOR CYSTIC FIBROSIS AN OVERVIEW OF COCHRANE SYSTEMATIC REVIEWS COCHRANE DATABASE OF SYSTEMATIC REVIEWS DOI 10100214651858CD011231
bull VOLSKO TA DIFIORE JM CHATBURN RL (2003) PERFORMANCE COMPARISON OF TWO OSCILLATORY POSITIVE PRESSURE DEVICES ACAPELLA VERSUS FLUTTER RESPIRATORY CARE 48 (2) 124- 130
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SEDDON PC KHAN Y RESPIRATORY PROBLEMS IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT ARCHIVES OF DISEASE IN CHILDHOOD 2003 01 JAN88(1)75-8
bull MARKS JH PULMONARY CARE OF CHILDREN AND ADOLESCENTS WITH DEVELOPMENTAL DISABILITIES PEDIATR CLIN NORTH AM 2008 DECEMBER55(6)1299-314
bull ARENS R MUZUMDAR H SLEEP SLEEP DISORDERED BREATHING AND NOCTURNAL HYPOVENTILATION IN CHILDREN WITH NEUROMUSCULAR DISEASES PAEDIATRIC RESPIRATORY REVIEWS 2010 MAR11(1)24-30
bull FITZGERALD DA FOLLETT J VAN ASPEREN PP ASSESSING AND MANAGING LUNG DISEASE AND SLEEP DISORDERED BREATHING IN CHILDREN WITH CEREBRAL PALSY PAEDIATRIC RESPIRATORY REVIEWS 2009 MARCH10(1)18-24
bull HSIAO KH NIXON GM THE EFFECT OF TREATMENT OF OBSTRUCTIVE SLEEP APNEA ON QUALITY OF LIFE IN CHILDREN WITH CEREBRAL PALSY RES DEV DISABIL 2008 MAR-APR29(2)133-40
bull LUNDBERG A OXYGEN CONSUMPTION IN RELATION TO WORKLOAD IN STUDENTS WITH CEREBRAL PALSY J APPL PHYSIO 197640873-5
bull SULLIVAN PB ROSENBLOOM L FEEDING THE DISABLED CHILD CLINICS IN DEVELOPMENTAL MEDICINE MACKEITH PRESS 1999140
bull MARTIN TR THE RELATIONSHIP BETWEEN MALNUTRITION AND LUNG INFECTIONS CLIN CHEST MED 19878359
bull MOSTAFA SM BHANDARI S RITCHIE G ET AL CONSTIPATION AND ITS IMPLICATIONS IN THE CRITICALLY ILL PATIENT BR J ANAESTH 200391815-9 3
bull GACOUIN A CAMUS C GROS A ET AL CONSTIPATION IN LONGTERM VENTILATED PATIENTS ASSOCIATED FACTORS AND IMPACT ON INTENSIVE CARE UNIT OUTCOMES CRIT CARE MED 2010381933- 8
bull NGUYEN T FRENETTE AJ JOHANSON C ET AL IMPAIRED GASTROINTESTINAL TRANSIT AND ITS ASSOCIATED MORBIDITY IN THE INTENSIVE CARE UNIT J CRIT CARE 201328537
bull ASAI T CONSTIPATION DOES IT INCREASE MORBIDITY AND MORTALITY IN CRITICALLY ILL PATIENTS CRIT CARE MED 2007352861-2
bull UNDERSTANDING THE PHYSIOLOGICAL EFFECTS OF UNTREATED PAIN NURSING TIMES VOL 99 ISSUE 37 PAGE NO 28
bull WINFIELD ET AL NON-PHARMACEUTICAL MANAGEMENT OF RESPIRATORY MORBIDITY IN CHILDREN WITH SEVERE GLOBAL DEVELOPMENTAL DELAY THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014
bull OLOUGHLIN EV SOMERVILLE HM SOMERVILLE ER DEALING WITH MULTISYSTEM DISEASE IN PEOPLE WITH A DEVELOPMENTAL DISABILITY MEDICAL JOURNAL OF AUSTRALIA 2009 JUN 1190(11)616-7
bull MESTROVIC J KARDUM G POLIC B MESTROVIC M MARKIC J SUSTIC A ET AL THE INFLUENCE OF CHRONIC HEALTH CONDITIONS ON SUSCEPTIBILITY TO SEVERE ACUTE ILLNESS OF CHILDREN TREATED IN PICU EUROPEAN JOURNAL OF PEDIATRICS 2006 AUG165(8)526-
9
bull HEALY F PANITCH HB PULMONARY COMPLICATIONS OF PEDIATRIC NEUROLOGICAL DISEASES PEDIATR ANN 2010 APR39(4)216-24
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SRIVASTAVA R JACKSON WD BARNHART DC DYSPHAGIA AND GASTROESOPHAGEAL REFLUX DISEASE DILEMMAS IN DIAGNOSIS AND MANAGEMENT IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT PEDIATR ANN 2010 APR39(4)225-31
bull SULLIVAN PB JUSZCZAK E BACHLET AME LAMBERT B VERNON-ROBERTS A GRANT HW ET AL GASTROSTOMY TUBE FEEDING IN CHILDREN WITH CEREBRAL PALSY A PROSPECTIVE LONGITUDINAL STUDY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 2005
FEBRUARY47(2)77-85
bull SOMERVILLE H TZANNES G WOOD J SHUN A HILL C ARROWSMITH F ET AL GASTROINTESTINAL AND NUTRITIONAL PROBLEMS IN SEVERE DEVELOPMENTAL DISABILITY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 200850(9)712-6
bull TODER DS RESPIRATORY PROBLEMS IN THE ADOLESCENT WITH DEVELOPMENTAL DELAY ADOLESCENT MEDICINE 2000 3 OCTOBER 200011(3)617-31
bull LEVIN K COLON A DIPALMA J FITZPATRICK S USING THE RADIONUCLIDE SALIVAGRAM TO DETECT PULMONARY ASPIRATION AND ESOPHAGEAL DYSMOTILITY CLIN NUCL MED 1993 FEB18(2)110-4
bull SCHROEDER AS KLING T HUSS K BORGGRAEFE I KOERTE IK BLASCHEK A ET AL BOTULINUM TOXIN TYPE A AND B FOR THE REDUCTION OF HYPERSALIVATION IN CHILDREN WITH NEUROLOGICAL DISORDERS A FOCUS ON EFFECTIVENESS AND THERAPY ADHERENCE
NEUROPEDIATRICS 201243(1)27-36
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull GOEMINNE P AND DUPONT L (2010) NON-CYSTIC FIBROSIS BRONCHIECTASIS DIAGNOSIS AND MANAGEMENT IN 21ST CENTURY POSTGRADUATE MEDICAL JOURNAL 86(1018) PP493-501
bull LEE A BUTTON B AND TANNENBAUM E (2017) AIRWAY-CLEARANCE TECHNIQUES IN CHILDREN AND ADOLESCENTS WITH CHRONIC SUPPURATIVE LUNG DISEASE AND BRONCHIECTASIS FRONTIERS IN PEDIATRICS 5
bull MANDAL P SIDHU M KOPE L POLLOCK W STEVENSON L PENTLAND J TURNBULL K MAC QUARRIE S AND HILL A (2012) A PILOT STUDY OF PULMONARY REHABILITATION AND CHEST PHYSIOTHERAPY VERSUS CHEST PHYSIOTHERAPY ALONE IN
BRONCHIECTASIS RESPIRATORY MEDICINE 106(12) PP1647-1654
bull MURRAY M PENTLAND J AND HILL A (2009) A RANDOMISED CROSSOVER TRIAL OF CHEST PHYSIOTHERAPY IN NON-CYSTIC FIBROSIS BRONCHIECTASIS EUROPEAN RESPIRATORY JOURNAL 34(5) PP1086-1092
bull NEWALL C STOCKLEY R AND HILL S (2005) EXERCISE TRAINING AND INSPIRATORY MUSCLE TRAINING IN PATIENTS WITH BRONCHIECTASIS THORAX 60(11) PP943-948
bull ONG H LEE A HILL C HOLLAND A AND DENEHY L (2011) EFFECTS OF PULMONARY REHABILITATION IN BRONCHIECTASIS A RETROSPECTIVE STUDY CHRONIC RESPIRATORY DISEASE 8(1) PP21-30
bull QUINT J MILLETT E JOSHI M NAVARATNAM V THOMAS S HURST J SMEETH L AND BROWN J (2015) CHANGES IN THE INCIDENCE PREVALENCE AND MORTALITY OF BRONCHIECTASIS IN THE UK FROM 2004 TO 2013 A POPULATION-BASED COHORT
STUDY EUROPEAN RESPIRATORY JOURNAL 47(1) PP186-193
bull SNIJDERS D FERNANDEZ DOMINGUEZ B CALGARO S BERTOZZI I ESCRIBANO MONTANER A PERILONGO G AND BARBATO A (2015) MUCOCILIARY CLEARANCE TECHNIQUES FOR TREATING NON-CYSTIC FIBROSIS BRONCHIECTASIS IS THERE
EVIDENCE INTERNATIONAL JOURNAL OF IMMUNOPATHOLOGY AND PHARMACOLOGY 28(2) PP150-159
TECHNIQUE AS OSCILLATING PEP
BUBBLE PEP
Suction tubing (~1cm diameter) The end MUST sit at the bottom of the bottle
Plastic bottle Any widthshapediameter must be gt20cm tall 15cm fresh tapsterile water
(depth of water determines the amount of pressure ie cm H20
Washing up bowl
INDICATIONS
bull REDUCED LUNG VOLUME (FVClt50)
bull WEAK COUGH (PCFlt270)
bull SECRETIONS RETENTION
bull ATELECTASIS
bull REDUCED MECHANICAL COMPLIANCE
bull CHILD ABLE TO COMPLY
BENEFITS
bull INCREASE LUNG VOLUME = IMPROVES PCF
bull SECRETION CLEARANCE
bull MAY REVERSE ATELECTASIS
bull IMPROVE MECHANICAL COMPLIANCE = LUNG AND CHEST WALL MOBILITY
bull IMPROVE VOICE STRENGTH
LUNG VOLUME RECRUITMENT
bull LABEL NOT FOR RESUSCITATION
bull BEST IN SITTING
bull SUCTION READY
bull AGREE SIGNAL WITH CHILD WHEN MIC ACHIEVED
bull ASK TO BREATH OUT
bull PLACE MOUTHPIECE +- NOSE CLIP OR MASK
bull ASK TO BREATH IN AND HOLD WHILE GENTLY SQUEEZING BAG
bull WITHOUT LETTING AIR OUT ASK CHILD TO TAKE ANOTHER BREATH IN ON TOP OF THE FIRST BREATH AND SQUEEZE BAG IN TIME WITH BREATH
bull REPEAT UNTIL LUNGS ARE FULL (NORMALLY 3-5 BREATHS) OR SIGNAL
bull REMOVE MASK OR MOUTHPIECE ASK TO HOLD FOR 3-5 SECONDS
bull EXHALE OR IF SECRETIONS ARE PRESENT ENCOURAGE TO HAVE A COUGH OR MAC
bull REPEATED X3-5 X2-4 DAY
LVR TREATMENT
bull AIRWAY CLEARANCE OR THORACIC MOBILITY
bull AMBU RESUS BAG
bull GREEN ldquoPHYSIOrdquo BAG
bull MANUAL TECHNIQUES WITH BAGGING
bull MHI AT HOME
bull MANOMETERS
MHI
PHYSIO WITH NIV
bull PHYSIO SETTINGS
bull SECRETIONS
bull THORACIC MOBILITY
bull ALLOWS REST PERIOD PRE ACT
bull HUMIDIFICATION
bull INFLATABLE VEST CONNECTED BY TUBES TO AN AIR PULSE GENERATOR WHICH RAPIDLY INFLATES AND DEFLATES THE VEST PRODUCING OSCILLATIONS TO THE CHEST WALL
bull RAPID CHEST MOVEMENT MIMICS A COUGH-LIKE EXPIRATORY FLOW THAT SHEARS MUCUS AWAY FROM THE AIRWAY WALLS AND HELPS TO MOVE IT ALONG TO THE CENTRAL AIRWAYS
bull PASSIVE TREATMENT amp NOT POSITION DEPENDANT
bull COMBINATION OF RX
bull CONTRAINDICATIONS
bull HEAD ANDOR NECK INJURY THAT HAS NOT BEEN STABILISED
bull ACTIVE HAEMORRHAGE WITH HEMODYNAMIC INSTABILITY
HFCWO
HFCWO INDICATIONS
bull CHRONIC MUCUS HYPERSECRETION OR RETENTION ASSOCIATED WITH A CHRONIC PULMONARY OR NEUROMUSCULAR CONDITION
bull LRT SECRETIONS AND FREQUENT LRTI REQUIRING HOSPITAL ADMISSION
bull INEFFECTIVE COUGH OR INABILITY TO REMOVE MUCUS BY COUGHING
bull TENACIOUS SECRETIONS THAT ARE NOT EASILY MOBILISED WITH STANDARD CPT
bull MECHANICALLY VENTILATED WITH EVIDENCE OF SECRETION RETENTION
bull ALTERNATIVE AIRWAY CLEARANCE THERAPY PROVEN INEFFECTIVE OR CONTRAINDICATEDDO NOT TOLERATE STANDARD CPT
bull CONSTANT FATIGUE LACK OF STRENGTH OR ABILITY TO PERFORM ACTIVE TREATMENT
bull SYMPTOMATIC
bull POOR COMPLIANCE WITH OTHER AIRWAY CLEARANCE METHODS
bull HIGH BURDEN OF CARE
bull PATIENT UNABLE TO TOLERATE THE INCREASED WORK OF BREATHING bull ACTIVE HAEMOPTYSIS bull UNTREATED PNEUMOTHORAX bull INTRACRANIAL PRESSURE (ICP) gt 20 MMHG bull HAEMODYNAMIC INSTABILITY bull SEVERE CARDIOVASCULAR INSULTDISEASE bull RECENT FACIAL ORAL OR SKULL SURGERY OR TRAUMA bull ACUTE SINUSITIS bull EPISTAXIS bull POST OESOPHAGEAL amp LUNG SURGERY bull KNOWN OR SUSPECTED TYMPANIC MEMBRANE RUPTURE OR OTHER MIDDLE EAR
PATHOLOGY
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
POSSIBLE HAZARDSCOMPLICATIONS
bull INCREASED WORK OF BREATHING THAT MAY LEAD TO HYPOVENTILATION AND
HYPERCARBIA
bull INCREASED INTRACRANIAL PRESSURE
bull CARDIOVASCULAR COMPROMISE
bull NAUSEA
bull MYOCARDIAL ISCHEMIA
bull DECREASED VENOUS RETURN
bull AIR SWALLOWING WITH INCREASED LIKELIHOOD OF VOMITING AND
ASPIRATION
bull CLAUSTROPHOBIA
bull SKIN BREAK DOWN AND DISCOMFORT FROM MASK
bull PULMONARY BAROTRAUMA
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
MI-E
bull USED WITH CHILDREN WHO HAVE DECREASED INSPIRATORY EFFORT DUE TO EITHER SPINAL CORD INJURY OR NMW AND WHO HAVE AN IMPAIRED OR INEFFECTIVE COUGH WITH APPROPRIATE RESPIRATORY SYMPTOMS
bull CONSIDERED WHEN CONVENTIONAL COUGH ASSISTANCE TECHNIQUES BECOME INEFFECTIVE
bull ACCEPTED AS THE CORE STANDARD FOR CHILD WITH NMW
bull MIE WORKS BY
bull INFLATING THE LUNGS WITH GRADUAL POSITIVE AIRWAY PRESSURE ASSISTING INSPIRATION CALLED INSUFFLATION
bull FOLLOWED BY A RAPID SWITCH TO NEGATIVE PRESSURE WHICH SIMULATES THE FLOW CHANGES THAT OCCUR DURING A COUGH THEREBY ENHANCING EXPIRATORY FLOW CALLED EXSUFFLATION AND ASSISTING EXPECTORATION OF SECRETIONS
bull MOVEMENT AND EXERCISE BEST FUNCTIONAL METHOD OF AIRWAY CLEARANCE
bull CPET BETTER CORRELATION THAN LUNG FUNCTION IN SURVIVAL RATES IN PEOPLE WITH
CYSTIC FIBROSIS
bull RUNNINGWALKING BETTER FOR SECRETION CLEARANCE THAN BIKE DURING TO SHEARING
MECHANISM
bull CONSIDER ADDING IN HUFFS (DYER)
bull CONSIDER USE OF AD BELT
EXERCISE
bull APCP SUCTION GUIDELINES
bull TYPESNASOPHARANGEAL OROPHARANGEAL AND TRACHEOSTOMY
bull MAIN VARIABLES SUCTION TYPE AND SIZE DEPTH OF SUCTION
PRESSURE TECHNIQUE
SUCTION
SPUTUM
bull SPUTUM bull 95 WATER bull COLOUR bull VOLUME bull CONSISTENCY bull ODOUR
bull PURPOSE bull HUMIDIFICATION bull WATERPROOFING bull PROTECTION OF EPITHELIUM
HUMIDIFICATION
bull METABOLIC AND VENTILATORY REQUIREMENTS ARE X2-3 OF ADULTS
IMPLICATION
bull HEAT AND MOISTURE LOSSES FROM RESPIRATION WILL INCREASE BY X2-3
bull CONSUME GREATER AMOUNTS OF ENERGY AND WATER
HUMIDIFICATION INHALATION
THERAPY
bull TRACHEOSTOMY HME
bull WET DRY CIRCUIT
bull NEBULISERS INHALERS MUCOLYTICS
bull HUMIDIFIERS WITH NIV
bull OXYGEN
bull SYSTEMIC HYDRATION ENVIRONMENT
NEBULISERS
bull NEBULISER CHAMBER CONVERTS LIQUID INTO
RESPIRABLE PARTICLES
bull MOISTURE DESCENDS THROUGH THE HOLES IN THE SUPERFICIAL GEL LAYER
bull INCREASES THE SOL LAYER SO THE CILIARY BEAT IS OPTIMAL FOR MUCUS TRANSPORT
bull SHORT TERM HUMIDIFICATION
bull DAILY WASHING OF NEBULISER SYSTEM
TIMING OF DRUG AND PHYSIOTHERAPY
BEFORE TREATMENT
bull DNASE (PULMOZYME)
bull SALBUTAMOL
(VENTOLIN BLUE)
bull SALINE NEBS
AFTER TREATMENT
bull SERETIDE (PURPLE)
bull BECLOMETHASONE (BECOTIDE BROWN)
bull COLISTIN (COLOMYCIN PROMIXIN)
bull TOBRAMYCIN
CONCLUSION
bull BE AWARE OF CHILDrsquoS RESPIRATORY FUNCTION
bull CHOSE ACT BEST FOR THEM bull TYPE OF KETCHUP BOTTLE bull LV SECRETION RETENTION WOB
bull EARLY RESPIRATORY REFERRAL
bull RESPIRATORY CARE COMPETENCIES
bull EFFECTIVE SECRETION CLEARANCE AT HOMERESPITESCHOOL
bull USE OF PEAK COUGH FLOWS TO AID CHOICE OF ADJUNCT
0
50
100
150
200
250
300
350
400
0
50
100
150
200
250
300
350
400
Green
Key
Additional info
(please comment) Please refer to BTSACPRC Guideline
Lothian University Hospitals NHS Trust
n PCF
gt270lmin
Breathstack
ing tri-
flow
blowing
REFERENCES bull BTSACPRC GUIDELINE IS PUBLISHED IN THORAX VOL 67 SUPPLEMENT 1
bull AVAILABLE ONLINE AT HTTPTHORAXBMJCOMCONTENTVOL64ISSUESUPPLI
bull HTTPWWWBRIT-THORACICORGUKPHYSIOGUIDE
bull BRITISH THORACIC SOCIETY REPORTS VOL 1 NO 1 2009
bull ADAPTED PRYOR AJ AND PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS3RD ED
bull HOUGH A PHYSIOTHERAPY IN RESPIRATORY CARE LONDON CHAPMAN AND HALL 1993
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1997) POSTURAL DRAINAGE AND GASTRO-OESOPHAGEAL REFLUX IN INFANTS WITH CYSTIC FIBROSIS ARCHIVES OF DISEASE IN CHILDHOOD 76 148-150
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1998) POSTURAL DRAINAGE IN CYSTIC FIBROSIS IS THERE A LINK WITH GASTRO-OESOPHAGEAL REFLUX JOURNAL OF PAEDIATRIC CHILD HEALTH 34 330-334
bull CECINS NM JENKINS SC PENGELLEY J ET AL (1999) THE ACTIVE CYCLE OF BREATHING TECHNIQUES-TO TIP OR NOT TO TIP RESPIRATORY MEDICINE 93 660-665
bull CONSTANTINI D BRIVIO A BRUSA D ET AL (2001) PEP MASK VERSUS POSTURAL DRAINAGE IN INFANTS A LONG-TERM COMPARATIVE TRIAL PEADIATRIC PULMONOLOGY
bull HOUGH A (2001) PHYSIOTHERAPY IN RESPIRATORY CARE AN EVIDENCE-BASED APPROACH TO RESPIRATORY AND CARDIAC MANAGEMENT CENGAGE LEARNING EMEA
bull INTERNATIONAL PHYSIOTHERAPY GROUP FOR CYSTIC FIBROSIS PHYSIOTHERAPY IN THE TREATMENT OF CYSTIC FIBROSIS (2009) HTTPSWWWECFSEUIPG_CFBOOKLET INTERNATIONAL PHYSIOTHERAPY GROUP ndash THE BLUE BOOKLET
bull KONSTAN MW STERN RC DOERSHUK CF (1994) EFFICACY OF THE FLUTTER DEVICE FOR AIRWAY MUCUS CLEARANCE IN PATIENTS WITH CYSTIC FIBROSIS JOURNAL OF PEDIATRICS 124 (5 (PT 1) 689-693
bull MCILWAINE M BUTTON B AND DWAN K (2015) POSITIVE EXPIRATORY PRESSURE PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 6 ART NO CD003147 DOI 10100214651858CD003147PUB4
bull MESTRINER RG FERNANDES RO STAFFEN LC ET AL (2009) OPTIMUM DESIGN PARAMETERS FOR A THERAPIST-CONSTRUCTED POSITIVE-EXPIRATORY-PRESSURE THERAPY BOTTLE DEVICE RESPIRATORY CARE 54 504-8
bull MORRISON L AND AGNEW J (2014) OSCILLATING DEVICES FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 7 ART NO CD006842 DOI 10100214651858CD006842PUB
bull OERMANN CM SOCKRIDER MM GILES D ET AL (2001) COMPARISON OF HIGH-FREQUENCY CHEST WALL OSCILLATION AND OSCILLATING POSITIVE EXPIRATORY PRESSURE IN THE HOME MANAGEMENT OF CYSTIC FIBROSIS A PILOT STUDY PEDIATRIC PULMONOLOGY 32 (5) 372-7
bull PRASAD SA AND HUSSEY J (1995) PAEDIATRIC RESPIRATORY CARE A GUIDE FOR PHYSIOTHERAPISTS AND HEALTH PROFESSIONALS CHAPMAN amp HALL
bull PRYOR J (1999) PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN ADULTS EUROPEAN RESPIRATORY JOURNAL 14 (6) 1418-1424
bull PRYOR JA amp PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS CHURCHILL LIVINGSTONE
bull PRYOR JA WEBBER BA HODSON ME ET AL (1994) THE FLUTTER VRP1 AS AN ADJUNCT TO CHEST PHYSIOTHERAPY IN CYSTIC FIBROSIS RESPIRATORY MEDICINE 88677-81
bull WEST K WALLEN M FOLLETT J (2010) ACAPELLA VS PEP MASK THERAPY A RANDOMISED TRIAL IN CHILDREN WITH CYSTIC FIBROSIS DURING RESPIRATORY EXACERBATION PHYSIOTHERAPY THEORY PRACTICE 26143-9
bull WILSONLM AGNEW J MORRISON L ET AL (2014) AIRWAY CLEARANCE TECHNIQUES FOR CYSTIC FIBROSIS AN OVERVIEW OF COCHRANE SYSTEMATIC REVIEWS COCHRANE DATABASE OF SYSTEMATIC REVIEWS DOI 10100214651858CD011231
bull VOLSKO TA DIFIORE JM CHATBURN RL (2003) PERFORMANCE COMPARISON OF TWO OSCILLATORY POSITIVE PRESSURE DEVICES ACAPELLA VERSUS FLUTTER RESPIRATORY CARE 48 (2) 124- 130
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SEDDON PC KHAN Y RESPIRATORY PROBLEMS IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT ARCHIVES OF DISEASE IN CHILDHOOD 2003 01 JAN88(1)75-8
bull MARKS JH PULMONARY CARE OF CHILDREN AND ADOLESCENTS WITH DEVELOPMENTAL DISABILITIES PEDIATR CLIN NORTH AM 2008 DECEMBER55(6)1299-314
bull ARENS R MUZUMDAR H SLEEP SLEEP DISORDERED BREATHING AND NOCTURNAL HYPOVENTILATION IN CHILDREN WITH NEUROMUSCULAR DISEASES PAEDIATRIC RESPIRATORY REVIEWS 2010 MAR11(1)24-30
bull FITZGERALD DA FOLLETT J VAN ASPEREN PP ASSESSING AND MANAGING LUNG DISEASE AND SLEEP DISORDERED BREATHING IN CHILDREN WITH CEREBRAL PALSY PAEDIATRIC RESPIRATORY REVIEWS 2009 MARCH10(1)18-24
bull HSIAO KH NIXON GM THE EFFECT OF TREATMENT OF OBSTRUCTIVE SLEEP APNEA ON QUALITY OF LIFE IN CHILDREN WITH CEREBRAL PALSY RES DEV DISABIL 2008 MAR-APR29(2)133-40
bull LUNDBERG A OXYGEN CONSUMPTION IN RELATION TO WORKLOAD IN STUDENTS WITH CEREBRAL PALSY J APPL PHYSIO 197640873-5
bull SULLIVAN PB ROSENBLOOM L FEEDING THE DISABLED CHILD CLINICS IN DEVELOPMENTAL MEDICINE MACKEITH PRESS 1999140
bull MARTIN TR THE RELATIONSHIP BETWEEN MALNUTRITION AND LUNG INFECTIONS CLIN CHEST MED 19878359
bull MOSTAFA SM BHANDARI S RITCHIE G ET AL CONSTIPATION AND ITS IMPLICATIONS IN THE CRITICALLY ILL PATIENT BR J ANAESTH 200391815-9 3
bull GACOUIN A CAMUS C GROS A ET AL CONSTIPATION IN LONGTERM VENTILATED PATIENTS ASSOCIATED FACTORS AND IMPACT ON INTENSIVE CARE UNIT OUTCOMES CRIT CARE MED 2010381933- 8
bull NGUYEN T FRENETTE AJ JOHANSON C ET AL IMPAIRED GASTROINTESTINAL TRANSIT AND ITS ASSOCIATED MORBIDITY IN THE INTENSIVE CARE UNIT J CRIT CARE 201328537
bull ASAI T CONSTIPATION DOES IT INCREASE MORBIDITY AND MORTALITY IN CRITICALLY ILL PATIENTS CRIT CARE MED 2007352861-2
bull UNDERSTANDING THE PHYSIOLOGICAL EFFECTS OF UNTREATED PAIN NURSING TIMES VOL 99 ISSUE 37 PAGE NO 28
bull WINFIELD ET AL NON-PHARMACEUTICAL MANAGEMENT OF RESPIRATORY MORBIDITY IN CHILDREN WITH SEVERE GLOBAL DEVELOPMENTAL DELAY THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014
bull OLOUGHLIN EV SOMERVILLE HM SOMERVILLE ER DEALING WITH MULTISYSTEM DISEASE IN PEOPLE WITH A DEVELOPMENTAL DISABILITY MEDICAL JOURNAL OF AUSTRALIA 2009 JUN 1190(11)616-7
bull MESTROVIC J KARDUM G POLIC B MESTROVIC M MARKIC J SUSTIC A ET AL THE INFLUENCE OF CHRONIC HEALTH CONDITIONS ON SUSCEPTIBILITY TO SEVERE ACUTE ILLNESS OF CHILDREN TREATED IN PICU EUROPEAN JOURNAL OF PEDIATRICS 2006 AUG165(8)526-
9
bull HEALY F PANITCH HB PULMONARY COMPLICATIONS OF PEDIATRIC NEUROLOGICAL DISEASES PEDIATR ANN 2010 APR39(4)216-24
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SRIVASTAVA R JACKSON WD BARNHART DC DYSPHAGIA AND GASTROESOPHAGEAL REFLUX DISEASE DILEMMAS IN DIAGNOSIS AND MANAGEMENT IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT PEDIATR ANN 2010 APR39(4)225-31
bull SULLIVAN PB JUSZCZAK E BACHLET AME LAMBERT B VERNON-ROBERTS A GRANT HW ET AL GASTROSTOMY TUBE FEEDING IN CHILDREN WITH CEREBRAL PALSY A PROSPECTIVE LONGITUDINAL STUDY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 2005
FEBRUARY47(2)77-85
bull SOMERVILLE H TZANNES G WOOD J SHUN A HILL C ARROWSMITH F ET AL GASTROINTESTINAL AND NUTRITIONAL PROBLEMS IN SEVERE DEVELOPMENTAL DISABILITY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 200850(9)712-6
bull TODER DS RESPIRATORY PROBLEMS IN THE ADOLESCENT WITH DEVELOPMENTAL DELAY ADOLESCENT MEDICINE 2000 3 OCTOBER 200011(3)617-31
bull LEVIN K COLON A DIPALMA J FITZPATRICK S USING THE RADIONUCLIDE SALIVAGRAM TO DETECT PULMONARY ASPIRATION AND ESOPHAGEAL DYSMOTILITY CLIN NUCL MED 1993 FEB18(2)110-4
bull SCHROEDER AS KLING T HUSS K BORGGRAEFE I KOERTE IK BLASCHEK A ET AL BOTULINUM TOXIN TYPE A AND B FOR THE REDUCTION OF HYPERSALIVATION IN CHILDREN WITH NEUROLOGICAL DISORDERS A FOCUS ON EFFECTIVENESS AND THERAPY ADHERENCE
NEUROPEDIATRICS 201243(1)27-36
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull GOEMINNE P AND DUPONT L (2010) NON-CYSTIC FIBROSIS BRONCHIECTASIS DIAGNOSIS AND MANAGEMENT IN 21ST CENTURY POSTGRADUATE MEDICAL JOURNAL 86(1018) PP493-501
bull LEE A BUTTON B AND TANNENBAUM E (2017) AIRWAY-CLEARANCE TECHNIQUES IN CHILDREN AND ADOLESCENTS WITH CHRONIC SUPPURATIVE LUNG DISEASE AND BRONCHIECTASIS FRONTIERS IN PEDIATRICS 5
bull MANDAL P SIDHU M KOPE L POLLOCK W STEVENSON L PENTLAND J TURNBULL K MAC QUARRIE S AND HILL A (2012) A PILOT STUDY OF PULMONARY REHABILITATION AND CHEST PHYSIOTHERAPY VERSUS CHEST PHYSIOTHERAPY ALONE IN
BRONCHIECTASIS RESPIRATORY MEDICINE 106(12) PP1647-1654
bull MURRAY M PENTLAND J AND HILL A (2009) A RANDOMISED CROSSOVER TRIAL OF CHEST PHYSIOTHERAPY IN NON-CYSTIC FIBROSIS BRONCHIECTASIS EUROPEAN RESPIRATORY JOURNAL 34(5) PP1086-1092
bull NEWALL C STOCKLEY R AND HILL S (2005) EXERCISE TRAINING AND INSPIRATORY MUSCLE TRAINING IN PATIENTS WITH BRONCHIECTASIS THORAX 60(11) PP943-948
bull ONG H LEE A HILL C HOLLAND A AND DENEHY L (2011) EFFECTS OF PULMONARY REHABILITATION IN BRONCHIECTASIS A RETROSPECTIVE STUDY CHRONIC RESPIRATORY DISEASE 8(1) PP21-30
bull QUINT J MILLETT E JOSHI M NAVARATNAM V THOMAS S HURST J SMEETH L AND BROWN J (2015) CHANGES IN THE INCIDENCE PREVALENCE AND MORTALITY OF BRONCHIECTASIS IN THE UK FROM 2004 TO 2013 A POPULATION-BASED COHORT
STUDY EUROPEAN RESPIRATORY JOURNAL 47(1) PP186-193
bull SNIJDERS D FERNANDEZ DOMINGUEZ B CALGARO S BERTOZZI I ESCRIBANO MONTANER A PERILONGO G AND BARBATO A (2015) MUCOCILIARY CLEARANCE TECHNIQUES FOR TREATING NON-CYSTIC FIBROSIS BRONCHIECTASIS IS THERE
EVIDENCE INTERNATIONAL JOURNAL OF IMMUNOPATHOLOGY AND PHARMACOLOGY 28(2) PP150-159
INDICATIONS
bull REDUCED LUNG VOLUME (FVClt50)
bull WEAK COUGH (PCFlt270)
bull SECRETIONS RETENTION
bull ATELECTASIS
bull REDUCED MECHANICAL COMPLIANCE
bull CHILD ABLE TO COMPLY
BENEFITS
bull INCREASE LUNG VOLUME = IMPROVES PCF
bull SECRETION CLEARANCE
bull MAY REVERSE ATELECTASIS
bull IMPROVE MECHANICAL COMPLIANCE = LUNG AND CHEST WALL MOBILITY
bull IMPROVE VOICE STRENGTH
LUNG VOLUME RECRUITMENT
bull LABEL NOT FOR RESUSCITATION
bull BEST IN SITTING
bull SUCTION READY
bull AGREE SIGNAL WITH CHILD WHEN MIC ACHIEVED
bull ASK TO BREATH OUT
bull PLACE MOUTHPIECE +- NOSE CLIP OR MASK
bull ASK TO BREATH IN AND HOLD WHILE GENTLY SQUEEZING BAG
bull WITHOUT LETTING AIR OUT ASK CHILD TO TAKE ANOTHER BREATH IN ON TOP OF THE FIRST BREATH AND SQUEEZE BAG IN TIME WITH BREATH
bull REPEAT UNTIL LUNGS ARE FULL (NORMALLY 3-5 BREATHS) OR SIGNAL
bull REMOVE MASK OR MOUTHPIECE ASK TO HOLD FOR 3-5 SECONDS
bull EXHALE OR IF SECRETIONS ARE PRESENT ENCOURAGE TO HAVE A COUGH OR MAC
bull REPEATED X3-5 X2-4 DAY
LVR TREATMENT
bull AIRWAY CLEARANCE OR THORACIC MOBILITY
bull AMBU RESUS BAG
bull GREEN ldquoPHYSIOrdquo BAG
bull MANUAL TECHNIQUES WITH BAGGING
bull MHI AT HOME
bull MANOMETERS
MHI
PHYSIO WITH NIV
bull PHYSIO SETTINGS
bull SECRETIONS
bull THORACIC MOBILITY
bull ALLOWS REST PERIOD PRE ACT
bull HUMIDIFICATION
bull INFLATABLE VEST CONNECTED BY TUBES TO AN AIR PULSE GENERATOR WHICH RAPIDLY INFLATES AND DEFLATES THE VEST PRODUCING OSCILLATIONS TO THE CHEST WALL
bull RAPID CHEST MOVEMENT MIMICS A COUGH-LIKE EXPIRATORY FLOW THAT SHEARS MUCUS AWAY FROM THE AIRWAY WALLS AND HELPS TO MOVE IT ALONG TO THE CENTRAL AIRWAYS
bull PASSIVE TREATMENT amp NOT POSITION DEPENDANT
bull COMBINATION OF RX
bull CONTRAINDICATIONS
bull HEAD ANDOR NECK INJURY THAT HAS NOT BEEN STABILISED
bull ACTIVE HAEMORRHAGE WITH HEMODYNAMIC INSTABILITY
HFCWO
HFCWO INDICATIONS
bull CHRONIC MUCUS HYPERSECRETION OR RETENTION ASSOCIATED WITH A CHRONIC PULMONARY OR NEUROMUSCULAR CONDITION
bull LRT SECRETIONS AND FREQUENT LRTI REQUIRING HOSPITAL ADMISSION
bull INEFFECTIVE COUGH OR INABILITY TO REMOVE MUCUS BY COUGHING
bull TENACIOUS SECRETIONS THAT ARE NOT EASILY MOBILISED WITH STANDARD CPT
bull MECHANICALLY VENTILATED WITH EVIDENCE OF SECRETION RETENTION
bull ALTERNATIVE AIRWAY CLEARANCE THERAPY PROVEN INEFFECTIVE OR CONTRAINDICATEDDO NOT TOLERATE STANDARD CPT
bull CONSTANT FATIGUE LACK OF STRENGTH OR ABILITY TO PERFORM ACTIVE TREATMENT
bull SYMPTOMATIC
bull POOR COMPLIANCE WITH OTHER AIRWAY CLEARANCE METHODS
bull HIGH BURDEN OF CARE
bull PATIENT UNABLE TO TOLERATE THE INCREASED WORK OF BREATHING bull ACTIVE HAEMOPTYSIS bull UNTREATED PNEUMOTHORAX bull INTRACRANIAL PRESSURE (ICP) gt 20 MMHG bull HAEMODYNAMIC INSTABILITY bull SEVERE CARDIOVASCULAR INSULTDISEASE bull RECENT FACIAL ORAL OR SKULL SURGERY OR TRAUMA bull ACUTE SINUSITIS bull EPISTAXIS bull POST OESOPHAGEAL amp LUNG SURGERY bull KNOWN OR SUSPECTED TYMPANIC MEMBRANE RUPTURE OR OTHER MIDDLE EAR
PATHOLOGY
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
POSSIBLE HAZARDSCOMPLICATIONS
bull INCREASED WORK OF BREATHING THAT MAY LEAD TO HYPOVENTILATION AND
HYPERCARBIA
bull INCREASED INTRACRANIAL PRESSURE
bull CARDIOVASCULAR COMPROMISE
bull NAUSEA
bull MYOCARDIAL ISCHEMIA
bull DECREASED VENOUS RETURN
bull AIR SWALLOWING WITH INCREASED LIKELIHOOD OF VOMITING AND
ASPIRATION
bull CLAUSTROPHOBIA
bull SKIN BREAK DOWN AND DISCOMFORT FROM MASK
bull PULMONARY BAROTRAUMA
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
MI-E
bull USED WITH CHILDREN WHO HAVE DECREASED INSPIRATORY EFFORT DUE TO EITHER SPINAL CORD INJURY OR NMW AND WHO HAVE AN IMPAIRED OR INEFFECTIVE COUGH WITH APPROPRIATE RESPIRATORY SYMPTOMS
bull CONSIDERED WHEN CONVENTIONAL COUGH ASSISTANCE TECHNIQUES BECOME INEFFECTIVE
bull ACCEPTED AS THE CORE STANDARD FOR CHILD WITH NMW
bull MIE WORKS BY
bull INFLATING THE LUNGS WITH GRADUAL POSITIVE AIRWAY PRESSURE ASSISTING INSPIRATION CALLED INSUFFLATION
bull FOLLOWED BY A RAPID SWITCH TO NEGATIVE PRESSURE WHICH SIMULATES THE FLOW CHANGES THAT OCCUR DURING A COUGH THEREBY ENHANCING EXPIRATORY FLOW CALLED EXSUFFLATION AND ASSISTING EXPECTORATION OF SECRETIONS
bull MOVEMENT AND EXERCISE BEST FUNCTIONAL METHOD OF AIRWAY CLEARANCE
bull CPET BETTER CORRELATION THAN LUNG FUNCTION IN SURVIVAL RATES IN PEOPLE WITH
CYSTIC FIBROSIS
bull RUNNINGWALKING BETTER FOR SECRETION CLEARANCE THAN BIKE DURING TO SHEARING
MECHANISM
bull CONSIDER ADDING IN HUFFS (DYER)
bull CONSIDER USE OF AD BELT
EXERCISE
bull APCP SUCTION GUIDELINES
bull TYPESNASOPHARANGEAL OROPHARANGEAL AND TRACHEOSTOMY
bull MAIN VARIABLES SUCTION TYPE AND SIZE DEPTH OF SUCTION
PRESSURE TECHNIQUE
SUCTION
SPUTUM
bull SPUTUM bull 95 WATER bull COLOUR bull VOLUME bull CONSISTENCY bull ODOUR
bull PURPOSE bull HUMIDIFICATION bull WATERPROOFING bull PROTECTION OF EPITHELIUM
HUMIDIFICATION
bull METABOLIC AND VENTILATORY REQUIREMENTS ARE X2-3 OF ADULTS
IMPLICATION
bull HEAT AND MOISTURE LOSSES FROM RESPIRATION WILL INCREASE BY X2-3
bull CONSUME GREATER AMOUNTS OF ENERGY AND WATER
HUMIDIFICATION INHALATION
THERAPY
bull TRACHEOSTOMY HME
bull WET DRY CIRCUIT
bull NEBULISERS INHALERS MUCOLYTICS
bull HUMIDIFIERS WITH NIV
bull OXYGEN
bull SYSTEMIC HYDRATION ENVIRONMENT
NEBULISERS
bull NEBULISER CHAMBER CONVERTS LIQUID INTO
RESPIRABLE PARTICLES
bull MOISTURE DESCENDS THROUGH THE HOLES IN THE SUPERFICIAL GEL LAYER
bull INCREASES THE SOL LAYER SO THE CILIARY BEAT IS OPTIMAL FOR MUCUS TRANSPORT
bull SHORT TERM HUMIDIFICATION
bull DAILY WASHING OF NEBULISER SYSTEM
TIMING OF DRUG AND PHYSIOTHERAPY
BEFORE TREATMENT
bull DNASE (PULMOZYME)
bull SALBUTAMOL
(VENTOLIN BLUE)
bull SALINE NEBS
AFTER TREATMENT
bull SERETIDE (PURPLE)
bull BECLOMETHASONE (BECOTIDE BROWN)
bull COLISTIN (COLOMYCIN PROMIXIN)
bull TOBRAMYCIN
CONCLUSION
bull BE AWARE OF CHILDrsquoS RESPIRATORY FUNCTION
bull CHOSE ACT BEST FOR THEM bull TYPE OF KETCHUP BOTTLE bull LV SECRETION RETENTION WOB
bull EARLY RESPIRATORY REFERRAL
bull RESPIRATORY CARE COMPETENCIES
bull EFFECTIVE SECRETION CLEARANCE AT HOMERESPITESCHOOL
bull USE OF PEAK COUGH FLOWS TO AID CHOICE OF ADJUNCT
0
50
100
150
200
250
300
350
400
0
50
100
150
200
250
300
350
400
Green
Key
Additional info
(please comment) Please refer to BTSACPRC Guideline
Lothian University Hospitals NHS Trust
n PCF
gt270lmin
Breathstack
ing tri-
flow
blowing
REFERENCES bull BTSACPRC GUIDELINE IS PUBLISHED IN THORAX VOL 67 SUPPLEMENT 1
bull AVAILABLE ONLINE AT HTTPTHORAXBMJCOMCONTENTVOL64ISSUESUPPLI
bull HTTPWWWBRIT-THORACICORGUKPHYSIOGUIDE
bull BRITISH THORACIC SOCIETY REPORTS VOL 1 NO 1 2009
bull ADAPTED PRYOR AJ AND PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS3RD ED
bull HOUGH A PHYSIOTHERAPY IN RESPIRATORY CARE LONDON CHAPMAN AND HALL 1993
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1997) POSTURAL DRAINAGE AND GASTRO-OESOPHAGEAL REFLUX IN INFANTS WITH CYSTIC FIBROSIS ARCHIVES OF DISEASE IN CHILDHOOD 76 148-150
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1998) POSTURAL DRAINAGE IN CYSTIC FIBROSIS IS THERE A LINK WITH GASTRO-OESOPHAGEAL REFLUX JOURNAL OF PAEDIATRIC CHILD HEALTH 34 330-334
bull CECINS NM JENKINS SC PENGELLEY J ET AL (1999) THE ACTIVE CYCLE OF BREATHING TECHNIQUES-TO TIP OR NOT TO TIP RESPIRATORY MEDICINE 93 660-665
bull CONSTANTINI D BRIVIO A BRUSA D ET AL (2001) PEP MASK VERSUS POSTURAL DRAINAGE IN INFANTS A LONG-TERM COMPARATIVE TRIAL PEADIATRIC PULMONOLOGY
bull HOUGH A (2001) PHYSIOTHERAPY IN RESPIRATORY CARE AN EVIDENCE-BASED APPROACH TO RESPIRATORY AND CARDIAC MANAGEMENT CENGAGE LEARNING EMEA
bull INTERNATIONAL PHYSIOTHERAPY GROUP FOR CYSTIC FIBROSIS PHYSIOTHERAPY IN THE TREATMENT OF CYSTIC FIBROSIS (2009) HTTPSWWWECFSEUIPG_CFBOOKLET INTERNATIONAL PHYSIOTHERAPY GROUP ndash THE BLUE BOOKLET
bull KONSTAN MW STERN RC DOERSHUK CF (1994) EFFICACY OF THE FLUTTER DEVICE FOR AIRWAY MUCUS CLEARANCE IN PATIENTS WITH CYSTIC FIBROSIS JOURNAL OF PEDIATRICS 124 (5 (PT 1) 689-693
bull MCILWAINE M BUTTON B AND DWAN K (2015) POSITIVE EXPIRATORY PRESSURE PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 6 ART NO CD003147 DOI 10100214651858CD003147PUB4
bull MESTRINER RG FERNANDES RO STAFFEN LC ET AL (2009) OPTIMUM DESIGN PARAMETERS FOR A THERAPIST-CONSTRUCTED POSITIVE-EXPIRATORY-PRESSURE THERAPY BOTTLE DEVICE RESPIRATORY CARE 54 504-8
bull MORRISON L AND AGNEW J (2014) OSCILLATING DEVICES FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 7 ART NO CD006842 DOI 10100214651858CD006842PUB
bull OERMANN CM SOCKRIDER MM GILES D ET AL (2001) COMPARISON OF HIGH-FREQUENCY CHEST WALL OSCILLATION AND OSCILLATING POSITIVE EXPIRATORY PRESSURE IN THE HOME MANAGEMENT OF CYSTIC FIBROSIS A PILOT STUDY PEDIATRIC PULMONOLOGY 32 (5) 372-7
bull PRASAD SA AND HUSSEY J (1995) PAEDIATRIC RESPIRATORY CARE A GUIDE FOR PHYSIOTHERAPISTS AND HEALTH PROFESSIONALS CHAPMAN amp HALL
bull PRYOR J (1999) PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN ADULTS EUROPEAN RESPIRATORY JOURNAL 14 (6) 1418-1424
bull PRYOR JA amp PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS CHURCHILL LIVINGSTONE
bull PRYOR JA WEBBER BA HODSON ME ET AL (1994) THE FLUTTER VRP1 AS AN ADJUNCT TO CHEST PHYSIOTHERAPY IN CYSTIC FIBROSIS RESPIRATORY MEDICINE 88677-81
bull WEST K WALLEN M FOLLETT J (2010) ACAPELLA VS PEP MASK THERAPY A RANDOMISED TRIAL IN CHILDREN WITH CYSTIC FIBROSIS DURING RESPIRATORY EXACERBATION PHYSIOTHERAPY THEORY PRACTICE 26143-9
bull WILSONLM AGNEW J MORRISON L ET AL (2014) AIRWAY CLEARANCE TECHNIQUES FOR CYSTIC FIBROSIS AN OVERVIEW OF COCHRANE SYSTEMATIC REVIEWS COCHRANE DATABASE OF SYSTEMATIC REVIEWS DOI 10100214651858CD011231
bull VOLSKO TA DIFIORE JM CHATBURN RL (2003) PERFORMANCE COMPARISON OF TWO OSCILLATORY POSITIVE PRESSURE DEVICES ACAPELLA VERSUS FLUTTER RESPIRATORY CARE 48 (2) 124- 130
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SEDDON PC KHAN Y RESPIRATORY PROBLEMS IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT ARCHIVES OF DISEASE IN CHILDHOOD 2003 01 JAN88(1)75-8
bull MARKS JH PULMONARY CARE OF CHILDREN AND ADOLESCENTS WITH DEVELOPMENTAL DISABILITIES PEDIATR CLIN NORTH AM 2008 DECEMBER55(6)1299-314
bull ARENS R MUZUMDAR H SLEEP SLEEP DISORDERED BREATHING AND NOCTURNAL HYPOVENTILATION IN CHILDREN WITH NEUROMUSCULAR DISEASES PAEDIATRIC RESPIRATORY REVIEWS 2010 MAR11(1)24-30
bull FITZGERALD DA FOLLETT J VAN ASPEREN PP ASSESSING AND MANAGING LUNG DISEASE AND SLEEP DISORDERED BREATHING IN CHILDREN WITH CEREBRAL PALSY PAEDIATRIC RESPIRATORY REVIEWS 2009 MARCH10(1)18-24
bull HSIAO KH NIXON GM THE EFFECT OF TREATMENT OF OBSTRUCTIVE SLEEP APNEA ON QUALITY OF LIFE IN CHILDREN WITH CEREBRAL PALSY RES DEV DISABIL 2008 MAR-APR29(2)133-40
bull LUNDBERG A OXYGEN CONSUMPTION IN RELATION TO WORKLOAD IN STUDENTS WITH CEREBRAL PALSY J APPL PHYSIO 197640873-5
bull SULLIVAN PB ROSENBLOOM L FEEDING THE DISABLED CHILD CLINICS IN DEVELOPMENTAL MEDICINE MACKEITH PRESS 1999140
bull MARTIN TR THE RELATIONSHIP BETWEEN MALNUTRITION AND LUNG INFECTIONS CLIN CHEST MED 19878359
bull MOSTAFA SM BHANDARI S RITCHIE G ET AL CONSTIPATION AND ITS IMPLICATIONS IN THE CRITICALLY ILL PATIENT BR J ANAESTH 200391815-9 3
bull GACOUIN A CAMUS C GROS A ET AL CONSTIPATION IN LONGTERM VENTILATED PATIENTS ASSOCIATED FACTORS AND IMPACT ON INTENSIVE CARE UNIT OUTCOMES CRIT CARE MED 2010381933- 8
bull NGUYEN T FRENETTE AJ JOHANSON C ET AL IMPAIRED GASTROINTESTINAL TRANSIT AND ITS ASSOCIATED MORBIDITY IN THE INTENSIVE CARE UNIT J CRIT CARE 201328537
bull ASAI T CONSTIPATION DOES IT INCREASE MORBIDITY AND MORTALITY IN CRITICALLY ILL PATIENTS CRIT CARE MED 2007352861-2
bull UNDERSTANDING THE PHYSIOLOGICAL EFFECTS OF UNTREATED PAIN NURSING TIMES VOL 99 ISSUE 37 PAGE NO 28
bull WINFIELD ET AL NON-PHARMACEUTICAL MANAGEMENT OF RESPIRATORY MORBIDITY IN CHILDREN WITH SEVERE GLOBAL DEVELOPMENTAL DELAY THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014
bull OLOUGHLIN EV SOMERVILLE HM SOMERVILLE ER DEALING WITH MULTISYSTEM DISEASE IN PEOPLE WITH A DEVELOPMENTAL DISABILITY MEDICAL JOURNAL OF AUSTRALIA 2009 JUN 1190(11)616-7
bull MESTROVIC J KARDUM G POLIC B MESTROVIC M MARKIC J SUSTIC A ET AL THE INFLUENCE OF CHRONIC HEALTH CONDITIONS ON SUSCEPTIBILITY TO SEVERE ACUTE ILLNESS OF CHILDREN TREATED IN PICU EUROPEAN JOURNAL OF PEDIATRICS 2006 AUG165(8)526-
9
bull HEALY F PANITCH HB PULMONARY COMPLICATIONS OF PEDIATRIC NEUROLOGICAL DISEASES PEDIATR ANN 2010 APR39(4)216-24
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SRIVASTAVA R JACKSON WD BARNHART DC DYSPHAGIA AND GASTROESOPHAGEAL REFLUX DISEASE DILEMMAS IN DIAGNOSIS AND MANAGEMENT IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT PEDIATR ANN 2010 APR39(4)225-31
bull SULLIVAN PB JUSZCZAK E BACHLET AME LAMBERT B VERNON-ROBERTS A GRANT HW ET AL GASTROSTOMY TUBE FEEDING IN CHILDREN WITH CEREBRAL PALSY A PROSPECTIVE LONGITUDINAL STUDY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 2005
FEBRUARY47(2)77-85
bull SOMERVILLE H TZANNES G WOOD J SHUN A HILL C ARROWSMITH F ET AL GASTROINTESTINAL AND NUTRITIONAL PROBLEMS IN SEVERE DEVELOPMENTAL DISABILITY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 200850(9)712-6
bull TODER DS RESPIRATORY PROBLEMS IN THE ADOLESCENT WITH DEVELOPMENTAL DELAY ADOLESCENT MEDICINE 2000 3 OCTOBER 200011(3)617-31
bull LEVIN K COLON A DIPALMA J FITZPATRICK S USING THE RADIONUCLIDE SALIVAGRAM TO DETECT PULMONARY ASPIRATION AND ESOPHAGEAL DYSMOTILITY CLIN NUCL MED 1993 FEB18(2)110-4
bull SCHROEDER AS KLING T HUSS K BORGGRAEFE I KOERTE IK BLASCHEK A ET AL BOTULINUM TOXIN TYPE A AND B FOR THE REDUCTION OF HYPERSALIVATION IN CHILDREN WITH NEUROLOGICAL DISORDERS A FOCUS ON EFFECTIVENESS AND THERAPY ADHERENCE
NEUROPEDIATRICS 201243(1)27-36
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull GOEMINNE P AND DUPONT L (2010) NON-CYSTIC FIBROSIS BRONCHIECTASIS DIAGNOSIS AND MANAGEMENT IN 21ST CENTURY POSTGRADUATE MEDICAL JOURNAL 86(1018) PP493-501
bull LEE A BUTTON B AND TANNENBAUM E (2017) AIRWAY-CLEARANCE TECHNIQUES IN CHILDREN AND ADOLESCENTS WITH CHRONIC SUPPURATIVE LUNG DISEASE AND BRONCHIECTASIS FRONTIERS IN PEDIATRICS 5
bull MANDAL P SIDHU M KOPE L POLLOCK W STEVENSON L PENTLAND J TURNBULL K MAC QUARRIE S AND HILL A (2012) A PILOT STUDY OF PULMONARY REHABILITATION AND CHEST PHYSIOTHERAPY VERSUS CHEST PHYSIOTHERAPY ALONE IN
BRONCHIECTASIS RESPIRATORY MEDICINE 106(12) PP1647-1654
bull MURRAY M PENTLAND J AND HILL A (2009) A RANDOMISED CROSSOVER TRIAL OF CHEST PHYSIOTHERAPY IN NON-CYSTIC FIBROSIS BRONCHIECTASIS EUROPEAN RESPIRATORY JOURNAL 34(5) PP1086-1092
bull NEWALL C STOCKLEY R AND HILL S (2005) EXERCISE TRAINING AND INSPIRATORY MUSCLE TRAINING IN PATIENTS WITH BRONCHIECTASIS THORAX 60(11) PP943-948
bull ONG H LEE A HILL C HOLLAND A AND DENEHY L (2011) EFFECTS OF PULMONARY REHABILITATION IN BRONCHIECTASIS A RETROSPECTIVE STUDY CHRONIC RESPIRATORY DISEASE 8(1) PP21-30
bull QUINT J MILLETT E JOSHI M NAVARATNAM V THOMAS S HURST J SMEETH L AND BROWN J (2015) CHANGES IN THE INCIDENCE PREVALENCE AND MORTALITY OF BRONCHIECTASIS IN THE UK FROM 2004 TO 2013 A POPULATION-BASED COHORT
STUDY EUROPEAN RESPIRATORY JOURNAL 47(1) PP186-193
bull SNIJDERS D FERNANDEZ DOMINGUEZ B CALGARO S BERTOZZI I ESCRIBANO MONTANER A PERILONGO G AND BARBATO A (2015) MUCOCILIARY CLEARANCE TECHNIQUES FOR TREATING NON-CYSTIC FIBROSIS BRONCHIECTASIS IS THERE
EVIDENCE INTERNATIONAL JOURNAL OF IMMUNOPATHOLOGY AND PHARMACOLOGY 28(2) PP150-159
bull LABEL NOT FOR RESUSCITATION
bull BEST IN SITTING
bull SUCTION READY
bull AGREE SIGNAL WITH CHILD WHEN MIC ACHIEVED
bull ASK TO BREATH OUT
bull PLACE MOUTHPIECE +- NOSE CLIP OR MASK
bull ASK TO BREATH IN AND HOLD WHILE GENTLY SQUEEZING BAG
bull WITHOUT LETTING AIR OUT ASK CHILD TO TAKE ANOTHER BREATH IN ON TOP OF THE FIRST BREATH AND SQUEEZE BAG IN TIME WITH BREATH
bull REPEAT UNTIL LUNGS ARE FULL (NORMALLY 3-5 BREATHS) OR SIGNAL
bull REMOVE MASK OR MOUTHPIECE ASK TO HOLD FOR 3-5 SECONDS
bull EXHALE OR IF SECRETIONS ARE PRESENT ENCOURAGE TO HAVE A COUGH OR MAC
bull REPEATED X3-5 X2-4 DAY
LVR TREATMENT
bull AIRWAY CLEARANCE OR THORACIC MOBILITY
bull AMBU RESUS BAG
bull GREEN ldquoPHYSIOrdquo BAG
bull MANUAL TECHNIQUES WITH BAGGING
bull MHI AT HOME
bull MANOMETERS
MHI
PHYSIO WITH NIV
bull PHYSIO SETTINGS
bull SECRETIONS
bull THORACIC MOBILITY
bull ALLOWS REST PERIOD PRE ACT
bull HUMIDIFICATION
bull INFLATABLE VEST CONNECTED BY TUBES TO AN AIR PULSE GENERATOR WHICH RAPIDLY INFLATES AND DEFLATES THE VEST PRODUCING OSCILLATIONS TO THE CHEST WALL
bull RAPID CHEST MOVEMENT MIMICS A COUGH-LIKE EXPIRATORY FLOW THAT SHEARS MUCUS AWAY FROM THE AIRWAY WALLS AND HELPS TO MOVE IT ALONG TO THE CENTRAL AIRWAYS
bull PASSIVE TREATMENT amp NOT POSITION DEPENDANT
bull COMBINATION OF RX
bull CONTRAINDICATIONS
bull HEAD ANDOR NECK INJURY THAT HAS NOT BEEN STABILISED
bull ACTIVE HAEMORRHAGE WITH HEMODYNAMIC INSTABILITY
HFCWO
HFCWO INDICATIONS
bull CHRONIC MUCUS HYPERSECRETION OR RETENTION ASSOCIATED WITH A CHRONIC PULMONARY OR NEUROMUSCULAR CONDITION
bull LRT SECRETIONS AND FREQUENT LRTI REQUIRING HOSPITAL ADMISSION
bull INEFFECTIVE COUGH OR INABILITY TO REMOVE MUCUS BY COUGHING
bull TENACIOUS SECRETIONS THAT ARE NOT EASILY MOBILISED WITH STANDARD CPT
bull MECHANICALLY VENTILATED WITH EVIDENCE OF SECRETION RETENTION
bull ALTERNATIVE AIRWAY CLEARANCE THERAPY PROVEN INEFFECTIVE OR CONTRAINDICATEDDO NOT TOLERATE STANDARD CPT
bull CONSTANT FATIGUE LACK OF STRENGTH OR ABILITY TO PERFORM ACTIVE TREATMENT
bull SYMPTOMATIC
bull POOR COMPLIANCE WITH OTHER AIRWAY CLEARANCE METHODS
bull HIGH BURDEN OF CARE
bull PATIENT UNABLE TO TOLERATE THE INCREASED WORK OF BREATHING bull ACTIVE HAEMOPTYSIS bull UNTREATED PNEUMOTHORAX bull INTRACRANIAL PRESSURE (ICP) gt 20 MMHG bull HAEMODYNAMIC INSTABILITY bull SEVERE CARDIOVASCULAR INSULTDISEASE bull RECENT FACIAL ORAL OR SKULL SURGERY OR TRAUMA bull ACUTE SINUSITIS bull EPISTAXIS bull POST OESOPHAGEAL amp LUNG SURGERY bull KNOWN OR SUSPECTED TYMPANIC MEMBRANE RUPTURE OR OTHER MIDDLE EAR
PATHOLOGY
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
POSSIBLE HAZARDSCOMPLICATIONS
bull INCREASED WORK OF BREATHING THAT MAY LEAD TO HYPOVENTILATION AND
HYPERCARBIA
bull INCREASED INTRACRANIAL PRESSURE
bull CARDIOVASCULAR COMPROMISE
bull NAUSEA
bull MYOCARDIAL ISCHEMIA
bull DECREASED VENOUS RETURN
bull AIR SWALLOWING WITH INCREASED LIKELIHOOD OF VOMITING AND
ASPIRATION
bull CLAUSTROPHOBIA
bull SKIN BREAK DOWN AND DISCOMFORT FROM MASK
bull PULMONARY BAROTRAUMA
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
MI-E
bull USED WITH CHILDREN WHO HAVE DECREASED INSPIRATORY EFFORT DUE TO EITHER SPINAL CORD INJURY OR NMW AND WHO HAVE AN IMPAIRED OR INEFFECTIVE COUGH WITH APPROPRIATE RESPIRATORY SYMPTOMS
bull CONSIDERED WHEN CONVENTIONAL COUGH ASSISTANCE TECHNIQUES BECOME INEFFECTIVE
bull ACCEPTED AS THE CORE STANDARD FOR CHILD WITH NMW
bull MIE WORKS BY
bull INFLATING THE LUNGS WITH GRADUAL POSITIVE AIRWAY PRESSURE ASSISTING INSPIRATION CALLED INSUFFLATION
bull FOLLOWED BY A RAPID SWITCH TO NEGATIVE PRESSURE WHICH SIMULATES THE FLOW CHANGES THAT OCCUR DURING A COUGH THEREBY ENHANCING EXPIRATORY FLOW CALLED EXSUFFLATION AND ASSISTING EXPECTORATION OF SECRETIONS
bull MOVEMENT AND EXERCISE BEST FUNCTIONAL METHOD OF AIRWAY CLEARANCE
bull CPET BETTER CORRELATION THAN LUNG FUNCTION IN SURVIVAL RATES IN PEOPLE WITH
CYSTIC FIBROSIS
bull RUNNINGWALKING BETTER FOR SECRETION CLEARANCE THAN BIKE DURING TO SHEARING
MECHANISM
bull CONSIDER ADDING IN HUFFS (DYER)
bull CONSIDER USE OF AD BELT
EXERCISE
bull APCP SUCTION GUIDELINES
bull TYPESNASOPHARANGEAL OROPHARANGEAL AND TRACHEOSTOMY
bull MAIN VARIABLES SUCTION TYPE AND SIZE DEPTH OF SUCTION
PRESSURE TECHNIQUE
SUCTION
SPUTUM
bull SPUTUM bull 95 WATER bull COLOUR bull VOLUME bull CONSISTENCY bull ODOUR
bull PURPOSE bull HUMIDIFICATION bull WATERPROOFING bull PROTECTION OF EPITHELIUM
HUMIDIFICATION
bull METABOLIC AND VENTILATORY REQUIREMENTS ARE X2-3 OF ADULTS
IMPLICATION
bull HEAT AND MOISTURE LOSSES FROM RESPIRATION WILL INCREASE BY X2-3
bull CONSUME GREATER AMOUNTS OF ENERGY AND WATER
HUMIDIFICATION INHALATION
THERAPY
bull TRACHEOSTOMY HME
bull WET DRY CIRCUIT
bull NEBULISERS INHALERS MUCOLYTICS
bull HUMIDIFIERS WITH NIV
bull OXYGEN
bull SYSTEMIC HYDRATION ENVIRONMENT
NEBULISERS
bull NEBULISER CHAMBER CONVERTS LIQUID INTO
RESPIRABLE PARTICLES
bull MOISTURE DESCENDS THROUGH THE HOLES IN THE SUPERFICIAL GEL LAYER
bull INCREASES THE SOL LAYER SO THE CILIARY BEAT IS OPTIMAL FOR MUCUS TRANSPORT
bull SHORT TERM HUMIDIFICATION
bull DAILY WASHING OF NEBULISER SYSTEM
TIMING OF DRUG AND PHYSIOTHERAPY
BEFORE TREATMENT
bull DNASE (PULMOZYME)
bull SALBUTAMOL
(VENTOLIN BLUE)
bull SALINE NEBS
AFTER TREATMENT
bull SERETIDE (PURPLE)
bull BECLOMETHASONE (BECOTIDE BROWN)
bull COLISTIN (COLOMYCIN PROMIXIN)
bull TOBRAMYCIN
CONCLUSION
bull BE AWARE OF CHILDrsquoS RESPIRATORY FUNCTION
bull CHOSE ACT BEST FOR THEM bull TYPE OF KETCHUP BOTTLE bull LV SECRETION RETENTION WOB
bull EARLY RESPIRATORY REFERRAL
bull RESPIRATORY CARE COMPETENCIES
bull EFFECTIVE SECRETION CLEARANCE AT HOMERESPITESCHOOL
bull USE OF PEAK COUGH FLOWS TO AID CHOICE OF ADJUNCT
0
50
100
150
200
250
300
350
400
0
50
100
150
200
250
300
350
400
Green
Key
Additional info
(please comment) Please refer to BTSACPRC Guideline
Lothian University Hospitals NHS Trust
n PCF
gt270lmin
Breathstack
ing tri-
flow
blowing
REFERENCES bull BTSACPRC GUIDELINE IS PUBLISHED IN THORAX VOL 67 SUPPLEMENT 1
bull AVAILABLE ONLINE AT HTTPTHORAXBMJCOMCONTENTVOL64ISSUESUPPLI
bull HTTPWWWBRIT-THORACICORGUKPHYSIOGUIDE
bull BRITISH THORACIC SOCIETY REPORTS VOL 1 NO 1 2009
bull ADAPTED PRYOR AJ AND PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS3RD ED
bull HOUGH A PHYSIOTHERAPY IN RESPIRATORY CARE LONDON CHAPMAN AND HALL 1993
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1997) POSTURAL DRAINAGE AND GASTRO-OESOPHAGEAL REFLUX IN INFANTS WITH CYSTIC FIBROSIS ARCHIVES OF DISEASE IN CHILDHOOD 76 148-150
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1998) POSTURAL DRAINAGE IN CYSTIC FIBROSIS IS THERE A LINK WITH GASTRO-OESOPHAGEAL REFLUX JOURNAL OF PAEDIATRIC CHILD HEALTH 34 330-334
bull CECINS NM JENKINS SC PENGELLEY J ET AL (1999) THE ACTIVE CYCLE OF BREATHING TECHNIQUES-TO TIP OR NOT TO TIP RESPIRATORY MEDICINE 93 660-665
bull CONSTANTINI D BRIVIO A BRUSA D ET AL (2001) PEP MASK VERSUS POSTURAL DRAINAGE IN INFANTS A LONG-TERM COMPARATIVE TRIAL PEADIATRIC PULMONOLOGY
bull HOUGH A (2001) PHYSIOTHERAPY IN RESPIRATORY CARE AN EVIDENCE-BASED APPROACH TO RESPIRATORY AND CARDIAC MANAGEMENT CENGAGE LEARNING EMEA
bull INTERNATIONAL PHYSIOTHERAPY GROUP FOR CYSTIC FIBROSIS PHYSIOTHERAPY IN THE TREATMENT OF CYSTIC FIBROSIS (2009) HTTPSWWWECFSEUIPG_CFBOOKLET INTERNATIONAL PHYSIOTHERAPY GROUP ndash THE BLUE BOOKLET
bull KONSTAN MW STERN RC DOERSHUK CF (1994) EFFICACY OF THE FLUTTER DEVICE FOR AIRWAY MUCUS CLEARANCE IN PATIENTS WITH CYSTIC FIBROSIS JOURNAL OF PEDIATRICS 124 (5 (PT 1) 689-693
bull MCILWAINE M BUTTON B AND DWAN K (2015) POSITIVE EXPIRATORY PRESSURE PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 6 ART NO CD003147 DOI 10100214651858CD003147PUB4
bull MESTRINER RG FERNANDES RO STAFFEN LC ET AL (2009) OPTIMUM DESIGN PARAMETERS FOR A THERAPIST-CONSTRUCTED POSITIVE-EXPIRATORY-PRESSURE THERAPY BOTTLE DEVICE RESPIRATORY CARE 54 504-8
bull MORRISON L AND AGNEW J (2014) OSCILLATING DEVICES FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 7 ART NO CD006842 DOI 10100214651858CD006842PUB
bull OERMANN CM SOCKRIDER MM GILES D ET AL (2001) COMPARISON OF HIGH-FREQUENCY CHEST WALL OSCILLATION AND OSCILLATING POSITIVE EXPIRATORY PRESSURE IN THE HOME MANAGEMENT OF CYSTIC FIBROSIS A PILOT STUDY PEDIATRIC PULMONOLOGY 32 (5) 372-7
bull PRASAD SA AND HUSSEY J (1995) PAEDIATRIC RESPIRATORY CARE A GUIDE FOR PHYSIOTHERAPISTS AND HEALTH PROFESSIONALS CHAPMAN amp HALL
bull PRYOR J (1999) PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN ADULTS EUROPEAN RESPIRATORY JOURNAL 14 (6) 1418-1424
bull PRYOR JA amp PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS CHURCHILL LIVINGSTONE
bull PRYOR JA WEBBER BA HODSON ME ET AL (1994) THE FLUTTER VRP1 AS AN ADJUNCT TO CHEST PHYSIOTHERAPY IN CYSTIC FIBROSIS RESPIRATORY MEDICINE 88677-81
bull WEST K WALLEN M FOLLETT J (2010) ACAPELLA VS PEP MASK THERAPY A RANDOMISED TRIAL IN CHILDREN WITH CYSTIC FIBROSIS DURING RESPIRATORY EXACERBATION PHYSIOTHERAPY THEORY PRACTICE 26143-9
bull WILSONLM AGNEW J MORRISON L ET AL (2014) AIRWAY CLEARANCE TECHNIQUES FOR CYSTIC FIBROSIS AN OVERVIEW OF COCHRANE SYSTEMATIC REVIEWS COCHRANE DATABASE OF SYSTEMATIC REVIEWS DOI 10100214651858CD011231
bull VOLSKO TA DIFIORE JM CHATBURN RL (2003) PERFORMANCE COMPARISON OF TWO OSCILLATORY POSITIVE PRESSURE DEVICES ACAPELLA VERSUS FLUTTER RESPIRATORY CARE 48 (2) 124- 130
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SEDDON PC KHAN Y RESPIRATORY PROBLEMS IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT ARCHIVES OF DISEASE IN CHILDHOOD 2003 01 JAN88(1)75-8
bull MARKS JH PULMONARY CARE OF CHILDREN AND ADOLESCENTS WITH DEVELOPMENTAL DISABILITIES PEDIATR CLIN NORTH AM 2008 DECEMBER55(6)1299-314
bull ARENS R MUZUMDAR H SLEEP SLEEP DISORDERED BREATHING AND NOCTURNAL HYPOVENTILATION IN CHILDREN WITH NEUROMUSCULAR DISEASES PAEDIATRIC RESPIRATORY REVIEWS 2010 MAR11(1)24-30
bull FITZGERALD DA FOLLETT J VAN ASPEREN PP ASSESSING AND MANAGING LUNG DISEASE AND SLEEP DISORDERED BREATHING IN CHILDREN WITH CEREBRAL PALSY PAEDIATRIC RESPIRATORY REVIEWS 2009 MARCH10(1)18-24
bull HSIAO KH NIXON GM THE EFFECT OF TREATMENT OF OBSTRUCTIVE SLEEP APNEA ON QUALITY OF LIFE IN CHILDREN WITH CEREBRAL PALSY RES DEV DISABIL 2008 MAR-APR29(2)133-40
bull LUNDBERG A OXYGEN CONSUMPTION IN RELATION TO WORKLOAD IN STUDENTS WITH CEREBRAL PALSY J APPL PHYSIO 197640873-5
bull SULLIVAN PB ROSENBLOOM L FEEDING THE DISABLED CHILD CLINICS IN DEVELOPMENTAL MEDICINE MACKEITH PRESS 1999140
bull MARTIN TR THE RELATIONSHIP BETWEEN MALNUTRITION AND LUNG INFECTIONS CLIN CHEST MED 19878359
bull MOSTAFA SM BHANDARI S RITCHIE G ET AL CONSTIPATION AND ITS IMPLICATIONS IN THE CRITICALLY ILL PATIENT BR J ANAESTH 200391815-9 3
bull GACOUIN A CAMUS C GROS A ET AL CONSTIPATION IN LONGTERM VENTILATED PATIENTS ASSOCIATED FACTORS AND IMPACT ON INTENSIVE CARE UNIT OUTCOMES CRIT CARE MED 2010381933- 8
bull NGUYEN T FRENETTE AJ JOHANSON C ET AL IMPAIRED GASTROINTESTINAL TRANSIT AND ITS ASSOCIATED MORBIDITY IN THE INTENSIVE CARE UNIT J CRIT CARE 201328537
bull ASAI T CONSTIPATION DOES IT INCREASE MORBIDITY AND MORTALITY IN CRITICALLY ILL PATIENTS CRIT CARE MED 2007352861-2
bull UNDERSTANDING THE PHYSIOLOGICAL EFFECTS OF UNTREATED PAIN NURSING TIMES VOL 99 ISSUE 37 PAGE NO 28
bull WINFIELD ET AL NON-PHARMACEUTICAL MANAGEMENT OF RESPIRATORY MORBIDITY IN CHILDREN WITH SEVERE GLOBAL DEVELOPMENTAL DELAY THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014
bull OLOUGHLIN EV SOMERVILLE HM SOMERVILLE ER DEALING WITH MULTISYSTEM DISEASE IN PEOPLE WITH A DEVELOPMENTAL DISABILITY MEDICAL JOURNAL OF AUSTRALIA 2009 JUN 1190(11)616-7
bull MESTROVIC J KARDUM G POLIC B MESTROVIC M MARKIC J SUSTIC A ET AL THE INFLUENCE OF CHRONIC HEALTH CONDITIONS ON SUSCEPTIBILITY TO SEVERE ACUTE ILLNESS OF CHILDREN TREATED IN PICU EUROPEAN JOURNAL OF PEDIATRICS 2006 AUG165(8)526-
9
bull HEALY F PANITCH HB PULMONARY COMPLICATIONS OF PEDIATRIC NEUROLOGICAL DISEASES PEDIATR ANN 2010 APR39(4)216-24
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SRIVASTAVA R JACKSON WD BARNHART DC DYSPHAGIA AND GASTROESOPHAGEAL REFLUX DISEASE DILEMMAS IN DIAGNOSIS AND MANAGEMENT IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT PEDIATR ANN 2010 APR39(4)225-31
bull SULLIVAN PB JUSZCZAK E BACHLET AME LAMBERT B VERNON-ROBERTS A GRANT HW ET AL GASTROSTOMY TUBE FEEDING IN CHILDREN WITH CEREBRAL PALSY A PROSPECTIVE LONGITUDINAL STUDY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 2005
FEBRUARY47(2)77-85
bull SOMERVILLE H TZANNES G WOOD J SHUN A HILL C ARROWSMITH F ET AL GASTROINTESTINAL AND NUTRITIONAL PROBLEMS IN SEVERE DEVELOPMENTAL DISABILITY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 200850(9)712-6
bull TODER DS RESPIRATORY PROBLEMS IN THE ADOLESCENT WITH DEVELOPMENTAL DELAY ADOLESCENT MEDICINE 2000 3 OCTOBER 200011(3)617-31
bull LEVIN K COLON A DIPALMA J FITZPATRICK S USING THE RADIONUCLIDE SALIVAGRAM TO DETECT PULMONARY ASPIRATION AND ESOPHAGEAL DYSMOTILITY CLIN NUCL MED 1993 FEB18(2)110-4
bull SCHROEDER AS KLING T HUSS K BORGGRAEFE I KOERTE IK BLASCHEK A ET AL BOTULINUM TOXIN TYPE A AND B FOR THE REDUCTION OF HYPERSALIVATION IN CHILDREN WITH NEUROLOGICAL DISORDERS A FOCUS ON EFFECTIVENESS AND THERAPY ADHERENCE
NEUROPEDIATRICS 201243(1)27-36
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull GOEMINNE P AND DUPONT L (2010) NON-CYSTIC FIBROSIS BRONCHIECTASIS DIAGNOSIS AND MANAGEMENT IN 21ST CENTURY POSTGRADUATE MEDICAL JOURNAL 86(1018) PP493-501
bull LEE A BUTTON B AND TANNENBAUM E (2017) AIRWAY-CLEARANCE TECHNIQUES IN CHILDREN AND ADOLESCENTS WITH CHRONIC SUPPURATIVE LUNG DISEASE AND BRONCHIECTASIS FRONTIERS IN PEDIATRICS 5
bull MANDAL P SIDHU M KOPE L POLLOCK W STEVENSON L PENTLAND J TURNBULL K MAC QUARRIE S AND HILL A (2012) A PILOT STUDY OF PULMONARY REHABILITATION AND CHEST PHYSIOTHERAPY VERSUS CHEST PHYSIOTHERAPY ALONE IN
BRONCHIECTASIS RESPIRATORY MEDICINE 106(12) PP1647-1654
bull MURRAY M PENTLAND J AND HILL A (2009) A RANDOMISED CROSSOVER TRIAL OF CHEST PHYSIOTHERAPY IN NON-CYSTIC FIBROSIS BRONCHIECTASIS EUROPEAN RESPIRATORY JOURNAL 34(5) PP1086-1092
bull NEWALL C STOCKLEY R AND HILL S (2005) EXERCISE TRAINING AND INSPIRATORY MUSCLE TRAINING IN PATIENTS WITH BRONCHIECTASIS THORAX 60(11) PP943-948
bull ONG H LEE A HILL C HOLLAND A AND DENEHY L (2011) EFFECTS OF PULMONARY REHABILITATION IN BRONCHIECTASIS A RETROSPECTIVE STUDY CHRONIC RESPIRATORY DISEASE 8(1) PP21-30
bull QUINT J MILLETT E JOSHI M NAVARATNAM V THOMAS S HURST J SMEETH L AND BROWN J (2015) CHANGES IN THE INCIDENCE PREVALENCE AND MORTALITY OF BRONCHIECTASIS IN THE UK FROM 2004 TO 2013 A POPULATION-BASED COHORT
STUDY EUROPEAN RESPIRATORY JOURNAL 47(1) PP186-193
bull SNIJDERS D FERNANDEZ DOMINGUEZ B CALGARO S BERTOZZI I ESCRIBANO MONTANER A PERILONGO G AND BARBATO A (2015) MUCOCILIARY CLEARANCE TECHNIQUES FOR TREATING NON-CYSTIC FIBROSIS BRONCHIECTASIS IS THERE
EVIDENCE INTERNATIONAL JOURNAL OF IMMUNOPATHOLOGY AND PHARMACOLOGY 28(2) PP150-159
bull AIRWAY CLEARANCE OR THORACIC MOBILITY
bull AMBU RESUS BAG
bull GREEN ldquoPHYSIOrdquo BAG
bull MANUAL TECHNIQUES WITH BAGGING
bull MHI AT HOME
bull MANOMETERS
MHI
PHYSIO WITH NIV
bull PHYSIO SETTINGS
bull SECRETIONS
bull THORACIC MOBILITY
bull ALLOWS REST PERIOD PRE ACT
bull HUMIDIFICATION
bull INFLATABLE VEST CONNECTED BY TUBES TO AN AIR PULSE GENERATOR WHICH RAPIDLY INFLATES AND DEFLATES THE VEST PRODUCING OSCILLATIONS TO THE CHEST WALL
bull RAPID CHEST MOVEMENT MIMICS A COUGH-LIKE EXPIRATORY FLOW THAT SHEARS MUCUS AWAY FROM THE AIRWAY WALLS AND HELPS TO MOVE IT ALONG TO THE CENTRAL AIRWAYS
bull PASSIVE TREATMENT amp NOT POSITION DEPENDANT
bull COMBINATION OF RX
bull CONTRAINDICATIONS
bull HEAD ANDOR NECK INJURY THAT HAS NOT BEEN STABILISED
bull ACTIVE HAEMORRHAGE WITH HEMODYNAMIC INSTABILITY
HFCWO
HFCWO INDICATIONS
bull CHRONIC MUCUS HYPERSECRETION OR RETENTION ASSOCIATED WITH A CHRONIC PULMONARY OR NEUROMUSCULAR CONDITION
bull LRT SECRETIONS AND FREQUENT LRTI REQUIRING HOSPITAL ADMISSION
bull INEFFECTIVE COUGH OR INABILITY TO REMOVE MUCUS BY COUGHING
bull TENACIOUS SECRETIONS THAT ARE NOT EASILY MOBILISED WITH STANDARD CPT
bull MECHANICALLY VENTILATED WITH EVIDENCE OF SECRETION RETENTION
bull ALTERNATIVE AIRWAY CLEARANCE THERAPY PROVEN INEFFECTIVE OR CONTRAINDICATEDDO NOT TOLERATE STANDARD CPT
bull CONSTANT FATIGUE LACK OF STRENGTH OR ABILITY TO PERFORM ACTIVE TREATMENT
bull SYMPTOMATIC
bull POOR COMPLIANCE WITH OTHER AIRWAY CLEARANCE METHODS
bull HIGH BURDEN OF CARE
bull PATIENT UNABLE TO TOLERATE THE INCREASED WORK OF BREATHING bull ACTIVE HAEMOPTYSIS bull UNTREATED PNEUMOTHORAX bull INTRACRANIAL PRESSURE (ICP) gt 20 MMHG bull HAEMODYNAMIC INSTABILITY bull SEVERE CARDIOVASCULAR INSULTDISEASE bull RECENT FACIAL ORAL OR SKULL SURGERY OR TRAUMA bull ACUTE SINUSITIS bull EPISTAXIS bull POST OESOPHAGEAL amp LUNG SURGERY bull KNOWN OR SUSPECTED TYMPANIC MEMBRANE RUPTURE OR OTHER MIDDLE EAR
PATHOLOGY
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
POSSIBLE HAZARDSCOMPLICATIONS
bull INCREASED WORK OF BREATHING THAT MAY LEAD TO HYPOVENTILATION AND
HYPERCARBIA
bull INCREASED INTRACRANIAL PRESSURE
bull CARDIOVASCULAR COMPROMISE
bull NAUSEA
bull MYOCARDIAL ISCHEMIA
bull DECREASED VENOUS RETURN
bull AIR SWALLOWING WITH INCREASED LIKELIHOOD OF VOMITING AND
ASPIRATION
bull CLAUSTROPHOBIA
bull SKIN BREAK DOWN AND DISCOMFORT FROM MASK
bull PULMONARY BAROTRAUMA
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
MI-E
bull USED WITH CHILDREN WHO HAVE DECREASED INSPIRATORY EFFORT DUE TO EITHER SPINAL CORD INJURY OR NMW AND WHO HAVE AN IMPAIRED OR INEFFECTIVE COUGH WITH APPROPRIATE RESPIRATORY SYMPTOMS
bull CONSIDERED WHEN CONVENTIONAL COUGH ASSISTANCE TECHNIQUES BECOME INEFFECTIVE
bull ACCEPTED AS THE CORE STANDARD FOR CHILD WITH NMW
bull MIE WORKS BY
bull INFLATING THE LUNGS WITH GRADUAL POSITIVE AIRWAY PRESSURE ASSISTING INSPIRATION CALLED INSUFFLATION
bull FOLLOWED BY A RAPID SWITCH TO NEGATIVE PRESSURE WHICH SIMULATES THE FLOW CHANGES THAT OCCUR DURING A COUGH THEREBY ENHANCING EXPIRATORY FLOW CALLED EXSUFFLATION AND ASSISTING EXPECTORATION OF SECRETIONS
bull MOVEMENT AND EXERCISE BEST FUNCTIONAL METHOD OF AIRWAY CLEARANCE
bull CPET BETTER CORRELATION THAN LUNG FUNCTION IN SURVIVAL RATES IN PEOPLE WITH
CYSTIC FIBROSIS
bull RUNNINGWALKING BETTER FOR SECRETION CLEARANCE THAN BIKE DURING TO SHEARING
MECHANISM
bull CONSIDER ADDING IN HUFFS (DYER)
bull CONSIDER USE OF AD BELT
EXERCISE
bull APCP SUCTION GUIDELINES
bull TYPESNASOPHARANGEAL OROPHARANGEAL AND TRACHEOSTOMY
bull MAIN VARIABLES SUCTION TYPE AND SIZE DEPTH OF SUCTION
PRESSURE TECHNIQUE
SUCTION
SPUTUM
bull SPUTUM bull 95 WATER bull COLOUR bull VOLUME bull CONSISTENCY bull ODOUR
bull PURPOSE bull HUMIDIFICATION bull WATERPROOFING bull PROTECTION OF EPITHELIUM
HUMIDIFICATION
bull METABOLIC AND VENTILATORY REQUIREMENTS ARE X2-3 OF ADULTS
IMPLICATION
bull HEAT AND MOISTURE LOSSES FROM RESPIRATION WILL INCREASE BY X2-3
bull CONSUME GREATER AMOUNTS OF ENERGY AND WATER
HUMIDIFICATION INHALATION
THERAPY
bull TRACHEOSTOMY HME
bull WET DRY CIRCUIT
bull NEBULISERS INHALERS MUCOLYTICS
bull HUMIDIFIERS WITH NIV
bull OXYGEN
bull SYSTEMIC HYDRATION ENVIRONMENT
NEBULISERS
bull NEBULISER CHAMBER CONVERTS LIQUID INTO
RESPIRABLE PARTICLES
bull MOISTURE DESCENDS THROUGH THE HOLES IN THE SUPERFICIAL GEL LAYER
bull INCREASES THE SOL LAYER SO THE CILIARY BEAT IS OPTIMAL FOR MUCUS TRANSPORT
bull SHORT TERM HUMIDIFICATION
bull DAILY WASHING OF NEBULISER SYSTEM
TIMING OF DRUG AND PHYSIOTHERAPY
BEFORE TREATMENT
bull DNASE (PULMOZYME)
bull SALBUTAMOL
(VENTOLIN BLUE)
bull SALINE NEBS
AFTER TREATMENT
bull SERETIDE (PURPLE)
bull BECLOMETHASONE (BECOTIDE BROWN)
bull COLISTIN (COLOMYCIN PROMIXIN)
bull TOBRAMYCIN
CONCLUSION
bull BE AWARE OF CHILDrsquoS RESPIRATORY FUNCTION
bull CHOSE ACT BEST FOR THEM bull TYPE OF KETCHUP BOTTLE bull LV SECRETION RETENTION WOB
bull EARLY RESPIRATORY REFERRAL
bull RESPIRATORY CARE COMPETENCIES
bull EFFECTIVE SECRETION CLEARANCE AT HOMERESPITESCHOOL
bull USE OF PEAK COUGH FLOWS TO AID CHOICE OF ADJUNCT
0
50
100
150
200
250
300
350
400
0
50
100
150
200
250
300
350
400
Green
Key
Additional info
(please comment) Please refer to BTSACPRC Guideline
Lothian University Hospitals NHS Trust
n PCF
gt270lmin
Breathstack
ing tri-
flow
blowing
REFERENCES bull BTSACPRC GUIDELINE IS PUBLISHED IN THORAX VOL 67 SUPPLEMENT 1
bull AVAILABLE ONLINE AT HTTPTHORAXBMJCOMCONTENTVOL64ISSUESUPPLI
bull HTTPWWWBRIT-THORACICORGUKPHYSIOGUIDE
bull BRITISH THORACIC SOCIETY REPORTS VOL 1 NO 1 2009
bull ADAPTED PRYOR AJ AND PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS3RD ED
bull HOUGH A PHYSIOTHERAPY IN RESPIRATORY CARE LONDON CHAPMAN AND HALL 1993
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1997) POSTURAL DRAINAGE AND GASTRO-OESOPHAGEAL REFLUX IN INFANTS WITH CYSTIC FIBROSIS ARCHIVES OF DISEASE IN CHILDHOOD 76 148-150
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1998) POSTURAL DRAINAGE IN CYSTIC FIBROSIS IS THERE A LINK WITH GASTRO-OESOPHAGEAL REFLUX JOURNAL OF PAEDIATRIC CHILD HEALTH 34 330-334
bull CECINS NM JENKINS SC PENGELLEY J ET AL (1999) THE ACTIVE CYCLE OF BREATHING TECHNIQUES-TO TIP OR NOT TO TIP RESPIRATORY MEDICINE 93 660-665
bull CONSTANTINI D BRIVIO A BRUSA D ET AL (2001) PEP MASK VERSUS POSTURAL DRAINAGE IN INFANTS A LONG-TERM COMPARATIVE TRIAL PEADIATRIC PULMONOLOGY
bull HOUGH A (2001) PHYSIOTHERAPY IN RESPIRATORY CARE AN EVIDENCE-BASED APPROACH TO RESPIRATORY AND CARDIAC MANAGEMENT CENGAGE LEARNING EMEA
bull INTERNATIONAL PHYSIOTHERAPY GROUP FOR CYSTIC FIBROSIS PHYSIOTHERAPY IN THE TREATMENT OF CYSTIC FIBROSIS (2009) HTTPSWWWECFSEUIPG_CFBOOKLET INTERNATIONAL PHYSIOTHERAPY GROUP ndash THE BLUE BOOKLET
bull KONSTAN MW STERN RC DOERSHUK CF (1994) EFFICACY OF THE FLUTTER DEVICE FOR AIRWAY MUCUS CLEARANCE IN PATIENTS WITH CYSTIC FIBROSIS JOURNAL OF PEDIATRICS 124 (5 (PT 1) 689-693
bull MCILWAINE M BUTTON B AND DWAN K (2015) POSITIVE EXPIRATORY PRESSURE PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 6 ART NO CD003147 DOI 10100214651858CD003147PUB4
bull MESTRINER RG FERNANDES RO STAFFEN LC ET AL (2009) OPTIMUM DESIGN PARAMETERS FOR A THERAPIST-CONSTRUCTED POSITIVE-EXPIRATORY-PRESSURE THERAPY BOTTLE DEVICE RESPIRATORY CARE 54 504-8
bull MORRISON L AND AGNEW J (2014) OSCILLATING DEVICES FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 7 ART NO CD006842 DOI 10100214651858CD006842PUB
bull OERMANN CM SOCKRIDER MM GILES D ET AL (2001) COMPARISON OF HIGH-FREQUENCY CHEST WALL OSCILLATION AND OSCILLATING POSITIVE EXPIRATORY PRESSURE IN THE HOME MANAGEMENT OF CYSTIC FIBROSIS A PILOT STUDY PEDIATRIC PULMONOLOGY 32 (5) 372-7
bull PRASAD SA AND HUSSEY J (1995) PAEDIATRIC RESPIRATORY CARE A GUIDE FOR PHYSIOTHERAPISTS AND HEALTH PROFESSIONALS CHAPMAN amp HALL
bull PRYOR J (1999) PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN ADULTS EUROPEAN RESPIRATORY JOURNAL 14 (6) 1418-1424
bull PRYOR JA amp PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS CHURCHILL LIVINGSTONE
bull PRYOR JA WEBBER BA HODSON ME ET AL (1994) THE FLUTTER VRP1 AS AN ADJUNCT TO CHEST PHYSIOTHERAPY IN CYSTIC FIBROSIS RESPIRATORY MEDICINE 88677-81
bull WEST K WALLEN M FOLLETT J (2010) ACAPELLA VS PEP MASK THERAPY A RANDOMISED TRIAL IN CHILDREN WITH CYSTIC FIBROSIS DURING RESPIRATORY EXACERBATION PHYSIOTHERAPY THEORY PRACTICE 26143-9
bull WILSONLM AGNEW J MORRISON L ET AL (2014) AIRWAY CLEARANCE TECHNIQUES FOR CYSTIC FIBROSIS AN OVERVIEW OF COCHRANE SYSTEMATIC REVIEWS COCHRANE DATABASE OF SYSTEMATIC REVIEWS DOI 10100214651858CD011231
bull VOLSKO TA DIFIORE JM CHATBURN RL (2003) PERFORMANCE COMPARISON OF TWO OSCILLATORY POSITIVE PRESSURE DEVICES ACAPELLA VERSUS FLUTTER RESPIRATORY CARE 48 (2) 124- 130
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SEDDON PC KHAN Y RESPIRATORY PROBLEMS IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT ARCHIVES OF DISEASE IN CHILDHOOD 2003 01 JAN88(1)75-8
bull MARKS JH PULMONARY CARE OF CHILDREN AND ADOLESCENTS WITH DEVELOPMENTAL DISABILITIES PEDIATR CLIN NORTH AM 2008 DECEMBER55(6)1299-314
bull ARENS R MUZUMDAR H SLEEP SLEEP DISORDERED BREATHING AND NOCTURNAL HYPOVENTILATION IN CHILDREN WITH NEUROMUSCULAR DISEASES PAEDIATRIC RESPIRATORY REVIEWS 2010 MAR11(1)24-30
bull FITZGERALD DA FOLLETT J VAN ASPEREN PP ASSESSING AND MANAGING LUNG DISEASE AND SLEEP DISORDERED BREATHING IN CHILDREN WITH CEREBRAL PALSY PAEDIATRIC RESPIRATORY REVIEWS 2009 MARCH10(1)18-24
bull HSIAO KH NIXON GM THE EFFECT OF TREATMENT OF OBSTRUCTIVE SLEEP APNEA ON QUALITY OF LIFE IN CHILDREN WITH CEREBRAL PALSY RES DEV DISABIL 2008 MAR-APR29(2)133-40
bull LUNDBERG A OXYGEN CONSUMPTION IN RELATION TO WORKLOAD IN STUDENTS WITH CEREBRAL PALSY J APPL PHYSIO 197640873-5
bull SULLIVAN PB ROSENBLOOM L FEEDING THE DISABLED CHILD CLINICS IN DEVELOPMENTAL MEDICINE MACKEITH PRESS 1999140
bull MARTIN TR THE RELATIONSHIP BETWEEN MALNUTRITION AND LUNG INFECTIONS CLIN CHEST MED 19878359
bull MOSTAFA SM BHANDARI S RITCHIE G ET AL CONSTIPATION AND ITS IMPLICATIONS IN THE CRITICALLY ILL PATIENT BR J ANAESTH 200391815-9 3
bull GACOUIN A CAMUS C GROS A ET AL CONSTIPATION IN LONGTERM VENTILATED PATIENTS ASSOCIATED FACTORS AND IMPACT ON INTENSIVE CARE UNIT OUTCOMES CRIT CARE MED 2010381933- 8
bull NGUYEN T FRENETTE AJ JOHANSON C ET AL IMPAIRED GASTROINTESTINAL TRANSIT AND ITS ASSOCIATED MORBIDITY IN THE INTENSIVE CARE UNIT J CRIT CARE 201328537
bull ASAI T CONSTIPATION DOES IT INCREASE MORBIDITY AND MORTALITY IN CRITICALLY ILL PATIENTS CRIT CARE MED 2007352861-2
bull UNDERSTANDING THE PHYSIOLOGICAL EFFECTS OF UNTREATED PAIN NURSING TIMES VOL 99 ISSUE 37 PAGE NO 28
bull WINFIELD ET AL NON-PHARMACEUTICAL MANAGEMENT OF RESPIRATORY MORBIDITY IN CHILDREN WITH SEVERE GLOBAL DEVELOPMENTAL DELAY THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014
bull OLOUGHLIN EV SOMERVILLE HM SOMERVILLE ER DEALING WITH MULTISYSTEM DISEASE IN PEOPLE WITH A DEVELOPMENTAL DISABILITY MEDICAL JOURNAL OF AUSTRALIA 2009 JUN 1190(11)616-7
bull MESTROVIC J KARDUM G POLIC B MESTROVIC M MARKIC J SUSTIC A ET AL THE INFLUENCE OF CHRONIC HEALTH CONDITIONS ON SUSCEPTIBILITY TO SEVERE ACUTE ILLNESS OF CHILDREN TREATED IN PICU EUROPEAN JOURNAL OF PEDIATRICS 2006 AUG165(8)526-
9
bull HEALY F PANITCH HB PULMONARY COMPLICATIONS OF PEDIATRIC NEUROLOGICAL DISEASES PEDIATR ANN 2010 APR39(4)216-24
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SRIVASTAVA R JACKSON WD BARNHART DC DYSPHAGIA AND GASTROESOPHAGEAL REFLUX DISEASE DILEMMAS IN DIAGNOSIS AND MANAGEMENT IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT PEDIATR ANN 2010 APR39(4)225-31
bull SULLIVAN PB JUSZCZAK E BACHLET AME LAMBERT B VERNON-ROBERTS A GRANT HW ET AL GASTROSTOMY TUBE FEEDING IN CHILDREN WITH CEREBRAL PALSY A PROSPECTIVE LONGITUDINAL STUDY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 2005
FEBRUARY47(2)77-85
bull SOMERVILLE H TZANNES G WOOD J SHUN A HILL C ARROWSMITH F ET AL GASTROINTESTINAL AND NUTRITIONAL PROBLEMS IN SEVERE DEVELOPMENTAL DISABILITY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 200850(9)712-6
bull TODER DS RESPIRATORY PROBLEMS IN THE ADOLESCENT WITH DEVELOPMENTAL DELAY ADOLESCENT MEDICINE 2000 3 OCTOBER 200011(3)617-31
bull LEVIN K COLON A DIPALMA J FITZPATRICK S USING THE RADIONUCLIDE SALIVAGRAM TO DETECT PULMONARY ASPIRATION AND ESOPHAGEAL DYSMOTILITY CLIN NUCL MED 1993 FEB18(2)110-4
bull SCHROEDER AS KLING T HUSS K BORGGRAEFE I KOERTE IK BLASCHEK A ET AL BOTULINUM TOXIN TYPE A AND B FOR THE REDUCTION OF HYPERSALIVATION IN CHILDREN WITH NEUROLOGICAL DISORDERS A FOCUS ON EFFECTIVENESS AND THERAPY ADHERENCE
NEUROPEDIATRICS 201243(1)27-36
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull GOEMINNE P AND DUPONT L (2010) NON-CYSTIC FIBROSIS BRONCHIECTASIS DIAGNOSIS AND MANAGEMENT IN 21ST CENTURY POSTGRADUATE MEDICAL JOURNAL 86(1018) PP493-501
bull LEE A BUTTON B AND TANNENBAUM E (2017) AIRWAY-CLEARANCE TECHNIQUES IN CHILDREN AND ADOLESCENTS WITH CHRONIC SUPPURATIVE LUNG DISEASE AND BRONCHIECTASIS FRONTIERS IN PEDIATRICS 5
bull MANDAL P SIDHU M KOPE L POLLOCK W STEVENSON L PENTLAND J TURNBULL K MAC QUARRIE S AND HILL A (2012) A PILOT STUDY OF PULMONARY REHABILITATION AND CHEST PHYSIOTHERAPY VERSUS CHEST PHYSIOTHERAPY ALONE IN
BRONCHIECTASIS RESPIRATORY MEDICINE 106(12) PP1647-1654
bull MURRAY M PENTLAND J AND HILL A (2009) A RANDOMISED CROSSOVER TRIAL OF CHEST PHYSIOTHERAPY IN NON-CYSTIC FIBROSIS BRONCHIECTASIS EUROPEAN RESPIRATORY JOURNAL 34(5) PP1086-1092
bull NEWALL C STOCKLEY R AND HILL S (2005) EXERCISE TRAINING AND INSPIRATORY MUSCLE TRAINING IN PATIENTS WITH BRONCHIECTASIS THORAX 60(11) PP943-948
bull ONG H LEE A HILL C HOLLAND A AND DENEHY L (2011) EFFECTS OF PULMONARY REHABILITATION IN BRONCHIECTASIS A RETROSPECTIVE STUDY CHRONIC RESPIRATORY DISEASE 8(1) PP21-30
bull QUINT J MILLETT E JOSHI M NAVARATNAM V THOMAS S HURST J SMEETH L AND BROWN J (2015) CHANGES IN THE INCIDENCE PREVALENCE AND MORTALITY OF BRONCHIECTASIS IN THE UK FROM 2004 TO 2013 A POPULATION-BASED COHORT
STUDY EUROPEAN RESPIRATORY JOURNAL 47(1) PP186-193
bull SNIJDERS D FERNANDEZ DOMINGUEZ B CALGARO S BERTOZZI I ESCRIBANO MONTANER A PERILONGO G AND BARBATO A (2015) MUCOCILIARY CLEARANCE TECHNIQUES FOR TREATING NON-CYSTIC FIBROSIS BRONCHIECTASIS IS THERE
EVIDENCE INTERNATIONAL JOURNAL OF IMMUNOPATHOLOGY AND PHARMACOLOGY 28(2) PP150-159
PHYSIO WITH NIV
bull PHYSIO SETTINGS
bull SECRETIONS
bull THORACIC MOBILITY
bull ALLOWS REST PERIOD PRE ACT
bull HUMIDIFICATION
bull INFLATABLE VEST CONNECTED BY TUBES TO AN AIR PULSE GENERATOR WHICH RAPIDLY INFLATES AND DEFLATES THE VEST PRODUCING OSCILLATIONS TO THE CHEST WALL
bull RAPID CHEST MOVEMENT MIMICS A COUGH-LIKE EXPIRATORY FLOW THAT SHEARS MUCUS AWAY FROM THE AIRWAY WALLS AND HELPS TO MOVE IT ALONG TO THE CENTRAL AIRWAYS
bull PASSIVE TREATMENT amp NOT POSITION DEPENDANT
bull COMBINATION OF RX
bull CONTRAINDICATIONS
bull HEAD ANDOR NECK INJURY THAT HAS NOT BEEN STABILISED
bull ACTIVE HAEMORRHAGE WITH HEMODYNAMIC INSTABILITY
HFCWO
HFCWO INDICATIONS
bull CHRONIC MUCUS HYPERSECRETION OR RETENTION ASSOCIATED WITH A CHRONIC PULMONARY OR NEUROMUSCULAR CONDITION
bull LRT SECRETIONS AND FREQUENT LRTI REQUIRING HOSPITAL ADMISSION
bull INEFFECTIVE COUGH OR INABILITY TO REMOVE MUCUS BY COUGHING
bull TENACIOUS SECRETIONS THAT ARE NOT EASILY MOBILISED WITH STANDARD CPT
bull MECHANICALLY VENTILATED WITH EVIDENCE OF SECRETION RETENTION
bull ALTERNATIVE AIRWAY CLEARANCE THERAPY PROVEN INEFFECTIVE OR CONTRAINDICATEDDO NOT TOLERATE STANDARD CPT
bull CONSTANT FATIGUE LACK OF STRENGTH OR ABILITY TO PERFORM ACTIVE TREATMENT
bull SYMPTOMATIC
bull POOR COMPLIANCE WITH OTHER AIRWAY CLEARANCE METHODS
bull HIGH BURDEN OF CARE
bull PATIENT UNABLE TO TOLERATE THE INCREASED WORK OF BREATHING bull ACTIVE HAEMOPTYSIS bull UNTREATED PNEUMOTHORAX bull INTRACRANIAL PRESSURE (ICP) gt 20 MMHG bull HAEMODYNAMIC INSTABILITY bull SEVERE CARDIOVASCULAR INSULTDISEASE bull RECENT FACIAL ORAL OR SKULL SURGERY OR TRAUMA bull ACUTE SINUSITIS bull EPISTAXIS bull POST OESOPHAGEAL amp LUNG SURGERY bull KNOWN OR SUSPECTED TYMPANIC MEMBRANE RUPTURE OR OTHER MIDDLE EAR
PATHOLOGY
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
POSSIBLE HAZARDSCOMPLICATIONS
bull INCREASED WORK OF BREATHING THAT MAY LEAD TO HYPOVENTILATION AND
HYPERCARBIA
bull INCREASED INTRACRANIAL PRESSURE
bull CARDIOVASCULAR COMPROMISE
bull NAUSEA
bull MYOCARDIAL ISCHEMIA
bull DECREASED VENOUS RETURN
bull AIR SWALLOWING WITH INCREASED LIKELIHOOD OF VOMITING AND
ASPIRATION
bull CLAUSTROPHOBIA
bull SKIN BREAK DOWN AND DISCOMFORT FROM MASK
bull PULMONARY BAROTRAUMA
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
MI-E
bull USED WITH CHILDREN WHO HAVE DECREASED INSPIRATORY EFFORT DUE TO EITHER SPINAL CORD INJURY OR NMW AND WHO HAVE AN IMPAIRED OR INEFFECTIVE COUGH WITH APPROPRIATE RESPIRATORY SYMPTOMS
bull CONSIDERED WHEN CONVENTIONAL COUGH ASSISTANCE TECHNIQUES BECOME INEFFECTIVE
bull ACCEPTED AS THE CORE STANDARD FOR CHILD WITH NMW
bull MIE WORKS BY
bull INFLATING THE LUNGS WITH GRADUAL POSITIVE AIRWAY PRESSURE ASSISTING INSPIRATION CALLED INSUFFLATION
bull FOLLOWED BY A RAPID SWITCH TO NEGATIVE PRESSURE WHICH SIMULATES THE FLOW CHANGES THAT OCCUR DURING A COUGH THEREBY ENHANCING EXPIRATORY FLOW CALLED EXSUFFLATION AND ASSISTING EXPECTORATION OF SECRETIONS
bull MOVEMENT AND EXERCISE BEST FUNCTIONAL METHOD OF AIRWAY CLEARANCE
bull CPET BETTER CORRELATION THAN LUNG FUNCTION IN SURVIVAL RATES IN PEOPLE WITH
CYSTIC FIBROSIS
bull RUNNINGWALKING BETTER FOR SECRETION CLEARANCE THAN BIKE DURING TO SHEARING
MECHANISM
bull CONSIDER ADDING IN HUFFS (DYER)
bull CONSIDER USE OF AD BELT
EXERCISE
bull APCP SUCTION GUIDELINES
bull TYPESNASOPHARANGEAL OROPHARANGEAL AND TRACHEOSTOMY
bull MAIN VARIABLES SUCTION TYPE AND SIZE DEPTH OF SUCTION
PRESSURE TECHNIQUE
SUCTION
SPUTUM
bull SPUTUM bull 95 WATER bull COLOUR bull VOLUME bull CONSISTENCY bull ODOUR
bull PURPOSE bull HUMIDIFICATION bull WATERPROOFING bull PROTECTION OF EPITHELIUM
HUMIDIFICATION
bull METABOLIC AND VENTILATORY REQUIREMENTS ARE X2-3 OF ADULTS
IMPLICATION
bull HEAT AND MOISTURE LOSSES FROM RESPIRATION WILL INCREASE BY X2-3
bull CONSUME GREATER AMOUNTS OF ENERGY AND WATER
HUMIDIFICATION INHALATION
THERAPY
bull TRACHEOSTOMY HME
bull WET DRY CIRCUIT
bull NEBULISERS INHALERS MUCOLYTICS
bull HUMIDIFIERS WITH NIV
bull OXYGEN
bull SYSTEMIC HYDRATION ENVIRONMENT
NEBULISERS
bull NEBULISER CHAMBER CONVERTS LIQUID INTO
RESPIRABLE PARTICLES
bull MOISTURE DESCENDS THROUGH THE HOLES IN THE SUPERFICIAL GEL LAYER
bull INCREASES THE SOL LAYER SO THE CILIARY BEAT IS OPTIMAL FOR MUCUS TRANSPORT
bull SHORT TERM HUMIDIFICATION
bull DAILY WASHING OF NEBULISER SYSTEM
TIMING OF DRUG AND PHYSIOTHERAPY
BEFORE TREATMENT
bull DNASE (PULMOZYME)
bull SALBUTAMOL
(VENTOLIN BLUE)
bull SALINE NEBS
AFTER TREATMENT
bull SERETIDE (PURPLE)
bull BECLOMETHASONE (BECOTIDE BROWN)
bull COLISTIN (COLOMYCIN PROMIXIN)
bull TOBRAMYCIN
CONCLUSION
bull BE AWARE OF CHILDrsquoS RESPIRATORY FUNCTION
bull CHOSE ACT BEST FOR THEM bull TYPE OF KETCHUP BOTTLE bull LV SECRETION RETENTION WOB
bull EARLY RESPIRATORY REFERRAL
bull RESPIRATORY CARE COMPETENCIES
bull EFFECTIVE SECRETION CLEARANCE AT HOMERESPITESCHOOL
bull USE OF PEAK COUGH FLOWS TO AID CHOICE OF ADJUNCT
0
50
100
150
200
250
300
350
400
0
50
100
150
200
250
300
350
400
Green
Key
Additional info
(please comment) Please refer to BTSACPRC Guideline
Lothian University Hospitals NHS Trust
n PCF
gt270lmin
Breathstack
ing tri-
flow
blowing
REFERENCES bull BTSACPRC GUIDELINE IS PUBLISHED IN THORAX VOL 67 SUPPLEMENT 1
bull AVAILABLE ONLINE AT HTTPTHORAXBMJCOMCONTENTVOL64ISSUESUPPLI
bull HTTPWWWBRIT-THORACICORGUKPHYSIOGUIDE
bull BRITISH THORACIC SOCIETY REPORTS VOL 1 NO 1 2009
bull ADAPTED PRYOR AJ AND PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS3RD ED
bull HOUGH A PHYSIOTHERAPY IN RESPIRATORY CARE LONDON CHAPMAN AND HALL 1993
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1997) POSTURAL DRAINAGE AND GASTRO-OESOPHAGEAL REFLUX IN INFANTS WITH CYSTIC FIBROSIS ARCHIVES OF DISEASE IN CHILDHOOD 76 148-150
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1998) POSTURAL DRAINAGE IN CYSTIC FIBROSIS IS THERE A LINK WITH GASTRO-OESOPHAGEAL REFLUX JOURNAL OF PAEDIATRIC CHILD HEALTH 34 330-334
bull CECINS NM JENKINS SC PENGELLEY J ET AL (1999) THE ACTIVE CYCLE OF BREATHING TECHNIQUES-TO TIP OR NOT TO TIP RESPIRATORY MEDICINE 93 660-665
bull CONSTANTINI D BRIVIO A BRUSA D ET AL (2001) PEP MASK VERSUS POSTURAL DRAINAGE IN INFANTS A LONG-TERM COMPARATIVE TRIAL PEADIATRIC PULMONOLOGY
bull HOUGH A (2001) PHYSIOTHERAPY IN RESPIRATORY CARE AN EVIDENCE-BASED APPROACH TO RESPIRATORY AND CARDIAC MANAGEMENT CENGAGE LEARNING EMEA
bull INTERNATIONAL PHYSIOTHERAPY GROUP FOR CYSTIC FIBROSIS PHYSIOTHERAPY IN THE TREATMENT OF CYSTIC FIBROSIS (2009) HTTPSWWWECFSEUIPG_CFBOOKLET INTERNATIONAL PHYSIOTHERAPY GROUP ndash THE BLUE BOOKLET
bull KONSTAN MW STERN RC DOERSHUK CF (1994) EFFICACY OF THE FLUTTER DEVICE FOR AIRWAY MUCUS CLEARANCE IN PATIENTS WITH CYSTIC FIBROSIS JOURNAL OF PEDIATRICS 124 (5 (PT 1) 689-693
bull MCILWAINE M BUTTON B AND DWAN K (2015) POSITIVE EXPIRATORY PRESSURE PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 6 ART NO CD003147 DOI 10100214651858CD003147PUB4
bull MESTRINER RG FERNANDES RO STAFFEN LC ET AL (2009) OPTIMUM DESIGN PARAMETERS FOR A THERAPIST-CONSTRUCTED POSITIVE-EXPIRATORY-PRESSURE THERAPY BOTTLE DEVICE RESPIRATORY CARE 54 504-8
bull MORRISON L AND AGNEW J (2014) OSCILLATING DEVICES FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 7 ART NO CD006842 DOI 10100214651858CD006842PUB
bull OERMANN CM SOCKRIDER MM GILES D ET AL (2001) COMPARISON OF HIGH-FREQUENCY CHEST WALL OSCILLATION AND OSCILLATING POSITIVE EXPIRATORY PRESSURE IN THE HOME MANAGEMENT OF CYSTIC FIBROSIS A PILOT STUDY PEDIATRIC PULMONOLOGY 32 (5) 372-7
bull PRASAD SA AND HUSSEY J (1995) PAEDIATRIC RESPIRATORY CARE A GUIDE FOR PHYSIOTHERAPISTS AND HEALTH PROFESSIONALS CHAPMAN amp HALL
bull PRYOR J (1999) PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN ADULTS EUROPEAN RESPIRATORY JOURNAL 14 (6) 1418-1424
bull PRYOR JA amp PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS CHURCHILL LIVINGSTONE
bull PRYOR JA WEBBER BA HODSON ME ET AL (1994) THE FLUTTER VRP1 AS AN ADJUNCT TO CHEST PHYSIOTHERAPY IN CYSTIC FIBROSIS RESPIRATORY MEDICINE 88677-81
bull WEST K WALLEN M FOLLETT J (2010) ACAPELLA VS PEP MASK THERAPY A RANDOMISED TRIAL IN CHILDREN WITH CYSTIC FIBROSIS DURING RESPIRATORY EXACERBATION PHYSIOTHERAPY THEORY PRACTICE 26143-9
bull WILSONLM AGNEW J MORRISON L ET AL (2014) AIRWAY CLEARANCE TECHNIQUES FOR CYSTIC FIBROSIS AN OVERVIEW OF COCHRANE SYSTEMATIC REVIEWS COCHRANE DATABASE OF SYSTEMATIC REVIEWS DOI 10100214651858CD011231
bull VOLSKO TA DIFIORE JM CHATBURN RL (2003) PERFORMANCE COMPARISON OF TWO OSCILLATORY POSITIVE PRESSURE DEVICES ACAPELLA VERSUS FLUTTER RESPIRATORY CARE 48 (2) 124- 130
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SEDDON PC KHAN Y RESPIRATORY PROBLEMS IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT ARCHIVES OF DISEASE IN CHILDHOOD 2003 01 JAN88(1)75-8
bull MARKS JH PULMONARY CARE OF CHILDREN AND ADOLESCENTS WITH DEVELOPMENTAL DISABILITIES PEDIATR CLIN NORTH AM 2008 DECEMBER55(6)1299-314
bull ARENS R MUZUMDAR H SLEEP SLEEP DISORDERED BREATHING AND NOCTURNAL HYPOVENTILATION IN CHILDREN WITH NEUROMUSCULAR DISEASES PAEDIATRIC RESPIRATORY REVIEWS 2010 MAR11(1)24-30
bull FITZGERALD DA FOLLETT J VAN ASPEREN PP ASSESSING AND MANAGING LUNG DISEASE AND SLEEP DISORDERED BREATHING IN CHILDREN WITH CEREBRAL PALSY PAEDIATRIC RESPIRATORY REVIEWS 2009 MARCH10(1)18-24
bull HSIAO KH NIXON GM THE EFFECT OF TREATMENT OF OBSTRUCTIVE SLEEP APNEA ON QUALITY OF LIFE IN CHILDREN WITH CEREBRAL PALSY RES DEV DISABIL 2008 MAR-APR29(2)133-40
bull LUNDBERG A OXYGEN CONSUMPTION IN RELATION TO WORKLOAD IN STUDENTS WITH CEREBRAL PALSY J APPL PHYSIO 197640873-5
bull SULLIVAN PB ROSENBLOOM L FEEDING THE DISABLED CHILD CLINICS IN DEVELOPMENTAL MEDICINE MACKEITH PRESS 1999140
bull MARTIN TR THE RELATIONSHIP BETWEEN MALNUTRITION AND LUNG INFECTIONS CLIN CHEST MED 19878359
bull MOSTAFA SM BHANDARI S RITCHIE G ET AL CONSTIPATION AND ITS IMPLICATIONS IN THE CRITICALLY ILL PATIENT BR J ANAESTH 200391815-9 3
bull GACOUIN A CAMUS C GROS A ET AL CONSTIPATION IN LONGTERM VENTILATED PATIENTS ASSOCIATED FACTORS AND IMPACT ON INTENSIVE CARE UNIT OUTCOMES CRIT CARE MED 2010381933- 8
bull NGUYEN T FRENETTE AJ JOHANSON C ET AL IMPAIRED GASTROINTESTINAL TRANSIT AND ITS ASSOCIATED MORBIDITY IN THE INTENSIVE CARE UNIT J CRIT CARE 201328537
bull ASAI T CONSTIPATION DOES IT INCREASE MORBIDITY AND MORTALITY IN CRITICALLY ILL PATIENTS CRIT CARE MED 2007352861-2
bull UNDERSTANDING THE PHYSIOLOGICAL EFFECTS OF UNTREATED PAIN NURSING TIMES VOL 99 ISSUE 37 PAGE NO 28
bull WINFIELD ET AL NON-PHARMACEUTICAL MANAGEMENT OF RESPIRATORY MORBIDITY IN CHILDREN WITH SEVERE GLOBAL DEVELOPMENTAL DELAY THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014
bull OLOUGHLIN EV SOMERVILLE HM SOMERVILLE ER DEALING WITH MULTISYSTEM DISEASE IN PEOPLE WITH A DEVELOPMENTAL DISABILITY MEDICAL JOURNAL OF AUSTRALIA 2009 JUN 1190(11)616-7
bull MESTROVIC J KARDUM G POLIC B MESTROVIC M MARKIC J SUSTIC A ET AL THE INFLUENCE OF CHRONIC HEALTH CONDITIONS ON SUSCEPTIBILITY TO SEVERE ACUTE ILLNESS OF CHILDREN TREATED IN PICU EUROPEAN JOURNAL OF PEDIATRICS 2006 AUG165(8)526-
9
bull HEALY F PANITCH HB PULMONARY COMPLICATIONS OF PEDIATRIC NEUROLOGICAL DISEASES PEDIATR ANN 2010 APR39(4)216-24
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SRIVASTAVA R JACKSON WD BARNHART DC DYSPHAGIA AND GASTROESOPHAGEAL REFLUX DISEASE DILEMMAS IN DIAGNOSIS AND MANAGEMENT IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT PEDIATR ANN 2010 APR39(4)225-31
bull SULLIVAN PB JUSZCZAK E BACHLET AME LAMBERT B VERNON-ROBERTS A GRANT HW ET AL GASTROSTOMY TUBE FEEDING IN CHILDREN WITH CEREBRAL PALSY A PROSPECTIVE LONGITUDINAL STUDY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 2005
FEBRUARY47(2)77-85
bull SOMERVILLE H TZANNES G WOOD J SHUN A HILL C ARROWSMITH F ET AL GASTROINTESTINAL AND NUTRITIONAL PROBLEMS IN SEVERE DEVELOPMENTAL DISABILITY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 200850(9)712-6
bull TODER DS RESPIRATORY PROBLEMS IN THE ADOLESCENT WITH DEVELOPMENTAL DELAY ADOLESCENT MEDICINE 2000 3 OCTOBER 200011(3)617-31
bull LEVIN K COLON A DIPALMA J FITZPATRICK S USING THE RADIONUCLIDE SALIVAGRAM TO DETECT PULMONARY ASPIRATION AND ESOPHAGEAL DYSMOTILITY CLIN NUCL MED 1993 FEB18(2)110-4
bull SCHROEDER AS KLING T HUSS K BORGGRAEFE I KOERTE IK BLASCHEK A ET AL BOTULINUM TOXIN TYPE A AND B FOR THE REDUCTION OF HYPERSALIVATION IN CHILDREN WITH NEUROLOGICAL DISORDERS A FOCUS ON EFFECTIVENESS AND THERAPY ADHERENCE
NEUROPEDIATRICS 201243(1)27-36
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull GOEMINNE P AND DUPONT L (2010) NON-CYSTIC FIBROSIS BRONCHIECTASIS DIAGNOSIS AND MANAGEMENT IN 21ST CENTURY POSTGRADUATE MEDICAL JOURNAL 86(1018) PP493-501
bull LEE A BUTTON B AND TANNENBAUM E (2017) AIRWAY-CLEARANCE TECHNIQUES IN CHILDREN AND ADOLESCENTS WITH CHRONIC SUPPURATIVE LUNG DISEASE AND BRONCHIECTASIS FRONTIERS IN PEDIATRICS 5
bull MANDAL P SIDHU M KOPE L POLLOCK W STEVENSON L PENTLAND J TURNBULL K MAC QUARRIE S AND HILL A (2012) A PILOT STUDY OF PULMONARY REHABILITATION AND CHEST PHYSIOTHERAPY VERSUS CHEST PHYSIOTHERAPY ALONE IN
BRONCHIECTASIS RESPIRATORY MEDICINE 106(12) PP1647-1654
bull MURRAY M PENTLAND J AND HILL A (2009) A RANDOMISED CROSSOVER TRIAL OF CHEST PHYSIOTHERAPY IN NON-CYSTIC FIBROSIS BRONCHIECTASIS EUROPEAN RESPIRATORY JOURNAL 34(5) PP1086-1092
bull NEWALL C STOCKLEY R AND HILL S (2005) EXERCISE TRAINING AND INSPIRATORY MUSCLE TRAINING IN PATIENTS WITH BRONCHIECTASIS THORAX 60(11) PP943-948
bull ONG H LEE A HILL C HOLLAND A AND DENEHY L (2011) EFFECTS OF PULMONARY REHABILITATION IN BRONCHIECTASIS A RETROSPECTIVE STUDY CHRONIC RESPIRATORY DISEASE 8(1) PP21-30
bull QUINT J MILLETT E JOSHI M NAVARATNAM V THOMAS S HURST J SMEETH L AND BROWN J (2015) CHANGES IN THE INCIDENCE PREVALENCE AND MORTALITY OF BRONCHIECTASIS IN THE UK FROM 2004 TO 2013 A POPULATION-BASED COHORT
STUDY EUROPEAN RESPIRATORY JOURNAL 47(1) PP186-193
bull SNIJDERS D FERNANDEZ DOMINGUEZ B CALGARO S BERTOZZI I ESCRIBANO MONTANER A PERILONGO G AND BARBATO A (2015) MUCOCILIARY CLEARANCE TECHNIQUES FOR TREATING NON-CYSTIC FIBROSIS BRONCHIECTASIS IS THERE
EVIDENCE INTERNATIONAL JOURNAL OF IMMUNOPATHOLOGY AND PHARMACOLOGY 28(2) PP150-159
bull INFLATABLE VEST CONNECTED BY TUBES TO AN AIR PULSE GENERATOR WHICH RAPIDLY INFLATES AND DEFLATES THE VEST PRODUCING OSCILLATIONS TO THE CHEST WALL
bull RAPID CHEST MOVEMENT MIMICS A COUGH-LIKE EXPIRATORY FLOW THAT SHEARS MUCUS AWAY FROM THE AIRWAY WALLS AND HELPS TO MOVE IT ALONG TO THE CENTRAL AIRWAYS
bull PASSIVE TREATMENT amp NOT POSITION DEPENDANT
bull COMBINATION OF RX
bull CONTRAINDICATIONS
bull HEAD ANDOR NECK INJURY THAT HAS NOT BEEN STABILISED
bull ACTIVE HAEMORRHAGE WITH HEMODYNAMIC INSTABILITY
HFCWO
HFCWO INDICATIONS
bull CHRONIC MUCUS HYPERSECRETION OR RETENTION ASSOCIATED WITH A CHRONIC PULMONARY OR NEUROMUSCULAR CONDITION
bull LRT SECRETIONS AND FREQUENT LRTI REQUIRING HOSPITAL ADMISSION
bull INEFFECTIVE COUGH OR INABILITY TO REMOVE MUCUS BY COUGHING
bull TENACIOUS SECRETIONS THAT ARE NOT EASILY MOBILISED WITH STANDARD CPT
bull MECHANICALLY VENTILATED WITH EVIDENCE OF SECRETION RETENTION
bull ALTERNATIVE AIRWAY CLEARANCE THERAPY PROVEN INEFFECTIVE OR CONTRAINDICATEDDO NOT TOLERATE STANDARD CPT
bull CONSTANT FATIGUE LACK OF STRENGTH OR ABILITY TO PERFORM ACTIVE TREATMENT
bull SYMPTOMATIC
bull POOR COMPLIANCE WITH OTHER AIRWAY CLEARANCE METHODS
bull HIGH BURDEN OF CARE
bull PATIENT UNABLE TO TOLERATE THE INCREASED WORK OF BREATHING bull ACTIVE HAEMOPTYSIS bull UNTREATED PNEUMOTHORAX bull INTRACRANIAL PRESSURE (ICP) gt 20 MMHG bull HAEMODYNAMIC INSTABILITY bull SEVERE CARDIOVASCULAR INSULTDISEASE bull RECENT FACIAL ORAL OR SKULL SURGERY OR TRAUMA bull ACUTE SINUSITIS bull EPISTAXIS bull POST OESOPHAGEAL amp LUNG SURGERY bull KNOWN OR SUSPECTED TYMPANIC MEMBRANE RUPTURE OR OTHER MIDDLE EAR
PATHOLOGY
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
POSSIBLE HAZARDSCOMPLICATIONS
bull INCREASED WORK OF BREATHING THAT MAY LEAD TO HYPOVENTILATION AND
HYPERCARBIA
bull INCREASED INTRACRANIAL PRESSURE
bull CARDIOVASCULAR COMPROMISE
bull NAUSEA
bull MYOCARDIAL ISCHEMIA
bull DECREASED VENOUS RETURN
bull AIR SWALLOWING WITH INCREASED LIKELIHOOD OF VOMITING AND
ASPIRATION
bull CLAUSTROPHOBIA
bull SKIN BREAK DOWN AND DISCOMFORT FROM MASK
bull PULMONARY BAROTRAUMA
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
MI-E
bull USED WITH CHILDREN WHO HAVE DECREASED INSPIRATORY EFFORT DUE TO EITHER SPINAL CORD INJURY OR NMW AND WHO HAVE AN IMPAIRED OR INEFFECTIVE COUGH WITH APPROPRIATE RESPIRATORY SYMPTOMS
bull CONSIDERED WHEN CONVENTIONAL COUGH ASSISTANCE TECHNIQUES BECOME INEFFECTIVE
bull ACCEPTED AS THE CORE STANDARD FOR CHILD WITH NMW
bull MIE WORKS BY
bull INFLATING THE LUNGS WITH GRADUAL POSITIVE AIRWAY PRESSURE ASSISTING INSPIRATION CALLED INSUFFLATION
bull FOLLOWED BY A RAPID SWITCH TO NEGATIVE PRESSURE WHICH SIMULATES THE FLOW CHANGES THAT OCCUR DURING A COUGH THEREBY ENHANCING EXPIRATORY FLOW CALLED EXSUFFLATION AND ASSISTING EXPECTORATION OF SECRETIONS
bull MOVEMENT AND EXERCISE BEST FUNCTIONAL METHOD OF AIRWAY CLEARANCE
bull CPET BETTER CORRELATION THAN LUNG FUNCTION IN SURVIVAL RATES IN PEOPLE WITH
CYSTIC FIBROSIS
bull RUNNINGWALKING BETTER FOR SECRETION CLEARANCE THAN BIKE DURING TO SHEARING
MECHANISM
bull CONSIDER ADDING IN HUFFS (DYER)
bull CONSIDER USE OF AD BELT
EXERCISE
bull APCP SUCTION GUIDELINES
bull TYPESNASOPHARANGEAL OROPHARANGEAL AND TRACHEOSTOMY
bull MAIN VARIABLES SUCTION TYPE AND SIZE DEPTH OF SUCTION
PRESSURE TECHNIQUE
SUCTION
SPUTUM
bull SPUTUM bull 95 WATER bull COLOUR bull VOLUME bull CONSISTENCY bull ODOUR
bull PURPOSE bull HUMIDIFICATION bull WATERPROOFING bull PROTECTION OF EPITHELIUM
HUMIDIFICATION
bull METABOLIC AND VENTILATORY REQUIREMENTS ARE X2-3 OF ADULTS
IMPLICATION
bull HEAT AND MOISTURE LOSSES FROM RESPIRATION WILL INCREASE BY X2-3
bull CONSUME GREATER AMOUNTS OF ENERGY AND WATER
HUMIDIFICATION INHALATION
THERAPY
bull TRACHEOSTOMY HME
bull WET DRY CIRCUIT
bull NEBULISERS INHALERS MUCOLYTICS
bull HUMIDIFIERS WITH NIV
bull OXYGEN
bull SYSTEMIC HYDRATION ENVIRONMENT
NEBULISERS
bull NEBULISER CHAMBER CONVERTS LIQUID INTO
RESPIRABLE PARTICLES
bull MOISTURE DESCENDS THROUGH THE HOLES IN THE SUPERFICIAL GEL LAYER
bull INCREASES THE SOL LAYER SO THE CILIARY BEAT IS OPTIMAL FOR MUCUS TRANSPORT
bull SHORT TERM HUMIDIFICATION
bull DAILY WASHING OF NEBULISER SYSTEM
TIMING OF DRUG AND PHYSIOTHERAPY
BEFORE TREATMENT
bull DNASE (PULMOZYME)
bull SALBUTAMOL
(VENTOLIN BLUE)
bull SALINE NEBS
AFTER TREATMENT
bull SERETIDE (PURPLE)
bull BECLOMETHASONE (BECOTIDE BROWN)
bull COLISTIN (COLOMYCIN PROMIXIN)
bull TOBRAMYCIN
CONCLUSION
bull BE AWARE OF CHILDrsquoS RESPIRATORY FUNCTION
bull CHOSE ACT BEST FOR THEM bull TYPE OF KETCHUP BOTTLE bull LV SECRETION RETENTION WOB
bull EARLY RESPIRATORY REFERRAL
bull RESPIRATORY CARE COMPETENCIES
bull EFFECTIVE SECRETION CLEARANCE AT HOMERESPITESCHOOL
bull USE OF PEAK COUGH FLOWS TO AID CHOICE OF ADJUNCT
0
50
100
150
200
250
300
350
400
0
50
100
150
200
250
300
350
400
Green
Key
Additional info
(please comment) Please refer to BTSACPRC Guideline
Lothian University Hospitals NHS Trust
n PCF
gt270lmin
Breathstack
ing tri-
flow
blowing
REFERENCES bull BTSACPRC GUIDELINE IS PUBLISHED IN THORAX VOL 67 SUPPLEMENT 1
bull AVAILABLE ONLINE AT HTTPTHORAXBMJCOMCONTENTVOL64ISSUESUPPLI
bull HTTPWWWBRIT-THORACICORGUKPHYSIOGUIDE
bull BRITISH THORACIC SOCIETY REPORTS VOL 1 NO 1 2009
bull ADAPTED PRYOR AJ AND PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS3RD ED
bull HOUGH A PHYSIOTHERAPY IN RESPIRATORY CARE LONDON CHAPMAN AND HALL 1993
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1997) POSTURAL DRAINAGE AND GASTRO-OESOPHAGEAL REFLUX IN INFANTS WITH CYSTIC FIBROSIS ARCHIVES OF DISEASE IN CHILDHOOD 76 148-150
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1998) POSTURAL DRAINAGE IN CYSTIC FIBROSIS IS THERE A LINK WITH GASTRO-OESOPHAGEAL REFLUX JOURNAL OF PAEDIATRIC CHILD HEALTH 34 330-334
bull CECINS NM JENKINS SC PENGELLEY J ET AL (1999) THE ACTIVE CYCLE OF BREATHING TECHNIQUES-TO TIP OR NOT TO TIP RESPIRATORY MEDICINE 93 660-665
bull CONSTANTINI D BRIVIO A BRUSA D ET AL (2001) PEP MASK VERSUS POSTURAL DRAINAGE IN INFANTS A LONG-TERM COMPARATIVE TRIAL PEADIATRIC PULMONOLOGY
bull HOUGH A (2001) PHYSIOTHERAPY IN RESPIRATORY CARE AN EVIDENCE-BASED APPROACH TO RESPIRATORY AND CARDIAC MANAGEMENT CENGAGE LEARNING EMEA
bull INTERNATIONAL PHYSIOTHERAPY GROUP FOR CYSTIC FIBROSIS PHYSIOTHERAPY IN THE TREATMENT OF CYSTIC FIBROSIS (2009) HTTPSWWWECFSEUIPG_CFBOOKLET INTERNATIONAL PHYSIOTHERAPY GROUP ndash THE BLUE BOOKLET
bull KONSTAN MW STERN RC DOERSHUK CF (1994) EFFICACY OF THE FLUTTER DEVICE FOR AIRWAY MUCUS CLEARANCE IN PATIENTS WITH CYSTIC FIBROSIS JOURNAL OF PEDIATRICS 124 (5 (PT 1) 689-693
bull MCILWAINE M BUTTON B AND DWAN K (2015) POSITIVE EXPIRATORY PRESSURE PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 6 ART NO CD003147 DOI 10100214651858CD003147PUB4
bull MESTRINER RG FERNANDES RO STAFFEN LC ET AL (2009) OPTIMUM DESIGN PARAMETERS FOR A THERAPIST-CONSTRUCTED POSITIVE-EXPIRATORY-PRESSURE THERAPY BOTTLE DEVICE RESPIRATORY CARE 54 504-8
bull MORRISON L AND AGNEW J (2014) OSCILLATING DEVICES FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 7 ART NO CD006842 DOI 10100214651858CD006842PUB
bull OERMANN CM SOCKRIDER MM GILES D ET AL (2001) COMPARISON OF HIGH-FREQUENCY CHEST WALL OSCILLATION AND OSCILLATING POSITIVE EXPIRATORY PRESSURE IN THE HOME MANAGEMENT OF CYSTIC FIBROSIS A PILOT STUDY PEDIATRIC PULMONOLOGY 32 (5) 372-7
bull PRASAD SA AND HUSSEY J (1995) PAEDIATRIC RESPIRATORY CARE A GUIDE FOR PHYSIOTHERAPISTS AND HEALTH PROFESSIONALS CHAPMAN amp HALL
bull PRYOR J (1999) PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN ADULTS EUROPEAN RESPIRATORY JOURNAL 14 (6) 1418-1424
bull PRYOR JA amp PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS CHURCHILL LIVINGSTONE
bull PRYOR JA WEBBER BA HODSON ME ET AL (1994) THE FLUTTER VRP1 AS AN ADJUNCT TO CHEST PHYSIOTHERAPY IN CYSTIC FIBROSIS RESPIRATORY MEDICINE 88677-81
bull WEST K WALLEN M FOLLETT J (2010) ACAPELLA VS PEP MASK THERAPY A RANDOMISED TRIAL IN CHILDREN WITH CYSTIC FIBROSIS DURING RESPIRATORY EXACERBATION PHYSIOTHERAPY THEORY PRACTICE 26143-9
bull WILSONLM AGNEW J MORRISON L ET AL (2014) AIRWAY CLEARANCE TECHNIQUES FOR CYSTIC FIBROSIS AN OVERVIEW OF COCHRANE SYSTEMATIC REVIEWS COCHRANE DATABASE OF SYSTEMATIC REVIEWS DOI 10100214651858CD011231
bull VOLSKO TA DIFIORE JM CHATBURN RL (2003) PERFORMANCE COMPARISON OF TWO OSCILLATORY POSITIVE PRESSURE DEVICES ACAPELLA VERSUS FLUTTER RESPIRATORY CARE 48 (2) 124- 130
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SEDDON PC KHAN Y RESPIRATORY PROBLEMS IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT ARCHIVES OF DISEASE IN CHILDHOOD 2003 01 JAN88(1)75-8
bull MARKS JH PULMONARY CARE OF CHILDREN AND ADOLESCENTS WITH DEVELOPMENTAL DISABILITIES PEDIATR CLIN NORTH AM 2008 DECEMBER55(6)1299-314
bull ARENS R MUZUMDAR H SLEEP SLEEP DISORDERED BREATHING AND NOCTURNAL HYPOVENTILATION IN CHILDREN WITH NEUROMUSCULAR DISEASES PAEDIATRIC RESPIRATORY REVIEWS 2010 MAR11(1)24-30
bull FITZGERALD DA FOLLETT J VAN ASPEREN PP ASSESSING AND MANAGING LUNG DISEASE AND SLEEP DISORDERED BREATHING IN CHILDREN WITH CEREBRAL PALSY PAEDIATRIC RESPIRATORY REVIEWS 2009 MARCH10(1)18-24
bull HSIAO KH NIXON GM THE EFFECT OF TREATMENT OF OBSTRUCTIVE SLEEP APNEA ON QUALITY OF LIFE IN CHILDREN WITH CEREBRAL PALSY RES DEV DISABIL 2008 MAR-APR29(2)133-40
bull LUNDBERG A OXYGEN CONSUMPTION IN RELATION TO WORKLOAD IN STUDENTS WITH CEREBRAL PALSY J APPL PHYSIO 197640873-5
bull SULLIVAN PB ROSENBLOOM L FEEDING THE DISABLED CHILD CLINICS IN DEVELOPMENTAL MEDICINE MACKEITH PRESS 1999140
bull MARTIN TR THE RELATIONSHIP BETWEEN MALNUTRITION AND LUNG INFECTIONS CLIN CHEST MED 19878359
bull MOSTAFA SM BHANDARI S RITCHIE G ET AL CONSTIPATION AND ITS IMPLICATIONS IN THE CRITICALLY ILL PATIENT BR J ANAESTH 200391815-9 3
bull GACOUIN A CAMUS C GROS A ET AL CONSTIPATION IN LONGTERM VENTILATED PATIENTS ASSOCIATED FACTORS AND IMPACT ON INTENSIVE CARE UNIT OUTCOMES CRIT CARE MED 2010381933- 8
bull NGUYEN T FRENETTE AJ JOHANSON C ET AL IMPAIRED GASTROINTESTINAL TRANSIT AND ITS ASSOCIATED MORBIDITY IN THE INTENSIVE CARE UNIT J CRIT CARE 201328537
bull ASAI T CONSTIPATION DOES IT INCREASE MORBIDITY AND MORTALITY IN CRITICALLY ILL PATIENTS CRIT CARE MED 2007352861-2
bull UNDERSTANDING THE PHYSIOLOGICAL EFFECTS OF UNTREATED PAIN NURSING TIMES VOL 99 ISSUE 37 PAGE NO 28
bull WINFIELD ET AL NON-PHARMACEUTICAL MANAGEMENT OF RESPIRATORY MORBIDITY IN CHILDREN WITH SEVERE GLOBAL DEVELOPMENTAL DELAY THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014
bull OLOUGHLIN EV SOMERVILLE HM SOMERVILLE ER DEALING WITH MULTISYSTEM DISEASE IN PEOPLE WITH A DEVELOPMENTAL DISABILITY MEDICAL JOURNAL OF AUSTRALIA 2009 JUN 1190(11)616-7
bull MESTROVIC J KARDUM G POLIC B MESTROVIC M MARKIC J SUSTIC A ET AL THE INFLUENCE OF CHRONIC HEALTH CONDITIONS ON SUSCEPTIBILITY TO SEVERE ACUTE ILLNESS OF CHILDREN TREATED IN PICU EUROPEAN JOURNAL OF PEDIATRICS 2006 AUG165(8)526-
9
bull HEALY F PANITCH HB PULMONARY COMPLICATIONS OF PEDIATRIC NEUROLOGICAL DISEASES PEDIATR ANN 2010 APR39(4)216-24
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SRIVASTAVA R JACKSON WD BARNHART DC DYSPHAGIA AND GASTROESOPHAGEAL REFLUX DISEASE DILEMMAS IN DIAGNOSIS AND MANAGEMENT IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT PEDIATR ANN 2010 APR39(4)225-31
bull SULLIVAN PB JUSZCZAK E BACHLET AME LAMBERT B VERNON-ROBERTS A GRANT HW ET AL GASTROSTOMY TUBE FEEDING IN CHILDREN WITH CEREBRAL PALSY A PROSPECTIVE LONGITUDINAL STUDY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 2005
FEBRUARY47(2)77-85
bull SOMERVILLE H TZANNES G WOOD J SHUN A HILL C ARROWSMITH F ET AL GASTROINTESTINAL AND NUTRITIONAL PROBLEMS IN SEVERE DEVELOPMENTAL DISABILITY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 200850(9)712-6
bull TODER DS RESPIRATORY PROBLEMS IN THE ADOLESCENT WITH DEVELOPMENTAL DELAY ADOLESCENT MEDICINE 2000 3 OCTOBER 200011(3)617-31
bull LEVIN K COLON A DIPALMA J FITZPATRICK S USING THE RADIONUCLIDE SALIVAGRAM TO DETECT PULMONARY ASPIRATION AND ESOPHAGEAL DYSMOTILITY CLIN NUCL MED 1993 FEB18(2)110-4
bull SCHROEDER AS KLING T HUSS K BORGGRAEFE I KOERTE IK BLASCHEK A ET AL BOTULINUM TOXIN TYPE A AND B FOR THE REDUCTION OF HYPERSALIVATION IN CHILDREN WITH NEUROLOGICAL DISORDERS A FOCUS ON EFFECTIVENESS AND THERAPY ADHERENCE
NEUROPEDIATRICS 201243(1)27-36
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull GOEMINNE P AND DUPONT L (2010) NON-CYSTIC FIBROSIS BRONCHIECTASIS DIAGNOSIS AND MANAGEMENT IN 21ST CENTURY POSTGRADUATE MEDICAL JOURNAL 86(1018) PP493-501
bull LEE A BUTTON B AND TANNENBAUM E (2017) AIRWAY-CLEARANCE TECHNIQUES IN CHILDREN AND ADOLESCENTS WITH CHRONIC SUPPURATIVE LUNG DISEASE AND BRONCHIECTASIS FRONTIERS IN PEDIATRICS 5
bull MANDAL P SIDHU M KOPE L POLLOCK W STEVENSON L PENTLAND J TURNBULL K MAC QUARRIE S AND HILL A (2012) A PILOT STUDY OF PULMONARY REHABILITATION AND CHEST PHYSIOTHERAPY VERSUS CHEST PHYSIOTHERAPY ALONE IN
BRONCHIECTASIS RESPIRATORY MEDICINE 106(12) PP1647-1654
bull MURRAY M PENTLAND J AND HILL A (2009) A RANDOMISED CROSSOVER TRIAL OF CHEST PHYSIOTHERAPY IN NON-CYSTIC FIBROSIS BRONCHIECTASIS EUROPEAN RESPIRATORY JOURNAL 34(5) PP1086-1092
bull NEWALL C STOCKLEY R AND HILL S (2005) EXERCISE TRAINING AND INSPIRATORY MUSCLE TRAINING IN PATIENTS WITH BRONCHIECTASIS THORAX 60(11) PP943-948
bull ONG H LEE A HILL C HOLLAND A AND DENEHY L (2011) EFFECTS OF PULMONARY REHABILITATION IN BRONCHIECTASIS A RETROSPECTIVE STUDY CHRONIC RESPIRATORY DISEASE 8(1) PP21-30
bull QUINT J MILLETT E JOSHI M NAVARATNAM V THOMAS S HURST J SMEETH L AND BROWN J (2015) CHANGES IN THE INCIDENCE PREVALENCE AND MORTALITY OF BRONCHIECTASIS IN THE UK FROM 2004 TO 2013 A POPULATION-BASED COHORT
STUDY EUROPEAN RESPIRATORY JOURNAL 47(1) PP186-193
bull SNIJDERS D FERNANDEZ DOMINGUEZ B CALGARO S BERTOZZI I ESCRIBANO MONTANER A PERILONGO G AND BARBATO A (2015) MUCOCILIARY CLEARANCE TECHNIQUES FOR TREATING NON-CYSTIC FIBROSIS BRONCHIECTASIS IS THERE
EVIDENCE INTERNATIONAL JOURNAL OF IMMUNOPATHOLOGY AND PHARMACOLOGY 28(2) PP150-159
HFCWO INDICATIONS
bull CHRONIC MUCUS HYPERSECRETION OR RETENTION ASSOCIATED WITH A CHRONIC PULMONARY OR NEUROMUSCULAR CONDITION
bull LRT SECRETIONS AND FREQUENT LRTI REQUIRING HOSPITAL ADMISSION
bull INEFFECTIVE COUGH OR INABILITY TO REMOVE MUCUS BY COUGHING
bull TENACIOUS SECRETIONS THAT ARE NOT EASILY MOBILISED WITH STANDARD CPT
bull MECHANICALLY VENTILATED WITH EVIDENCE OF SECRETION RETENTION
bull ALTERNATIVE AIRWAY CLEARANCE THERAPY PROVEN INEFFECTIVE OR CONTRAINDICATEDDO NOT TOLERATE STANDARD CPT
bull CONSTANT FATIGUE LACK OF STRENGTH OR ABILITY TO PERFORM ACTIVE TREATMENT
bull SYMPTOMATIC
bull POOR COMPLIANCE WITH OTHER AIRWAY CLEARANCE METHODS
bull HIGH BURDEN OF CARE
bull PATIENT UNABLE TO TOLERATE THE INCREASED WORK OF BREATHING bull ACTIVE HAEMOPTYSIS bull UNTREATED PNEUMOTHORAX bull INTRACRANIAL PRESSURE (ICP) gt 20 MMHG bull HAEMODYNAMIC INSTABILITY bull SEVERE CARDIOVASCULAR INSULTDISEASE bull RECENT FACIAL ORAL OR SKULL SURGERY OR TRAUMA bull ACUTE SINUSITIS bull EPISTAXIS bull POST OESOPHAGEAL amp LUNG SURGERY bull KNOWN OR SUSPECTED TYMPANIC MEMBRANE RUPTURE OR OTHER MIDDLE EAR
PATHOLOGY
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
POSSIBLE HAZARDSCOMPLICATIONS
bull INCREASED WORK OF BREATHING THAT MAY LEAD TO HYPOVENTILATION AND
HYPERCARBIA
bull INCREASED INTRACRANIAL PRESSURE
bull CARDIOVASCULAR COMPROMISE
bull NAUSEA
bull MYOCARDIAL ISCHEMIA
bull DECREASED VENOUS RETURN
bull AIR SWALLOWING WITH INCREASED LIKELIHOOD OF VOMITING AND
ASPIRATION
bull CLAUSTROPHOBIA
bull SKIN BREAK DOWN AND DISCOMFORT FROM MASK
bull PULMONARY BAROTRAUMA
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
MI-E
bull USED WITH CHILDREN WHO HAVE DECREASED INSPIRATORY EFFORT DUE TO EITHER SPINAL CORD INJURY OR NMW AND WHO HAVE AN IMPAIRED OR INEFFECTIVE COUGH WITH APPROPRIATE RESPIRATORY SYMPTOMS
bull CONSIDERED WHEN CONVENTIONAL COUGH ASSISTANCE TECHNIQUES BECOME INEFFECTIVE
bull ACCEPTED AS THE CORE STANDARD FOR CHILD WITH NMW
bull MIE WORKS BY
bull INFLATING THE LUNGS WITH GRADUAL POSITIVE AIRWAY PRESSURE ASSISTING INSPIRATION CALLED INSUFFLATION
bull FOLLOWED BY A RAPID SWITCH TO NEGATIVE PRESSURE WHICH SIMULATES THE FLOW CHANGES THAT OCCUR DURING A COUGH THEREBY ENHANCING EXPIRATORY FLOW CALLED EXSUFFLATION AND ASSISTING EXPECTORATION OF SECRETIONS
bull MOVEMENT AND EXERCISE BEST FUNCTIONAL METHOD OF AIRWAY CLEARANCE
bull CPET BETTER CORRELATION THAN LUNG FUNCTION IN SURVIVAL RATES IN PEOPLE WITH
CYSTIC FIBROSIS
bull RUNNINGWALKING BETTER FOR SECRETION CLEARANCE THAN BIKE DURING TO SHEARING
MECHANISM
bull CONSIDER ADDING IN HUFFS (DYER)
bull CONSIDER USE OF AD BELT
EXERCISE
bull APCP SUCTION GUIDELINES
bull TYPESNASOPHARANGEAL OROPHARANGEAL AND TRACHEOSTOMY
bull MAIN VARIABLES SUCTION TYPE AND SIZE DEPTH OF SUCTION
PRESSURE TECHNIQUE
SUCTION
SPUTUM
bull SPUTUM bull 95 WATER bull COLOUR bull VOLUME bull CONSISTENCY bull ODOUR
bull PURPOSE bull HUMIDIFICATION bull WATERPROOFING bull PROTECTION OF EPITHELIUM
HUMIDIFICATION
bull METABOLIC AND VENTILATORY REQUIREMENTS ARE X2-3 OF ADULTS
IMPLICATION
bull HEAT AND MOISTURE LOSSES FROM RESPIRATION WILL INCREASE BY X2-3
bull CONSUME GREATER AMOUNTS OF ENERGY AND WATER
HUMIDIFICATION INHALATION
THERAPY
bull TRACHEOSTOMY HME
bull WET DRY CIRCUIT
bull NEBULISERS INHALERS MUCOLYTICS
bull HUMIDIFIERS WITH NIV
bull OXYGEN
bull SYSTEMIC HYDRATION ENVIRONMENT
NEBULISERS
bull NEBULISER CHAMBER CONVERTS LIQUID INTO
RESPIRABLE PARTICLES
bull MOISTURE DESCENDS THROUGH THE HOLES IN THE SUPERFICIAL GEL LAYER
bull INCREASES THE SOL LAYER SO THE CILIARY BEAT IS OPTIMAL FOR MUCUS TRANSPORT
bull SHORT TERM HUMIDIFICATION
bull DAILY WASHING OF NEBULISER SYSTEM
TIMING OF DRUG AND PHYSIOTHERAPY
BEFORE TREATMENT
bull DNASE (PULMOZYME)
bull SALBUTAMOL
(VENTOLIN BLUE)
bull SALINE NEBS
AFTER TREATMENT
bull SERETIDE (PURPLE)
bull BECLOMETHASONE (BECOTIDE BROWN)
bull COLISTIN (COLOMYCIN PROMIXIN)
bull TOBRAMYCIN
CONCLUSION
bull BE AWARE OF CHILDrsquoS RESPIRATORY FUNCTION
bull CHOSE ACT BEST FOR THEM bull TYPE OF KETCHUP BOTTLE bull LV SECRETION RETENTION WOB
bull EARLY RESPIRATORY REFERRAL
bull RESPIRATORY CARE COMPETENCIES
bull EFFECTIVE SECRETION CLEARANCE AT HOMERESPITESCHOOL
bull USE OF PEAK COUGH FLOWS TO AID CHOICE OF ADJUNCT
0
50
100
150
200
250
300
350
400
0
50
100
150
200
250
300
350
400
Green
Key
Additional info
(please comment) Please refer to BTSACPRC Guideline
Lothian University Hospitals NHS Trust
n PCF
gt270lmin
Breathstack
ing tri-
flow
blowing
REFERENCES bull BTSACPRC GUIDELINE IS PUBLISHED IN THORAX VOL 67 SUPPLEMENT 1
bull AVAILABLE ONLINE AT HTTPTHORAXBMJCOMCONTENTVOL64ISSUESUPPLI
bull HTTPWWWBRIT-THORACICORGUKPHYSIOGUIDE
bull BRITISH THORACIC SOCIETY REPORTS VOL 1 NO 1 2009
bull ADAPTED PRYOR AJ AND PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS3RD ED
bull HOUGH A PHYSIOTHERAPY IN RESPIRATORY CARE LONDON CHAPMAN AND HALL 1993
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1997) POSTURAL DRAINAGE AND GASTRO-OESOPHAGEAL REFLUX IN INFANTS WITH CYSTIC FIBROSIS ARCHIVES OF DISEASE IN CHILDHOOD 76 148-150
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1998) POSTURAL DRAINAGE IN CYSTIC FIBROSIS IS THERE A LINK WITH GASTRO-OESOPHAGEAL REFLUX JOURNAL OF PAEDIATRIC CHILD HEALTH 34 330-334
bull CECINS NM JENKINS SC PENGELLEY J ET AL (1999) THE ACTIVE CYCLE OF BREATHING TECHNIQUES-TO TIP OR NOT TO TIP RESPIRATORY MEDICINE 93 660-665
bull CONSTANTINI D BRIVIO A BRUSA D ET AL (2001) PEP MASK VERSUS POSTURAL DRAINAGE IN INFANTS A LONG-TERM COMPARATIVE TRIAL PEADIATRIC PULMONOLOGY
bull HOUGH A (2001) PHYSIOTHERAPY IN RESPIRATORY CARE AN EVIDENCE-BASED APPROACH TO RESPIRATORY AND CARDIAC MANAGEMENT CENGAGE LEARNING EMEA
bull INTERNATIONAL PHYSIOTHERAPY GROUP FOR CYSTIC FIBROSIS PHYSIOTHERAPY IN THE TREATMENT OF CYSTIC FIBROSIS (2009) HTTPSWWWECFSEUIPG_CFBOOKLET INTERNATIONAL PHYSIOTHERAPY GROUP ndash THE BLUE BOOKLET
bull KONSTAN MW STERN RC DOERSHUK CF (1994) EFFICACY OF THE FLUTTER DEVICE FOR AIRWAY MUCUS CLEARANCE IN PATIENTS WITH CYSTIC FIBROSIS JOURNAL OF PEDIATRICS 124 (5 (PT 1) 689-693
bull MCILWAINE M BUTTON B AND DWAN K (2015) POSITIVE EXPIRATORY PRESSURE PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 6 ART NO CD003147 DOI 10100214651858CD003147PUB4
bull MESTRINER RG FERNANDES RO STAFFEN LC ET AL (2009) OPTIMUM DESIGN PARAMETERS FOR A THERAPIST-CONSTRUCTED POSITIVE-EXPIRATORY-PRESSURE THERAPY BOTTLE DEVICE RESPIRATORY CARE 54 504-8
bull MORRISON L AND AGNEW J (2014) OSCILLATING DEVICES FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 7 ART NO CD006842 DOI 10100214651858CD006842PUB
bull OERMANN CM SOCKRIDER MM GILES D ET AL (2001) COMPARISON OF HIGH-FREQUENCY CHEST WALL OSCILLATION AND OSCILLATING POSITIVE EXPIRATORY PRESSURE IN THE HOME MANAGEMENT OF CYSTIC FIBROSIS A PILOT STUDY PEDIATRIC PULMONOLOGY 32 (5) 372-7
bull PRASAD SA AND HUSSEY J (1995) PAEDIATRIC RESPIRATORY CARE A GUIDE FOR PHYSIOTHERAPISTS AND HEALTH PROFESSIONALS CHAPMAN amp HALL
bull PRYOR J (1999) PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN ADULTS EUROPEAN RESPIRATORY JOURNAL 14 (6) 1418-1424
bull PRYOR JA amp PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS CHURCHILL LIVINGSTONE
bull PRYOR JA WEBBER BA HODSON ME ET AL (1994) THE FLUTTER VRP1 AS AN ADJUNCT TO CHEST PHYSIOTHERAPY IN CYSTIC FIBROSIS RESPIRATORY MEDICINE 88677-81
bull WEST K WALLEN M FOLLETT J (2010) ACAPELLA VS PEP MASK THERAPY A RANDOMISED TRIAL IN CHILDREN WITH CYSTIC FIBROSIS DURING RESPIRATORY EXACERBATION PHYSIOTHERAPY THEORY PRACTICE 26143-9
bull WILSONLM AGNEW J MORRISON L ET AL (2014) AIRWAY CLEARANCE TECHNIQUES FOR CYSTIC FIBROSIS AN OVERVIEW OF COCHRANE SYSTEMATIC REVIEWS COCHRANE DATABASE OF SYSTEMATIC REVIEWS DOI 10100214651858CD011231
bull VOLSKO TA DIFIORE JM CHATBURN RL (2003) PERFORMANCE COMPARISON OF TWO OSCILLATORY POSITIVE PRESSURE DEVICES ACAPELLA VERSUS FLUTTER RESPIRATORY CARE 48 (2) 124- 130
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SEDDON PC KHAN Y RESPIRATORY PROBLEMS IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT ARCHIVES OF DISEASE IN CHILDHOOD 2003 01 JAN88(1)75-8
bull MARKS JH PULMONARY CARE OF CHILDREN AND ADOLESCENTS WITH DEVELOPMENTAL DISABILITIES PEDIATR CLIN NORTH AM 2008 DECEMBER55(6)1299-314
bull ARENS R MUZUMDAR H SLEEP SLEEP DISORDERED BREATHING AND NOCTURNAL HYPOVENTILATION IN CHILDREN WITH NEUROMUSCULAR DISEASES PAEDIATRIC RESPIRATORY REVIEWS 2010 MAR11(1)24-30
bull FITZGERALD DA FOLLETT J VAN ASPEREN PP ASSESSING AND MANAGING LUNG DISEASE AND SLEEP DISORDERED BREATHING IN CHILDREN WITH CEREBRAL PALSY PAEDIATRIC RESPIRATORY REVIEWS 2009 MARCH10(1)18-24
bull HSIAO KH NIXON GM THE EFFECT OF TREATMENT OF OBSTRUCTIVE SLEEP APNEA ON QUALITY OF LIFE IN CHILDREN WITH CEREBRAL PALSY RES DEV DISABIL 2008 MAR-APR29(2)133-40
bull LUNDBERG A OXYGEN CONSUMPTION IN RELATION TO WORKLOAD IN STUDENTS WITH CEREBRAL PALSY J APPL PHYSIO 197640873-5
bull SULLIVAN PB ROSENBLOOM L FEEDING THE DISABLED CHILD CLINICS IN DEVELOPMENTAL MEDICINE MACKEITH PRESS 1999140
bull MARTIN TR THE RELATIONSHIP BETWEEN MALNUTRITION AND LUNG INFECTIONS CLIN CHEST MED 19878359
bull MOSTAFA SM BHANDARI S RITCHIE G ET AL CONSTIPATION AND ITS IMPLICATIONS IN THE CRITICALLY ILL PATIENT BR J ANAESTH 200391815-9 3
bull GACOUIN A CAMUS C GROS A ET AL CONSTIPATION IN LONGTERM VENTILATED PATIENTS ASSOCIATED FACTORS AND IMPACT ON INTENSIVE CARE UNIT OUTCOMES CRIT CARE MED 2010381933- 8
bull NGUYEN T FRENETTE AJ JOHANSON C ET AL IMPAIRED GASTROINTESTINAL TRANSIT AND ITS ASSOCIATED MORBIDITY IN THE INTENSIVE CARE UNIT J CRIT CARE 201328537
bull ASAI T CONSTIPATION DOES IT INCREASE MORBIDITY AND MORTALITY IN CRITICALLY ILL PATIENTS CRIT CARE MED 2007352861-2
bull UNDERSTANDING THE PHYSIOLOGICAL EFFECTS OF UNTREATED PAIN NURSING TIMES VOL 99 ISSUE 37 PAGE NO 28
bull WINFIELD ET AL NON-PHARMACEUTICAL MANAGEMENT OF RESPIRATORY MORBIDITY IN CHILDREN WITH SEVERE GLOBAL DEVELOPMENTAL DELAY THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014
bull OLOUGHLIN EV SOMERVILLE HM SOMERVILLE ER DEALING WITH MULTISYSTEM DISEASE IN PEOPLE WITH A DEVELOPMENTAL DISABILITY MEDICAL JOURNAL OF AUSTRALIA 2009 JUN 1190(11)616-7
bull MESTROVIC J KARDUM G POLIC B MESTROVIC M MARKIC J SUSTIC A ET AL THE INFLUENCE OF CHRONIC HEALTH CONDITIONS ON SUSCEPTIBILITY TO SEVERE ACUTE ILLNESS OF CHILDREN TREATED IN PICU EUROPEAN JOURNAL OF PEDIATRICS 2006 AUG165(8)526-
9
bull HEALY F PANITCH HB PULMONARY COMPLICATIONS OF PEDIATRIC NEUROLOGICAL DISEASES PEDIATR ANN 2010 APR39(4)216-24
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SRIVASTAVA R JACKSON WD BARNHART DC DYSPHAGIA AND GASTROESOPHAGEAL REFLUX DISEASE DILEMMAS IN DIAGNOSIS AND MANAGEMENT IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT PEDIATR ANN 2010 APR39(4)225-31
bull SULLIVAN PB JUSZCZAK E BACHLET AME LAMBERT B VERNON-ROBERTS A GRANT HW ET AL GASTROSTOMY TUBE FEEDING IN CHILDREN WITH CEREBRAL PALSY A PROSPECTIVE LONGITUDINAL STUDY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 2005
FEBRUARY47(2)77-85
bull SOMERVILLE H TZANNES G WOOD J SHUN A HILL C ARROWSMITH F ET AL GASTROINTESTINAL AND NUTRITIONAL PROBLEMS IN SEVERE DEVELOPMENTAL DISABILITY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 200850(9)712-6
bull TODER DS RESPIRATORY PROBLEMS IN THE ADOLESCENT WITH DEVELOPMENTAL DELAY ADOLESCENT MEDICINE 2000 3 OCTOBER 200011(3)617-31
bull LEVIN K COLON A DIPALMA J FITZPATRICK S USING THE RADIONUCLIDE SALIVAGRAM TO DETECT PULMONARY ASPIRATION AND ESOPHAGEAL DYSMOTILITY CLIN NUCL MED 1993 FEB18(2)110-4
bull SCHROEDER AS KLING T HUSS K BORGGRAEFE I KOERTE IK BLASCHEK A ET AL BOTULINUM TOXIN TYPE A AND B FOR THE REDUCTION OF HYPERSALIVATION IN CHILDREN WITH NEUROLOGICAL DISORDERS A FOCUS ON EFFECTIVENESS AND THERAPY ADHERENCE
NEUROPEDIATRICS 201243(1)27-36
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull GOEMINNE P AND DUPONT L (2010) NON-CYSTIC FIBROSIS BRONCHIECTASIS DIAGNOSIS AND MANAGEMENT IN 21ST CENTURY POSTGRADUATE MEDICAL JOURNAL 86(1018) PP493-501
bull LEE A BUTTON B AND TANNENBAUM E (2017) AIRWAY-CLEARANCE TECHNIQUES IN CHILDREN AND ADOLESCENTS WITH CHRONIC SUPPURATIVE LUNG DISEASE AND BRONCHIECTASIS FRONTIERS IN PEDIATRICS 5
bull MANDAL P SIDHU M KOPE L POLLOCK W STEVENSON L PENTLAND J TURNBULL K MAC QUARRIE S AND HILL A (2012) A PILOT STUDY OF PULMONARY REHABILITATION AND CHEST PHYSIOTHERAPY VERSUS CHEST PHYSIOTHERAPY ALONE IN
BRONCHIECTASIS RESPIRATORY MEDICINE 106(12) PP1647-1654
bull MURRAY M PENTLAND J AND HILL A (2009) A RANDOMISED CROSSOVER TRIAL OF CHEST PHYSIOTHERAPY IN NON-CYSTIC FIBROSIS BRONCHIECTASIS EUROPEAN RESPIRATORY JOURNAL 34(5) PP1086-1092
bull NEWALL C STOCKLEY R AND HILL S (2005) EXERCISE TRAINING AND INSPIRATORY MUSCLE TRAINING IN PATIENTS WITH BRONCHIECTASIS THORAX 60(11) PP943-948
bull ONG H LEE A HILL C HOLLAND A AND DENEHY L (2011) EFFECTS OF PULMONARY REHABILITATION IN BRONCHIECTASIS A RETROSPECTIVE STUDY CHRONIC RESPIRATORY DISEASE 8(1) PP21-30
bull QUINT J MILLETT E JOSHI M NAVARATNAM V THOMAS S HURST J SMEETH L AND BROWN J (2015) CHANGES IN THE INCIDENCE PREVALENCE AND MORTALITY OF BRONCHIECTASIS IN THE UK FROM 2004 TO 2013 A POPULATION-BASED COHORT
STUDY EUROPEAN RESPIRATORY JOURNAL 47(1) PP186-193
bull SNIJDERS D FERNANDEZ DOMINGUEZ B CALGARO S BERTOZZI I ESCRIBANO MONTANER A PERILONGO G AND BARBATO A (2015) MUCOCILIARY CLEARANCE TECHNIQUES FOR TREATING NON-CYSTIC FIBROSIS BRONCHIECTASIS IS THERE
EVIDENCE INTERNATIONAL JOURNAL OF IMMUNOPATHOLOGY AND PHARMACOLOGY 28(2) PP150-159
bull PATIENT UNABLE TO TOLERATE THE INCREASED WORK OF BREATHING bull ACTIVE HAEMOPTYSIS bull UNTREATED PNEUMOTHORAX bull INTRACRANIAL PRESSURE (ICP) gt 20 MMHG bull HAEMODYNAMIC INSTABILITY bull SEVERE CARDIOVASCULAR INSULTDISEASE bull RECENT FACIAL ORAL OR SKULL SURGERY OR TRAUMA bull ACUTE SINUSITIS bull EPISTAXIS bull POST OESOPHAGEAL amp LUNG SURGERY bull KNOWN OR SUSPECTED TYMPANIC MEMBRANE RUPTURE OR OTHER MIDDLE EAR
PATHOLOGY
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
POSSIBLE HAZARDSCOMPLICATIONS
bull INCREASED WORK OF BREATHING THAT MAY LEAD TO HYPOVENTILATION AND
HYPERCARBIA
bull INCREASED INTRACRANIAL PRESSURE
bull CARDIOVASCULAR COMPROMISE
bull NAUSEA
bull MYOCARDIAL ISCHEMIA
bull DECREASED VENOUS RETURN
bull AIR SWALLOWING WITH INCREASED LIKELIHOOD OF VOMITING AND
ASPIRATION
bull CLAUSTROPHOBIA
bull SKIN BREAK DOWN AND DISCOMFORT FROM MASK
bull PULMONARY BAROTRAUMA
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
MI-E
bull USED WITH CHILDREN WHO HAVE DECREASED INSPIRATORY EFFORT DUE TO EITHER SPINAL CORD INJURY OR NMW AND WHO HAVE AN IMPAIRED OR INEFFECTIVE COUGH WITH APPROPRIATE RESPIRATORY SYMPTOMS
bull CONSIDERED WHEN CONVENTIONAL COUGH ASSISTANCE TECHNIQUES BECOME INEFFECTIVE
bull ACCEPTED AS THE CORE STANDARD FOR CHILD WITH NMW
bull MIE WORKS BY
bull INFLATING THE LUNGS WITH GRADUAL POSITIVE AIRWAY PRESSURE ASSISTING INSPIRATION CALLED INSUFFLATION
bull FOLLOWED BY A RAPID SWITCH TO NEGATIVE PRESSURE WHICH SIMULATES THE FLOW CHANGES THAT OCCUR DURING A COUGH THEREBY ENHANCING EXPIRATORY FLOW CALLED EXSUFFLATION AND ASSISTING EXPECTORATION OF SECRETIONS
bull MOVEMENT AND EXERCISE BEST FUNCTIONAL METHOD OF AIRWAY CLEARANCE
bull CPET BETTER CORRELATION THAN LUNG FUNCTION IN SURVIVAL RATES IN PEOPLE WITH
CYSTIC FIBROSIS
bull RUNNINGWALKING BETTER FOR SECRETION CLEARANCE THAN BIKE DURING TO SHEARING
MECHANISM
bull CONSIDER ADDING IN HUFFS (DYER)
bull CONSIDER USE OF AD BELT
EXERCISE
bull APCP SUCTION GUIDELINES
bull TYPESNASOPHARANGEAL OROPHARANGEAL AND TRACHEOSTOMY
bull MAIN VARIABLES SUCTION TYPE AND SIZE DEPTH OF SUCTION
PRESSURE TECHNIQUE
SUCTION
SPUTUM
bull SPUTUM bull 95 WATER bull COLOUR bull VOLUME bull CONSISTENCY bull ODOUR
bull PURPOSE bull HUMIDIFICATION bull WATERPROOFING bull PROTECTION OF EPITHELIUM
HUMIDIFICATION
bull METABOLIC AND VENTILATORY REQUIREMENTS ARE X2-3 OF ADULTS
IMPLICATION
bull HEAT AND MOISTURE LOSSES FROM RESPIRATION WILL INCREASE BY X2-3
bull CONSUME GREATER AMOUNTS OF ENERGY AND WATER
HUMIDIFICATION INHALATION
THERAPY
bull TRACHEOSTOMY HME
bull WET DRY CIRCUIT
bull NEBULISERS INHALERS MUCOLYTICS
bull HUMIDIFIERS WITH NIV
bull OXYGEN
bull SYSTEMIC HYDRATION ENVIRONMENT
NEBULISERS
bull NEBULISER CHAMBER CONVERTS LIQUID INTO
RESPIRABLE PARTICLES
bull MOISTURE DESCENDS THROUGH THE HOLES IN THE SUPERFICIAL GEL LAYER
bull INCREASES THE SOL LAYER SO THE CILIARY BEAT IS OPTIMAL FOR MUCUS TRANSPORT
bull SHORT TERM HUMIDIFICATION
bull DAILY WASHING OF NEBULISER SYSTEM
TIMING OF DRUG AND PHYSIOTHERAPY
BEFORE TREATMENT
bull DNASE (PULMOZYME)
bull SALBUTAMOL
(VENTOLIN BLUE)
bull SALINE NEBS
AFTER TREATMENT
bull SERETIDE (PURPLE)
bull BECLOMETHASONE (BECOTIDE BROWN)
bull COLISTIN (COLOMYCIN PROMIXIN)
bull TOBRAMYCIN
CONCLUSION
bull BE AWARE OF CHILDrsquoS RESPIRATORY FUNCTION
bull CHOSE ACT BEST FOR THEM bull TYPE OF KETCHUP BOTTLE bull LV SECRETION RETENTION WOB
bull EARLY RESPIRATORY REFERRAL
bull RESPIRATORY CARE COMPETENCIES
bull EFFECTIVE SECRETION CLEARANCE AT HOMERESPITESCHOOL
bull USE OF PEAK COUGH FLOWS TO AID CHOICE OF ADJUNCT
0
50
100
150
200
250
300
350
400
0
50
100
150
200
250
300
350
400
Green
Key
Additional info
(please comment) Please refer to BTSACPRC Guideline
Lothian University Hospitals NHS Trust
n PCF
gt270lmin
Breathstack
ing tri-
flow
blowing
REFERENCES bull BTSACPRC GUIDELINE IS PUBLISHED IN THORAX VOL 67 SUPPLEMENT 1
bull AVAILABLE ONLINE AT HTTPTHORAXBMJCOMCONTENTVOL64ISSUESUPPLI
bull HTTPWWWBRIT-THORACICORGUKPHYSIOGUIDE
bull BRITISH THORACIC SOCIETY REPORTS VOL 1 NO 1 2009
bull ADAPTED PRYOR AJ AND PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS3RD ED
bull HOUGH A PHYSIOTHERAPY IN RESPIRATORY CARE LONDON CHAPMAN AND HALL 1993
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1997) POSTURAL DRAINAGE AND GASTRO-OESOPHAGEAL REFLUX IN INFANTS WITH CYSTIC FIBROSIS ARCHIVES OF DISEASE IN CHILDHOOD 76 148-150
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1998) POSTURAL DRAINAGE IN CYSTIC FIBROSIS IS THERE A LINK WITH GASTRO-OESOPHAGEAL REFLUX JOURNAL OF PAEDIATRIC CHILD HEALTH 34 330-334
bull CECINS NM JENKINS SC PENGELLEY J ET AL (1999) THE ACTIVE CYCLE OF BREATHING TECHNIQUES-TO TIP OR NOT TO TIP RESPIRATORY MEDICINE 93 660-665
bull CONSTANTINI D BRIVIO A BRUSA D ET AL (2001) PEP MASK VERSUS POSTURAL DRAINAGE IN INFANTS A LONG-TERM COMPARATIVE TRIAL PEADIATRIC PULMONOLOGY
bull HOUGH A (2001) PHYSIOTHERAPY IN RESPIRATORY CARE AN EVIDENCE-BASED APPROACH TO RESPIRATORY AND CARDIAC MANAGEMENT CENGAGE LEARNING EMEA
bull INTERNATIONAL PHYSIOTHERAPY GROUP FOR CYSTIC FIBROSIS PHYSIOTHERAPY IN THE TREATMENT OF CYSTIC FIBROSIS (2009) HTTPSWWWECFSEUIPG_CFBOOKLET INTERNATIONAL PHYSIOTHERAPY GROUP ndash THE BLUE BOOKLET
bull KONSTAN MW STERN RC DOERSHUK CF (1994) EFFICACY OF THE FLUTTER DEVICE FOR AIRWAY MUCUS CLEARANCE IN PATIENTS WITH CYSTIC FIBROSIS JOURNAL OF PEDIATRICS 124 (5 (PT 1) 689-693
bull MCILWAINE M BUTTON B AND DWAN K (2015) POSITIVE EXPIRATORY PRESSURE PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 6 ART NO CD003147 DOI 10100214651858CD003147PUB4
bull MESTRINER RG FERNANDES RO STAFFEN LC ET AL (2009) OPTIMUM DESIGN PARAMETERS FOR A THERAPIST-CONSTRUCTED POSITIVE-EXPIRATORY-PRESSURE THERAPY BOTTLE DEVICE RESPIRATORY CARE 54 504-8
bull MORRISON L AND AGNEW J (2014) OSCILLATING DEVICES FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 7 ART NO CD006842 DOI 10100214651858CD006842PUB
bull OERMANN CM SOCKRIDER MM GILES D ET AL (2001) COMPARISON OF HIGH-FREQUENCY CHEST WALL OSCILLATION AND OSCILLATING POSITIVE EXPIRATORY PRESSURE IN THE HOME MANAGEMENT OF CYSTIC FIBROSIS A PILOT STUDY PEDIATRIC PULMONOLOGY 32 (5) 372-7
bull PRASAD SA AND HUSSEY J (1995) PAEDIATRIC RESPIRATORY CARE A GUIDE FOR PHYSIOTHERAPISTS AND HEALTH PROFESSIONALS CHAPMAN amp HALL
bull PRYOR J (1999) PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN ADULTS EUROPEAN RESPIRATORY JOURNAL 14 (6) 1418-1424
bull PRYOR JA amp PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS CHURCHILL LIVINGSTONE
bull PRYOR JA WEBBER BA HODSON ME ET AL (1994) THE FLUTTER VRP1 AS AN ADJUNCT TO CHEST PHYSIOTHERAPY IN CYSTIC FIBROSIS RESPIRATORY MEDICINE 88677-81
bull WEST K WALLEN M FOLLETT J (2010) ACAPELLA VS PEP MASK THERAPY A RANDOMISED TRIAL IN CHILDREN WITH CYSTIC FIBROSIS DURING RESPIRATORY EXACERBATION PHYSIOTHERAPY THEORY PRACTICE 26143-9
bull WILSONLM AGNEW J MORRISON L ET AL (2014) AIRWAY CLEARANCE TECHNIQUES FOR CYSTIC FIBROSIS AN OVERVIEW OF COCHRANE SYSTEMATIC REVIEWS COCHRANE DATABASE OF SYSTEMATIC REVIEWS DOI 10100214651858CD011231
bull VOLSKO TA DIFIORE JM CHATBURN RL (2003) PERFORMANCE COMPARISON OF TWO OSCILLATORY POSITIVE PRESSURE DEVICES ACAPELLA VERSUS FLUTTER RESPIRATORY CARE 48 (2) 124- 130
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SEDDON PC KHAN Y RESPIRATORY PROBLEMS IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT ARCHIVES OF DISEASE IN CHILDHOOD 2003 01 JAN88(1)75-8
bull MARKS JH PULMONARY CARE OF CHILDREN AND ADOLESCENTS WITH DEVELOPMENTAL DISABILITIES PEDIATR CLIN NORTH AM 2008 DECEMBER55(6)1299-314
bull ARENS R MUZUMDAR H SLEEP SLEEP DISORDERED BREATHING AND NOCTURNAL HYPOVENTILATION IN CHILDREN WITH NEUROMUSCULAR DISEASES PAEDIATRIC RESPIRATORY REVIEWS 2010 MAR11(1)24-30
bull FITZGERALD DA FOLLETT J VAN ASPEREN PP ASSESSING AND MANAGING LUNG DISEASE AND SLEEP DISORDERED BREATHING IN CHILDREN WITH CEREBRAL PALSY PAEDIATRIC RESPIRATORY REVIEWS 2009 MARCH10(1)18-24
bull HSIAO KH NIXON GM THE EFFECT OF TREATMENT OF OBSTRUCTIVE SLEEP APNEA ON QUALITY OF LIFE IN CHILDREN WITH CEREBRAL PALSY RES DEV DISABIL 2008 MAR-APR29(2)133-40
bull LUNDBERG A OXYGEN CONSUMPTION IN RELATION TO WORKLOAD IN STUDENTS WITH CEREBRAL PALSY J APPL PHYSIO 197640873-5
bull SULLIVAN PB ROSENBLOOM L FEEDING THE DISABLED CHILD CLINICS IN DEVELOPMENTAL MEDICINE MACKEITH PRESS 1999140
bull MARTIN TR THE RELATIONSHIP BETWEEN MALNUTRITION AND LUNG INFECTIONS CLIN CHEST MED 19878359
bull MOSTAFA SM BHANDARI S RITCHIE G ET AL CONSTIPATION AND ITS IMPLICATIONS IN THE CRITICALLY ILL PATIENT BR J ANAESTH 200391815-9 3
bull GACOUIN A CAMUS C GROS A ET AL CONSTIPATION IN LONGTERM VENTILATED PATIENTS ASSOCIATED FACTORS AND IMPACT ON INTENSIVE CARE UNIT OUTCOMES CRIT CARE MED 2010381933- 8
bull NGUYEN T FRENETTE AJ JOHANSON C ET AL IMPAIRED GASTROINTESTINAL TRANSIT AND ITS ASSOCIATED MORBIDITY IN THE INTENSIVE CARE UNIT J CRIT CARE 201328537
bull ASAI T CONSTIPATION DOES IT INCREASE MORBIDITY AND MORTALITY IN CRITICALLY ILL PATIENTS CRIT CARE MED 2007352861-2
bull UNDERSTANDING THE PHYSIOLOGICAL EFFECTS OF UNTREATED PAIN NURSING TIMES VOL 99 ISSUE 37 PAGE NO 28
bull WINFIELD ET AL NON-PHARMACEUTICAL MANAGEMENT OF RESPIRATORY MORBIDITY IN CHILDREN WITH SEVERE GLOBAL DEVELOPMENTAL DELAY THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014
bull OLOUGHLIN EV SOMERVILLE HM SOMERVILLE ER DEALING WITH MULTISYSTEM DISEASE IN PEOPLE WITH A DEVELOPMENTAL DISABILITY MEDICAL JOURNAL OF AUSTRALIA 2009 JUN 1190(11)616-7
bull MESTROVIC J KARDUM G POLIC B MESTROVIC M MARKIC J SUSTIC A ET AL THE INFLUENCE OF CHRONIC HEALTH CONDITIONS ON SUSCEPTIBILITY TO SEVERE ACUTE ILLNESS OF CHILDREN TREATED IN PICU EUROPEAN JOURNAL OF PEDIATRICS 2006 AUG165(8)526-
9
bull HEALY F PANITCH HB PULMONARY COMPLICATIONS OF PEDIATRIC NEUROLOGICAL DISEASES PEDIATR ANN 2010 APR39(4)216-24
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SRIVASTAVA R JACKSON WD BARNHART DC DYSPHAGIA AND GASTROESOPHAGEAL REFLUX DISEASE DILEMMAS IN DIAGNOSIS AND MANAGEMENT IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT PEDIATR ANN 2010 APR39(4)225-31
bull SULLIVAN PB JUSZCZAK E BACHLET AME LAMBERT B VERNON-ROBERTS A GRANT HW ET AL GASTROSTOMY TUBE FEEDING IN CHILDREN WITH CEREBRAL PALSY A PROSPECTIVE LONGITUDINAL STUDY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 2005
FEBRUARY47(2)77-85
bull SOMERVILLE H TZANNES G WOOD J SHUN A HILL C ARROWSMITH F ET AL GASTROINTESTINAL AND NUTRITIONAL PROBLEMS IN SEVERE DEVELOPMENTAL DISABILITY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 200850(9)712-6
bull TODER DS RESPIRATORY PROBLEMS IN THE ADOLESCENT WITH DEVELOPMENTAL DELAY ADOLESCENT MEDICINE 2000 3 OCTOBER 200011(3)617-31
bull LEVIN K COLON A DIPALMA J FITZPATRICK S USING THE RADIONUCLIDE SALIVAGRAM TO DETECT PULMONARY ASPIRATION AND ESOPHAGEAL DYSMOTILITY CLIN NUCL MED 1993 FEB18(2)110-4
bull SCHROEDER AS KLING T HUSS K BORGGRAEFE I KOERTE IK BLASCHEK A ET AL BOTULINUM TOXIN TYPE A AND B FOR THE REDUCTION OF HYPERSALIVATION IN CHILDREN WITH NEUROLOGICAL DISORDERS A FOCUS ON EFFECTIVENESS AND THERAPY ADHERENCE
NEUROPEDIATRICS 201243(1)27-36
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull GOEMINNE P AND DUPONT L (2010) NON-CYSTIC FIBROSIS BRONCHIECTASIS DIAGNOSIS AND MANAGEMENT IN 21ST CENTURY POSTGRADUATE MEDICAL JOURNAL 86(1018) PP493-501
bull LEE A BUTTON B AND TANNENBAUM E (2017) AIRWAY-CLEARANCE TECHNIQUES IN CHILDREN AND ADOLESCENTS WITH CHRONIC SUPPURATIVE LUNG DISEASE AND BRONCHIECTASIS FRONTIERS IN PEDIATRICS 5
bull MANDAL P SIDHU M KOPE L POLLOCK W STEVENSON L PENTLAND J TURNBULL K MAC QUARRIE S AND HILL A (2012) A PILOT STUDY OF PULMONARY REHABILITATION AND CHEST PHYSIOTHERAPY VERSUS CHEST PHYSIOTHERAPY ALONE IN
BRONCHIECTASIS RESPIRATORY MEDICINE 106(12) PP1647-1654
bull MURRAY M PENTLAND J AND HILL A (2009) A RANDOMISED CROSSOVER TRIAL OF CHEST PHYSIOTHERAPY IN NON-CYSTIC FIBROSIS BRONCHIECTASIS EUROPEAN RESPIRATORY JOURNAL 34(5) PP1086-1092
bull NEWALL C STOCKLEY R AND HILL S (2005) EXERCISE TRAINING AND INSPIRATORY MUSCLE TRAINING IN PATIENTS WITH BRONCHIECTASIS THORAX 60(11) PP943-948
bull ONG H LEE A HILL C HOLLAND A AND DENEHY L (2011) EFFECTS OF PULMONARY REHABILITATION IN BRONCHIECTASIS A RETROSPECTIVE STUDY CHRONIC RESPIRATORY DISEASE 8(1) PP21-30
bull QUINT J MILLETT E JOSHI M NAVARATNAM V THOMAS S HURST J SMEETH L AND BROWN J (2015) CHANGES IN THE INCIDENCE PREVALENCE AND MORTALITY OF BRONCHIECTASIS IN THE UK FROM 2004 TO 2013 A POPULATION-BASED COHORT
STUDY EUROPEAN RESPIRATORY JOURNAL 47(1) PP186-193
bull SNIJDERS D FERNANDEZ DOMINGUEZ B CALGARO S BERTOZZI I ESCRIBANO MONTANER A PERILONGO G AND BARBATO A (2015) MUCOCILIARY CLEARANCE TECHNIQUES FOR TREATING NON-CYSTIC FIBROSIS BRONCHIECTASIS IS THERE
EVIDENCE INTERNATIONAL JOURNAL OF IMMUNOPATHOLOGY AND PHARMACOLOGY 28(2) PP150-159
POSSIBLE HAZARDSCOMPLICATIONS
bull INCREASED WORK OF BREATHING THAT MAY LEAD TO HYPOVENTILATION AND
HYPERCARBIA
bull INCREASED INTRACRANIAL PRESSURE
bull CARDIOVASCULAR COMPROMISE
bull NAUSEA
bull MYOCARDIAL ISCHEMIA
bull DECREASED VENOUS RETURN
bull AIR SWALLOWING WITH INCREASED LIKELIHOOD OF VOMITING AND
ASPIRATION
bull CLAUSTROPHOBIA
bull SKIN BREAK DOWN AND DISCOMFORT FROM MASK
bull PULMONARY BAROTRAUMA
OPEP amp PEP CONTRAINDICATIONSPRECAUTIONS
MI-E
bull USED WITH CHILDREN WHO HAVE DECREASED INSPIRATORY EFFORT DUE TO EITHER SPINAL CORD INJURY OR NMW AND WHO HAVE AN IMPAIRED OR INEFFECTIVE COUGH WITH APPROPRIATE RESPIRATORY SYMPTOMS
bull CONSIDERED WHEN CONVENTIONAL COUGH ASSISTANCE TECHNIQUES BECOME INEFFECTIVE
bull ACCEPTED AS THE CORE STANDARD FOR CHILD WITH NMW
bull MIE WORKS BY
bull INFLATING THE LUNGS WITH GRADUAL POSITIVE AIRWAY PRESSURE ASSISTING INSPIRATION CALLED INSUFFLATION
bull FOLLOWED BY A RAPID SWITCH TO NEGATIVE PRESSURE WHICH SIMULATES THE FLOW CHANGES THAT OCCUR DURING A COUGH THEREBY ENHANCING EXPIRATORY FLOW CALLED EXSUFFLATION AND ASSISTING EXPECTORATION OF SECRETIONS
bull MOVEMENT AND EXERCISE BEST FUNCTIONAL METHOD OF AIRWAY CLEARANCE
bull CPET BETTER CORRELATION THAN LUNG FUNCTION IN SURVIVAL RATES IN PEOPLE WITH
CYSTIC FIBROSIS
bull RUNNINGWALKING BETTER FOR SECRETION CLEARANCE THAN BIKE DURING TO SHEARING
MECHANISM
bull CONSIDER ADDING IN HUFFS (DYER)
bull CONSIDER USE OF AD BELT
EXERCISE
bull APCP SUCTION GUIDELINES
bull TYPESNASOPHARANGEAL OROPHARANGEAL AND TRACHEOSTOMY
bull MAIN VARIABLES SUCTION TYPE AND SIZE DEPTH OF SUCTION
PRESSURE TECHNIQUE
SUCTION
SPUTUM
bull SPUTUM bull 95 WATER bull COLOUR bull VOLUME bull CONSISTENCY bull ODOUR
bull PURPOSE bull HUMIDIFICATION bull WATERPROOFING bull PROTECTION OF EPITHELIUM
HUMIDIFICATION
bull METABOLIC AND VENTILATORY REQUIREMENTS ARE X2-3 OF ADULTS
IMPLICATION
bull HEAT AND MOISTURE LOSSES FROM RESPIRATION WILL INCREASE BY X2-3
bull CONSUME GREATER AMOUNTS OF ENERGY AND WATER
HUMIDIFICATION INHALATION
THERAPY
bull TRACHEOSTOMY HME
bull WET DRY CIRCUIT
bull NEBULISERS INHALERS MUCOLYTICS
bull HUMIDIFIERS WITH NIV
bull OXYGEN
bull SYSTEMIC HYDRATION ENVIRONMENT
NEBULISERS
bull NEBULISER CHAMBER CONVERTS LIQUID INTO
RESPIRABLE PARTICLES
bull MOISTURE DESCENDS THROUGH THE HOLES IN THE SUPERFICIAL GEL LAYER
bull INCREASES THE SOL LAYER SO THE CILIARY BEAT IS OPTIMAL FOR MUCUS TRANSPORT
bull SHORT TERM HUMIDIFICATION
bull DAILY WASHING OF NEBULISER SYSTEM
TIMING OF DRUG AND PHYSIOTHERAPY
BEFORE TREATMENT
bull DNASE (PULMOZYME)
bull SALBUTAMOL
(VENTOLIN BLUE)
bull SALINE NEBS
AFTER TREATMENT
bull SERETIDE (PURPLE)
bull BECLOMETHASONE (BECOTIDE BROWN)
bull COLISTIN (COLOMYCIN PROMIXIN)
bull TOBRAMYCIN
CONCLUSION
bull BE AWARE OF CHILDrsquoS RESPIRATORY FUNCTION
bull CHOSE ACT BEST FOR THEM bull TYPE OF KETCHUP BOTTLE bull LV SECRETION RETENTION WOB
bull EARLY RESPIRATORY REFERRAL
bull RESPIRATORY CARE COMPETENCIES
bull EFFECTIVE SECRETION CLEARANCE AT HOMERESPITESCHOOL
bull USE OF PEAK COUGH FLOWS TO AID CHOICE OF ADJUNCT
0
50
100
150
200
250
300
350
400
0
50
100
150
200
250
300
350
400
Green
Key
Additional info
(please comment) Please refer to BTSACPRC Guideline
Lothian University Hospitals NHS Trust
n PCF
gt270lmin
Breathstack
ing tri-
flow
blowing
REFERENCES bull BTSACPRC GUIDELINE IS PUBLISHED IN THORAX VOL 67 SUPPLEMENT 1
bull AVAILABLE ONLINE AT HTTPTHORAXBMJCOMCONTENTVOL64ISSUESUPPLI
bull HTTPWWWBRIT-THORACICORGUKPHYSIOGUIDE
bull BRITISH THORACIC SOCIETY REPORTS VOL 1 NO 1 2009
bull ADAPTED PRYOR AJ AND PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS3RD ED
bull HOUGH A PHYSIOTHERAPY IN RESPIRATORY CARE LONDON CHAPMAN AND HALL 1993
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1997) POSTURAL DRAINAGE AND GASTRO-OESOPHAGEAL REFLUX IN INFANTS WITH CYSTIC FIBROSIS ARCHIVES OF DISEASE IN CHILDHOOD 76 148-150
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1998) POSTURAL DRAINAGE IN CYSTIC FIBROSIS IS THERE A LINK WITH GASTRO-OESOPHAGEAL REFLUX JOURNAL OF PAEDIATRIC CHILD HEALTH 34 330-334
bull CECINS NM JENKINS SC PENGELLEY J ET AL (1999) THE ACTIVE CYCLE OF BREATHING TECHNIQUES-TO TIP OR NOT TO TIP RESPIRATORY MEDICINE 93 660-665
bull CONSTANTINI D BRIVIO A BRUSA D ET AL (2001) PEP MASK VERSUS POSTURAL DRAINAGE IN INFANTS A LONG-TERM COMPARATIVE TRIAL PEADIATRIC PULMONOLOGY
bull HOUGH A (2001) PHYSIOTHERAPY IN RESPIRATORY CARE AN EVIDENCE-BASED APPROACH TO RESPIRATORY AND CARDIAC MANAGEMENT CENGAGE LEARNING EMEA
bull INTERNATIONAL PHYSIOTHERAPY GROUP FOR CYSTIC FIBROSIS PHYSIOTHERAPY IN THE TREATMENT OF CYSTIC FIBROSIS (2009) HTTPSWWWECFSEUIPG_CFBOOKLET INTERNATIONAL PHYSIOTHERAPY GROUP ndash THE BLUE BOOKLET
bull KONSTAN MW STERN RC DOERSHUK CF (1994) EFFICACY OF THE FLUTTER DEVICE FOR AIRWAY MUCUS CLEARANCE IN PATIENTS WITH CYSTIC FIBROSIS JOURNAL OF PEDIATRICS 124 (5 (PT 1) 689-693
bull MCILWAINE M BUTTON B AND DWAN K (2015) POSITIVE EXPIRATORY PRESSURE PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 6 ART NO CD003147 DOI 10100214651858CD003147PUB4
bull MESTRINER RG FERNANDES RO STAFFEN LC ET AL (2009) OPTIMUM DESIGN PARAMETERS FOR A THERAPIST-CONSTRUCTED POSITIVE-EXPIRATORY-PRESSURE THERAPY BOTTLE DEVICE RESPIRATORY CARE 54 504-8
bull MORRISON L AND AGNEW J (2014) OSCILLATING DEVICES FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 7 ART NO CD006842 DOI 10100214651858CD006842PUB
bull OERMANN CM SOCKRIDER MM GILES D ET AL (2001) COMPARISON OF HIGH-FREQUENCY CHEST WALL OSCILLATION AND OSCILLATING POSITIVE EXPIRATORY PRESSURE IN THE HOME MANAGEMENT OF CYSTIC FIBROSIS A PILOT STUDY PEDIATRIC PULMONOLOGY 32 (5) 372-7
bull PRASAD SA AND HUSSEY J (1995) PAEDIATRIC RESPIRATORY CARE A GUIDE FOR PHYSIOTHERAPISTS AND HEALTH PROFESSIONALS CHAPMAN amp HALL
bull PRYOR J (1999) PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN ADULTS EUROPEAN RESPIRATORY JOURNAL 14 (6) 1418-1424
bull PRYOR JA amp PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS CHURCHILL LIVINGSTONE
bull PRYOR JA WEBBER BA HODSON ME ET AL (1994) THE FLUTTER VRP1 AS AN ADJUNCT TO CHEST PHYSIOTHERAPY IN CYSTIC FIBROSIS RESPIRATORY MEDICINE 88677-81
bull WEST K WALLEN M FOLLETT J (2010) ACAPELLA VS PEP MASK THERAPY A RANDOMISED TRIAL IN CHILDREN WITH CYSTIC FIBROSIS DURING RESPIRATORY EXACERBATION PHYSIOTHERAPY THEORY PRACTICE 26143-9
bull WILSONLM AGNEW J MORRISON L ET AL (2014) AIRWAY CLEARANCE TECHNIQUES FOR CYSTIC FIBROSIS AN OVERVIEW OF COCHRANE SYSTEMATIC REVIEWS COCHRANE DATABASE OF SYSTEMATIC REVIEWS DOI 10100214651858CD011231
bull VOLSKO TA DIFIORE JM CHATBURN RL (2003) PERFORMANCE COMPARISON OF TWO OSCILLATORY POSITIVE PRESSURE DEVICES ACAPELLA VERSUS FLUTTER RESPIRATORY CARE 48 (2) 124- 130
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SEDDON PC KHAN Y RESPIRATORY PROBLEMS IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT ARCHIVES OF DISEASE IN CHILDHOOD 2003 01 JAN88(1)75-8
bull MARKS JH PULMONARY CARE OF CHILDREN AND ADOLESCENTS WITH DEVELOPMENTAL DISABILITIES PEDIATR CLIN NORTH AM 2008 DECEMBER55(6)1299-314
bull ARENS R MUZUMDAR H SLEEP SLEEP DISORDERED BREATHING AND NOCTURNAL HYPOVENTILATION IN CHILDREN WITH NEUROMUSCULAR DISEASES PAEDIATRIC RESPIRATORY REVIEWS 2010 MAR11(1)24-30
bull FITZGERALD DA FOLLETT J VAN ASPEREN PP ASSESSING AND MANAGING LUNG DISEASE AND SLEEP DISORDERED BREATHING IN CHILDREN WITH CEREBRAL PALSY PAEDIATRIC RESPIRATORY REVIEWS 2009 MARCH10(1)18-24
bull HSIAO KH NIXON GM THE EFFECT OF TREATMENT OF OBSTRUCTIVE SLEEP APNEA ON QUALITY OF LIFE IN CHILDREN WITH CEREBRAL PALSY RES DEV DISABIL 2008 MAR-APR29(2)133-40
bull LUNDBERG A OXYGEN CONSUMPTION IN RELATION TO WORKLOAD IN STUDENTS WITH CEREBRAL PALSY J APPL PHYSIO 197640873-5
bull SULLIVAN PB ROSENBLOOM L FEEDING THE DISABLED CHILD CLINICS IN DEVELOPMENTAL MEDICINE MACKEITH PRESS 1999140
bull MARTIN TR THE RELATIONSHIP BETWEEN MALNUTRITION AND LUNG INFECTIONS CLIN CHEST MED 19878359
bull MOSTAFA SM BHANDARI S RITCHIE G ET AL CONSTIPATION AND ITS IMPLICATIONS IN THE CRITICALLY ILL PATIENT BR J ANAESTH 200391815-9 3
bull GACOUIN A CAMUS C GROS A ET AL CONSTIPATION IN LONGTERM VENTILATED PATIENTS ASSOCIATED FACTORS AND IMPACT ON INTENSIVE CARE UNIT OUTCOMES CRIT CARE MED 2010381933- 8
bull NGUYEN T FRENETTE AJ JOHANSON C ET AL IMPAIRED GASTROINTESTINAL TRANSIT AND ITS ASSOCIATED MORBIDITY IN THE INTENSIVE CARE UNIT J CRIT CARE 201328537
bull ASAI T CONSTIPATION DOES IT INCREASE MORBIDITY AND MORTALITY IN CRITICALLY ILL PATIENTS CRIT CARE MED 2007352861-2
bull UNDERSTANDING THE PHYSIOLOGICAL EFFECTS OF UNTREATED PAIN NURSING TIMES VOL 99 ISSUE 37 PAGE NO 28
bull WINFIELD ET AL NON-PHARMACEUTICAL MANAGEMENT OF RESPIRATORY MORBIDITY IN CHILDREN WITH SEVERE GLOBAL DEVELOPMENTAL DELAY THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014
bull OLOUGHLIN EV SOMERVILLE HM SOMERVILLE ER DEALING WITH MULTISYSTEM DISEASE IN PEOPLE WITH A DEVELOPMENTAL DISABILITY MEDICAL JOURNAL OF AUSTRALIA 2009 JUN 1190(11)616-7
bull MESTROVIC J KARDUM G POLIC B MESTROVIC M MARKIC J SUSTIC A ET AL THE INFLUENCE OF CHRONIC HEALTH CONDITIONS ON SUSCEPTIBILITY TO SEVERE ACUTE ILLNESS OF CHILDREN TREATED IN PICU EUROPEAN JOURNAL OF PEDIATRICS 2006 AUG165(8)526-
9
bull HEALY F PANITCH HB PULMONARY COMPLICATIONS OF PEDIATRIC NEUROLOGICAL DISEASES PEDIATR ANN 2010 APR39(4)216-24
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SRIVASTAVA R JACKSON WD BARNHART DC DYSPHAGIA AND GASTROESOPHAGEAL REFLUX DISEASE DILEMMAS IN DIAGNOSIS AND MANAGEMENT IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT PEDIATR ANN 2010 APR39(4)225-31
bull SULLIVAN PB JUSZCZAK E BACHLET AME LAMBERT B VERNON-ROBERTS A GRANT HW ET AL GASTROSTOMY TUBE FEEDING IN CHILDREN WITH CEREBRAL PALSY A PROSPECTIVE LONGITUDINAL STUDY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 2005
FEBRUARY47(2)77-85
bull SOMERVILLE H TZANNES G WOOD J SHUN A HILL C ARROWSMITH F ET AL GASTROINTESTINAL AND NUTRITIONAL PROBLEMS IN SEVERE DEVELOPMENTAL DISABILITY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 200850(9)712-6
bull TODER DS RESPIRATORY PROBLEMS IN THE ADOLESCENT WITH DEVELOPMENTAL DELAY ADOLESCENT MEDICINE 2000 3 OCTOBER 200011(3)617-31
bull LEVIN K COLON A DIPALMA J FITZPATRICK S USING THE RADIONUCLIDE SALIVAGRAM TO DETECT PULMONARY ASPIRATION AND ESOPHAGEAL DYSMOTILITY CLIN NUCL MED 1993 FEB18(2)110-4
bull SCHROEDER AS KLING T HUSS K BORGGRAEFE I KOERTE IK BLASCHEK A ET AL BOTULINUM TOXIN TYPE A AND B FOR THE REDUCTION OF HYPERSALIVATION IN CHILDREN WITH NEUROLOGICAL DISORDERS A FOCUS ON EFFECTIVENESS AND THERAPY ADHERENCE
NEUROPEDIATRICS 201243(1)27-36
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull GOEMINNE P AND DUPONT L (2010) NON-CYSTIC FIBROSIS BRONCHIECTASIS DIAGNOSIS AND MANAGEMENT IN 21ST CENTURY POSTGRADUATE MEDICAL JOURNAL 86(1018) PP493-501
bull LEE A BUTTON B AND TANNENBAUM E (2017) AIRWAY-CLEARANCE TECHNIQUES IN CHILDREN AND ADOLESCENTS WITH CHRONIC SUPPURATIVE LUNG DISEASE AND BRONCHIECTASIS FRONTIERS IN PEDIATRICS 5
bull MANDAL P SIDHU M KOPE L POLLOCK W STEVENSON L PENTLAND J TURNBULL K MAC QUARRIE S AND HILL A (2012) A PILOT STUDY OF PULMONARY REHABILITATION AND CHEST PHYSIOTHERAPY VERSUS CHEST PHYSIOTHERAPY ALONE IN
BRONCHIECTASIS RESPIRATORY MEDICINE 106(12) PP1647-1654
bull MURRAY M PENTLAND J AND HILL A (2009) A RANDOMISED CROSSOVER TRIAL OF CHEST PHYSIOTHERAPY IN NON-CYSTIC FIBROSIS BRONCHIECTASIS EUROPEAN RESPIRATORY JOURNAL 34(5) PP1086-1092
bull NEWALL C STOCKLEY R AND HILL S (2005) EXERCISE TRAINING AND INSPIRATORY MUSCLE TRAINING IN PATIENTS WITH BRONCHIECTASIS THORAX 60(11) PP943-948
bull ONG H LEE A HILL C HOLLAND A AND DENEHY L (2011) EFFECTS OF PULMONARY REHABILITATION IN BRONCHIECTASIS A RETROSPECTIVE STUDY CHRONIC RESPIRATORY DISEASE 8(1) PP21-30
bull QUINT J MILLETT E JOSHI M NAVARATNAM V THOMAS S HURST J SMEETH L AND BROWN J (2015) CHANGES IN THE INCIDENCE PREVALENCE AND MORTALITY OF BRONCHIECTASIS IN THE UK FROM 2004 TO 2013 A POPULATION-BASED COHORT
STUDY EUROPEAN RESPIRATORY JOURNAL 47(1) PP186-193
bull SNIJDERS D FERNANDEZ DOMINGUEZ B CALGARO S BERTOZZI I ESCRIBANO MONTANER A PERILONGO G AND BARBATO A (2015) MUCOCILIARY CLEARANCE TECHNIQUES FOR TREATING NON-CYSTIC FIBROSIS BRONCHIECTASIS IS THERE
EVIDENCE INTERNATIONAL JOURNAL OF IMMUNOPATHOLOGY AND PHARMACOLOGY 28(2) PP150-159
MI-E
bull USED WITH CHILDREN WHO HAVE DECREASED INSPIRATORY EFFORT DUE TO EITHER SPINAL CORD INJURY OR NMW AND WHO HAVE AN IMPAIRED OR INEFFECTIVE COUGH WITH APPROPRIATE RESPIRATORY SYMPTOMS
bull CONSIDERED WHEN CONVENTIONAL COUGH ASSISTANCE TECHNIQUES BECOME INEFFECTIVE
bull ACCEPTED AS THE CORE STANDARD FOR CHILD WITH NMW
bull MIE WORKS BY
bull INFLATING THE LUNGS WITH GRADUAL POSITIVE AIRWAY PRESSURE ASSISTING INSPIRATION CALLED INSUFFLATION
bull FOLLOWED BY A RAPID SWITCH TO NEGATIVE PRESSURE WHICH SIMULATES THE FLOW CHANGES THAT OCCUR DURING A COUGH THEREBY ENHANCING EXPIRATORY FLOW CALLED EXSUFFLATION AND ASSISTING EXPECTORATION OF SECRETIONS
bull MOVEMENT AND EXERCISE BEST FUNCTIONAL METHOD OF AIRWAY CLEARANCE
bull CPET BETTER CORRELATION THAN LUNG FUNCTION IN SURVIVAL RATES IN PEOPLE WITH
CYSTIC FIBROSIS
bull RUNNINGWALKING BETTER FOR SECRETION CLEARANCE THAN BIKE DURING TO SHEARING
MECHANISM
bull CONSIDER ADDING IN HUFFS (DYER)
bull CONSIDER USE OF AD BELT
EXERCISE
bull APCP SUCTION GUIDELINES
bull TYPESNASOPHARANGEAL OROPHARANGEAL AND TRACHEOSTOMY
bull MAIN VARIABLES SUCTION TYPE AND SIZE DEPTH OF SUCTION
PRESSURE TECHNIQUE
SUCTION
SPUTUM
bull SPUTUM bull 95 WATER bull COLOUR bull VOLUME bull CONSISTENCY bull ODOUR
bull PURPOSE bull HUMIDIFICATION bull WATERPROOFING bull PROTECTION OF EPITHELIUM
HUMIDIFICATION
bull METABOLIC AND VENTILATORY REQUIREMENTS ARE X2-3 OF ADULTS
IMPLICATION
bull HEAT AND MOISTURE LOSSES FROM RESPIRATION WILL INCREASE BY X2-3
bull CONSUME GREATER AMOUNTS OF ENERGY AND WATER
HUMIDIFICATION INHALATION
THERAPY
bull TRACHEOSTOMY HME
bull WET DRY CIRCUIT
bull NEBULISERS INHALERS MUCOLYTICS
bull HUMIDIFIERS WITH NIV
bull OXYGEN
bull SYSTEMIC HYDRATION ENVIRONMENT
NEBULISERS
bull NEBULISER CHAMBER CONVERTS LIQUID INTO
RESPIRABLE PARTICLES
bull MOISTURE DESCENDS THROUGH THE HOLES IN THE SUPERFICIAL GEL LAYER
bull INCREASES THE SOL LAYER SO THE CILIARY BEAT IS OPTIMAL FOR MUCUS TRANSPORT
bull SHORT TERM HUMIDIFICATION
bull DAILY WASHING OF NEBULISER SYSTEM
TIMING OF DRUG AND PHYSIOTHERAPY
BEFORE TREATMENT
bull DNASE (PULMOZYME)
bull SALBUTAMOL
(VENTOLIN BLUE)
bull SALINE NEBS
AFTER TREATMENT
bull SERETIDE (PURPLE)
bull BECLOMETHASONE (BECOTIDE BROWN)
bull COLISTIN (COLOMYCIN PROMIXIN)
bull TOBRAMYCIN
CONCLUSION
bull BE AWARE OF CHILDrsquoS RESPIRATORY FUNCTION
bull CHOSE ACT BEST FOR THEM bull TYPE OF KETCHUP BOTTLE bull LV SECRETION RETENTION WOB
bull EARLY RESPIRATORY REFERRAL
bull RESPIRATORY CARE COMPETENCIES
bull EFFECTIVE SECRETION CLEARANCE AT HOMERESPITESCHOOL
bull USE OF PEAK COUGH FLOWS TO AID CHOICE OF ADJUNCT
0
50
100
150
200
250
300
350
400
0
50
100
150
200
250
300
350
400
Green
Key
Additional info
(please comment) Please refer to BTSACPRC Guideline
Lothian University Hospitals NHS Trust
n PCF
gt270lmin
Breathstack
ing tri-
flow
blowing
REFERENCES bull BTSACPRC GUIDELINE IS PUBLISHED IN THORAX VOL 67 SUPPLEMENT 1
bull AVAILABLE ONLINE AT HTTPTHORAXBMJCOMCONTENTVOL64ISSUESUPPLI
bull HTTPWWWBRIT-THORACICORGUKPHYSIOGUIDE
bull BRITISH THORACIC SOCIETY REPORTS VOL 1 NO 1 2009
bull ADAPTED PRYOR AJ AND PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS3RD ED
bull HOUGH A PHYSIOTHERAPY IN RESPIRATORY CARE LONDON CHAPMAN AND HALL 1993
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1997) POSTURAL DRAINAGE AND GASTRO-OESOPHAGEAL REFLUX IN INFANTS WITH CYSTIC FIBROSIS ARCHIVES OF DISEASE IN CHILDHOOD 76 148-150
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1998) POSTURAL DRAINAGE IN CYSTIC FIBROSIS IS THERE A LINK WITH GASTRO-OESOPHAGEAL REFLUX JOURNAL OF PAEDIATRIC CHILD HEALTH 34 330-334
bull CECINS NM JENKINS SC PENGELLEY J ET AL (1999) THE ACTIVE CYCLE OF BREATHING TECHNIQUES-TO TIP OR NOT TO TIP RESPIRATORY MEDICINE 93 660-665
bull CONSTANTINI D BRIVIO A BRUSA D ET AL (2001) PEP MASK VERSUS POSTURAL DRAINAGE IN INFANTS A LONG-TERM COMPARATIVE TRIAL PEADIATRIC PULMONOLOGY
bull HOUGH A (2001) PHYSIOTHERAPY IN RESPIRATORY CARE AN EVIDENCE-BASED APPROACH TO RESPIRATORY AND CARDIAC MANAGEMENT CENGAGE LEARNING EMEA
bull INTERNATIONAL PHYSIOTHERAPY GROUP FOR CYSTIC FIBROSIS PHYSIOTHERAPY IN THE TREATMENT OF CYSTIC FIBROSIS (2009) HTTPSWWWECFSEUIPG_CFBOOKLET INTERNATIONAL PHYSIOTHERAPY GROUP ndash THE BLUE BOOKLET
bull KONSTAN MW STERN RC DOERSHUK CF (1994) EFFICACY OF THE FLUTTER DEVICE FOR AIRWAY MUCUS CLEARANCE IN PATIENTS WITH CYSTIC FIBROSIS JOURNAL OF PEDIATRICS 124 (5 (PT 1) 689-693
bull MCILWAINE M BUTTON B AND DWAN K (2015) POSITIVE EXPIRATORY PRESSURE PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 6 ART NO CD003147 DOI 10100214651858CD003147PUB4
bull MESTRINER RG FERNANDES RO STAFFEN LC ET AL (2009) OPTIMUM DESIGN PARAMETERS FOR A THERAPIST-CONSTRUCTED POSITIVE-EXPIRATORY-PRESSURE THERAPY BOTTLE DEVICE RESPIRATORY CARE 54 504-8
bull MORRISON L AND AGNEW J (2014) OSCILLATING DEVICES FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 7 ART NO CD006842 DOI 10100214651858CD006842PUB
bull OERMANN CM SOCKRIDER MM GILES D ET AL (2001) COMPARISON OF HIGH-FREQUENCY CHEST WALL OSCILLATION AND OSCILLATING POSITIVE EXPIRATORY PRESSURE IN THE HOME MANAGEMENT OF CYSTIC FIBROSIS A PILOT STUDY PEDIATRIC PULMONOLOGY 32 (5) 372-7
bull PRASAD SA AND HUSSEY J (1995) PAEDIATRIC RESPIRATORY CARE A GUIDE FOR PHYSIOTHERAPISTS AND HEALTH PROFESSIONALS CHAPMAN amp HALL
bull PRYOR J (1999) PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN ADULTS EUROPEAN RESPIRATORY JOURNAL 14 (6) 1418-1424
bull PRYOR JA amp PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS CHURCHILL LIVINGSTONE
bull PRYOR JA WEBBER BA HODSON ME ET AL (1994) THE FLUTTER VRP1 AS AN ADJUNCT TO CHEST PHYSIOTHERAPY IN CYSTIC FIBROSIS RESPIRATORY MEDICINE 88677-81
bull WEST K WALLEN M FOLLETT J (2010) ACAPELLA VS PEP MASK THERAPY A RANDOMISED TRIAL IN CHILDREN WITH CYSTIC FIBROSIS DURING RESPIRATORY EXACERBATION PHYSIOTHERAPY THEORY PRACTICE 26143-9
bull WILSONLM AGNEW J MORRISON L ET AL (2014) AIRWAY CLEARANCE TECHNIQUES FOR CYSTIC FIBROSIS AN OVERVIEW OF COCHRANE SYSTEMATIC REVIEWS COCHRANE DATABASE OF SYSTEMATIC REVIEWS DOI 10100214651858CD011231
bull VOLSKO TA DIFIORE JM CHATBURN RL (2003) PERFORMANCE COMPARISON OF TWO OSCILLATORY POSITIVE PRESSURE DEVICES ACAPELLA VERSUS FLUTTER RESPIRATORY CARE 48 (2) 124- 130
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SEDDON PC KHAN Y RESPIRATORY PROBLEMS IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT ARCHIVES OF DISEASE IN CHILDHOOD 2003 01 JAN88(1)75-8
bull MARKS JH PULMONARY CARE OF CHILDREN AND ADOLESCENTS WITH DEVELOPMENTAL DISABILITIES PEDIATR CLIN NORTH AM 2008 DECEMBER55(6)1299-314
bull ARENS R MUZUMDAR H SLEEP SLEEP DISORDERED BREATHING AND NOCTURNAL HYPOVENTILATION IN CHILDREN WITH NEUROMUSCULAR DISEASES PAEDIATRIC RESPIRATORY REVIEWS 2010 MAR11(1)24-30
bull FITZGERALD DA FOLLETT J VAN ASPEREN PP ASSESSING AND MANAGING LUNG DISEASE AND SLEEP DISORDERED BREATHING IN CHILDREN WITH CEREBRAL PALSY PAEDIATRIC RESPIRATORY REVIEWS 2009 MARCH10(1)18-24
bull HSIAO KH NIXON GM THE EFFECT OF TREATMENT OF OBSTRUCTIVE SLEEP APNEA ON QUALITY OF LIFE IN CHILDREN WITH CEREBRAL PALSY RES DEV DISABIL 2008 MAR-APR29(2)133-40
bull LUNDBERG A OXYGEN CONSUMPTION IN RELATION TO WORKLOAD IN STUDENTS WITH CEREBRAL PALSY J APPL PHYSIO 197640873-5
bull SULLIVAN PB ROSENBLOOM L FEEDING THE DISABLED CHILD CLINICS IN DEVELOPMENTAL MEDICINE MACKEITH PRESS 1999140
bull MARTIN TR THE RELATIONSHIP BETWEEN MALNUTRITION AND LUNG INFECTIONS CLIN CHEST MED 19878359
bull MOSTAFA SM BHANDARI S RITCHIE G ET AL CONSTIPATION AND ITS IMPLICATIONS IN THE CRITICALLY ILL PATIENT BR J ANAESTH 200391815-9 3
bull GACOUIN A CAMUS C GROS A ET AL CONSTIPATION IN LONGTERM VENTILATED PATIENTS ASSOCIATED FACTORS AND IMPACT ON INTENSIVE CARE UNIT OUTCOMES CRIT CARE MED 2010381933- 8
bull NGUYEN T FRENETTE AJ JOHANSON C ET AL IMPAIRED GASTROINTESTINAL TRANSIT AND ITS ASSOCIATED MORBIDITY IN THE INTENSIVE CARE UNIT J CRIT CARE 201328537
bull ASAI T CONSTIPATION DOES IT INCREASE MORBIDITY AND MORTALITY IN CRITICALLY ILL PATIENTS CRIT CARE MED 2007352861-2
bull UNDERSTANDING THE PHYSIOLOGICAL EFFECTS OF UNTREATED PAIN NURSING TIMES VOL 99 ISSUE 37 PAGE NO 28
bull WINFIELD ET AL NON-PHARMACEUTICAL MANAGEMENT OF RESPIRATORY MORBIDITY IN CHILDREN WITH SEVERE GLOBAL DEVELOPMENTAL DELAY THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014
bull OLOUGHLIN EV SOMERVILLE HM SOMERVILLE ER DEALING WITH MULTISYSTEM DISEASE IN PEOPLE WITH A DEVELOPMENTAL DISABILITY MEDICAL JOURNAL OF AUSTRALIA 2009 JUN 1190(11)616-7
bull MESTROVIC J KARDUM G POLIC B MESTROVIC M MARKIC J SUSTIC A ET AL THE INFLUENCE OF CHRONIC HEALTH CONDITIONS ON SUSCEPTIBILITY TO SEVERE ACUTE ILLNESS OF CHILDREN TREATED IN PICU EUROPEAN JOURNAL OF PEDIATRICS 2006 AUG165(8)526-
9
bull HEALY F PANITCH HB PULMONARY COMPLICATIONS OF PEDIATRIC NEUROLOGICAL DISEASES PEDIATR ANN 2010 APR39(4)216-24
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SRIVASTAVA R JACKSON WD BARNHART DC DYSPHAGIA AND GASTROESOPHAGEAL REFLUX DISEASE DILEMMAS IN DIAGNOSIS AND MANAGEMENT IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT PEDIATR ANN 2010 APR39(4)225-31
bull SULLIVAN PB JUSZCZAK E BACHLET AME LAMBERT B VERNON-ROBERTS A GRANT HW ET AL GASTROSTOMY TUBE FEEDING IN CHILDREN WITH CEREBRAL PALSY A PROSPECTIVE LONGITUDINAL STUDY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 2005
FEBRUARY47(2)77-85
bull SOMERVILLE H TZANNES G WOOD J SHUN A HILL C ARROWSMITH F ET AL GASTROINTESTINAL AND NUTRITIONAL PROBLEMS IN SEVERE DEVELOPMENTAL DISABILITY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 200850(9)712-6
bull TODER DS RESPIRATORY PROBLEMS IN THE ADOLESCENT WITH DEVELOPMENTAL DELAY ADOLESCENT MEDICINE 2000 3 OCTOBER 200011(3)617-31
bull LEVIN K COLON A DIPALMA J FITZPATRICK S USING THE RADIONUCLIDE SALIVAGRAM TO DETECT PULMONARY ASPIRATION AND ESOPHAGEAL DYSMOTILITY CLIN NUCL MED 1993 FEB18(2)110-4
bull SCHROEDER AS KLING T HUSS K BORGGRAEFE I KOERTE IK BLASCHEK A ET AL BOTULINUM TOXIN TYPE A AND B FOR THE REDUCTION OF HYPERSALIVATION IN CHILDREN WITH NEUROLOGICAL DISORDERS A FOCUS ON EFFECTIVENESS AND THERAPY ADHERENCE
NEUROPEDIATRICS 201243(1)27-36
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull GOEMINNE P AND DUPONT L (2010) NON-CYSTIC FIBROSIS BRONCHIECTASIS DIAGNOSIS AND MANAGEMENT IN 21ST CENTURY POSTGRADUATE MEDICAL JOURNAL 86(1018) PP493-501
bull LEE A BUTTON B AND TANNENBAUM E (2017) AIRWAY-CLEARANCE TECHNIQUES IN CHILDREN AND ADOLESCENTS WITH CHRONIC SUPPURATIVE LUNG DISEASE AND BRONCHIECTASIS FRONTIERS IN PEDIATRICS 5
bull MANDAL P SIDHU M KOPE L POLLOCK W STEVENSON L PENTLAND J TURNBULL K MAC QUARRIE S AND HILL A (2012) A PILOT STUDY OF PULMONARY REHABILITATION AND CHEST PHYSIOTHERAPY VERSUS CHEST PHYSIOTHERAPY ALONE IN
BRONCHIECTASIS RESPIRATORY MEDICINE 106(12) PP1647-1654
bull MURRAY M PENTLAND J AND HILL A (2009) A RANDOMISED CROSSOVER TRIAL OF CHEST PHYSIOTHERAPY IN NON-CYSTIC FIBROSIS BRONCHIECTASIS EUROPEAN RESPIRATORY JOURNAL 34(5) PP1086-1092
bull NEWALL C STOCKLEY R AND HILL S (2005) EXERCISE TRAINING AND INSPIRATORY MUSCLE TRAINING IN PATIENTS WITH BRONCHIECTASIS THORAX 60(11) PP943-948
bull ONG H LEE A HILL C HOLLAND A AND DENEHY L (2011) EFFECTS OF PULMONARY REHABILITATION IN BRONCHIECTASIS A RETROSPECTIVE STUDY CHRONIC RESPIRATORY DISEASE 8(1) PP21-30
bull QUINT J MILLETT E JOSHI M NAVARATNAM V THOMAS S HURST J SMEETH L AND BROWN J (2015) CHANGES IN THE INCIDENCE PREVALENCE AND MORTALITY OF BRONCHIECTASIS IN THE UK FROM 2004 TO 2013 A POPULATION-BASED COHORT
STUDY EUROPEAN RESPIRATORY JOURNAL 47(1) PP186-193
bull SNIJDERS D FERNANDEZ DOMINGUEZ B CALGARO S BERTOZZI I ESCRIBANO MONTANER A PERILONGO G AND BARBATO A (2015) MUCOCILIARY CLEARANCE TECHNIQUES FOR TREATING NON-CYSTIC FIBROSIS BRONCHIECTASIS IS THERE
EVIDENCE INTERNATIONAL JOURNAL OF IMMUNOPATHOLOGY AND PHARMACOLOGY 28(2) PP150-159
bull MOVEMENT AND EXERCISE BEST FUNCTIONAL METHOD OF AIRWAY CLEARANCE
bull CPET BETTER CORRELATION THAN LUNG FUNCTION IN SURVIVAL RATES IN PEOPLE WITH
CYSTIC FIBROSIS
bull RUNNINGWALKING BETTER FOR SECRETION CLEARANCE THAN BIKE DURING TO SHEARING
MECHANISM
bull CONSIDER ADDING IN HUFFS (DYER)
bull CONSIDER USE OF AD BELT
EXERCISE
bull APCP SUCTION GUIDELINES
bull TYPESNASOPHARANGEAL OROPHARANGEAL AND TRACHEOSTOMY
bull MAIN VARIABLES SUCTION TYPE AND SIZE DEPTH OF SUCTION
PRESSURE TECHNIQUE
SUCTION
SPUTUM
bull SPUTUM bull 95 WATER bull COLOUR bull VOLUME bull CONSISTENCY bull ODOUR
bull PURPOSE bull HUMIDIFICATION bull WATERPROOFING bull PROTECTION OF EPITHELIUM
HUMIDIFICATION
bull METABOLIC AND VENTILATORY REQUIREMENTS ARE X2-3 OF ADULTS
IMPLICATION
bull HEAT AND MOISTURE LOSSES FROM RESPIRATION WILL INCREASE BY X2-3
bull CONSUME GREATER AMOUNTS OF ENERGY AND WATER
HUMIDIFICATION INHALATION
THERAPY
bull TRACHEOSTOMY HME
bull WET DRY CIRCUIT
bull NEBULISERS INHALERS MUCOLYTICS
bull HUMIDIFIERS WITH NIV
bull OXYGEN
bull SYSTEMIC HYDRATION ENVIRONMENT
NEBULISERS
bull NEBULISER CHAMBER CONVERTS LIQUID INTO
RESPIRABLE PARTICLES
bull MOISTURE DESCENDS THROUGH THE HOLES IN THE SUPERFICIAL GEL LAYER
bull INCREASES THE SOL LAYER SO THE CILIARY BEAT IS OPTIMAL FOR MUCUS TRANSPORT
bull SHORT TERM HUMIDIFICATION
bull DAILY WASHING OF NEBULISER SYSTEM
TIMING OF DRUG AND PHYSIOTHERAPY
BEFORE TREATMENT
bull DNASE (PULMOZYME)
bull SALBUTAMOL
(VENTOLIN BLUE)
bull SALINE NEBS
AFTER TREATMENT
bull SERETIDE (PURPLE)
bull BECLOMETHASONE (BECOTIDE BROWN)
bull COLISTIN (COLOMYCIN PROMIXIN)
bull TOBRAMYCIN
CONCLUSION
bull BE AWARE OF CHILDrsquoS RESPIRATORY FUNCTION
bull CHOSE ACT BEST FOR THEM bull TYPE OF KETCHUP BOTTLE bull LV SECRETION RETENTION WOB
bull EARLY RESPIRATORY REFERRAL
bull RESPIRATORY CARE COMPETENCIES
bull EFFECTIVE SECRETION CLEARANCE AT HOMERESPITESCHOOL
bull USE OF PEAK COUGH FLOWS TO AID CHOICE OF ADJUNCT
0
50
100
150
200
250
300
350
400
0
50
100
150
200
250
300
350
400
Green
Key
Additional info
(please comment) Please refer to BTSACPRC Guideline
Lothian University Hospitals NHS Trust
n PCF
gt270lmin
Breathstack
ing tri-
flow
blowing
REFERENCES bull BTSACPRC GUIDELINE IS PUBLISHED IN THORAX VOL 67 SUPPLEMENT 1
bull AVAILABLE ONLINE AT HTTPTHORAXBMJCOMCONTENTVOL64ISSUESUPPLI
bull HTTPWWWBRIT-THORACICORGUKPHYSIOGUIDE
bull BRITISH THORACIC SOCIETY REPORTS VOL 1 NO 1 2009
bull ADAPTED PRYOR AJ AND PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS3RD ED
bull HOUGH A PHYSIOTHERAPY IN RESPIRATORY CARE LONDON CHAPMAN AND HALL 1993
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1997) POSTURAL DRAINAGE AND GASTRO-OESOPHAGEAL REFLUX IN INFANTS WITH CYSTIC FIBROSIS ARCHIVES OF DISEASE IN CHILDHOOD 76 148-150
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1998) POSTURAL DRAINAGE IN CYSTIC FIBROSIS IS THERE A LINK WITH GASTRO-OESOPHAGEAL REFLUX JOURNAL OF PAEDIATRIC CHILD HEALTH 34 330-334
bull CECINS NM JENKINS SC PENGELLEY J ET AL (1999) THE ACTIVE CYCLE OF BREATHING TECHNIQUES-TO TIP OR NOT TO TIP RESPIRATORY MEDICINE 93 660-665
bull CONSTANTINI D BRIVIO A BRUSA D ET AL (2001) PEP MASK VERSUS POSTURAL DRAINAGE IN INFANTS A LONG-TERM COMPARATIVE TRIAL PEADIATRIC PULMONOLOGY
bull HOUGH A (2001) PHYSIOTHERAPY IN RESPIRATORY CARE AN EVIDENCE-BASED APPROACH TO RESPIRATORY AND CARDIAC MANAGEMENT CENGAGE LEARNING EMEA
bull INTERNATIONAL PHYSIOTHERAPY GROUP FOR CYSTIC FIBROSIS PHYSIOTHERAPY IN THE TREATMENT OF CYSTIC FIBROSIS (2009) HTTPSWWWECFSEUIPG_CFBOOKLET INTERNATIONAL PHYSIOTHERAPY GROUP ndash THE BLUE BOOKLET
bull KONSTAN MW STERN RC DOERSHUK CF (1994) EFFICACY OF THE FLUTTER DEVICE FOR AIRWAY MUCUS CLEARANCE IN PATIENTS WITH CYSTIC FIBROSIS JOURNAL OF PEDIATRICS 124 (5 (PT 1) 689-693
bull MCILWAINE M BUTTON B AND DWAN K (2015) POSITIVE EXPIRATORY PRESSURE PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 6 ART NO CD003147 DOI 10100214651858CD003147PUB4
bull MESTRINER RG FERNANDES RO STAFFEN LC ET AL (2009) OPTIMUM DESIGN PARAMETERS FOR A THERAPIST-CONSTRUCTED POSITIVE-EXPIRATORY-PRESSURE THERAPY BOTTLE DEVICE RESPIRATORY CARE 54 504-8
bull MORRISON L AND AGNEW J (2014) OSCILLATING DEVICES FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 7 ART NO CD006842 DOI 10100214651858CD006842PUB
bull OERMANN CM SOCKRIDER MM GILES D ET AL (2001) COMPARISON OF HIGH-FREQUENCY CHEST WALL OSCILLATION AND OSCILLATING POSITIVE EXPIRATORY PRESSURE IN THE HOME MANAGEMENT OF CYSTIC FIBROSIS A PILOT STUDY PEDIATRIC PULMONOLOGY 32 (5) 372-7
bull PRASAD SA AND HUSSEY J (1995) PAEDIATRIC RESPIRATORY CARE A GUIDE FOR PHYSIOTHERAPISTS AND HEALTH PROFESSIONALS CHAPMAN amp HALL
bull PRYOR J (1999) PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN ADULTS EUROPEAN RESPIRATORY JOURNAL 14 (6) 1418-1424
bull PRYOR JA amp PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS CHURCHILL LIVINGSTONE
bull PRYOR JA WEBBER BA HODSON ME ET AL (1994) THE FLUTTER VRP1 AS AN ADJUNCT TO CHEST PHYSIOTHERAPY IN CYSTIC FIBROSIS RESPIRATORY MEDICINE 88677-81
bull WEST K WALLEN M FOLLETT J (2010) ACAPELLA VS PEP MASK THERAPY A RANDOMISED TRIAL IN CHILDREN WITH CYSTIC FIBROSIS DURING RESPIRATORY EXACERBATION PHYSIOTHERAPY THEORY PRACTICE 26143-9
bull WILSONLM AGNEW J MORRISON L ET AL (2014) AIRWAY CLEARANCE TECHNIQUES FOR CYSTIC FIBROSIS AN OVERVIEW OF COCHRANE SYSTEMATIC REVIEWS COCHRANE DATABASE OF SYSTEMATIC REVIEWS DOI 10100214651858CD011231
bull VOLSKO TA DIFIORE JM CHATBURN RL (2003) PERFORMANCE COMPARISON OF TWO OSCILLATORY POSITIVE PRESSURE DEVICES ACAPELLA VERSUS FLUTTER RESPIRATORY CARE 48 (2) 124- 130
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SEDDON PC KHAN Y RESPIRATORY PROBLEMS IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT ARCHIVES OF DISEASE IN CHILDHOOD 2003 01 JAN88(1)75-8
bull MARKS JH PULMONARY CARE OF CHILDREN AND ADOLESCENTS WITH DEVELOPMENTAL DISABILITIES PEDIATR CLIN NORTH AM 2008 DECEMBER55(6)1299-314
bull ARENS R MUZUMDAR H SLEEP SLEEP DISORDERED BREATHING AND NOCTURNAL HYPOVENTILATION IN CHILDREN WITH NEUROMUSCULAR DISEASES PAEDIATRIC RESPIRATORY REVIEWS 2010 MAR11(1)24-30
bull FITZGERALD DA FOLLETT J VAN ASPEREN PP ASSESSING AND MANAGING LUNG DISEASE AND SLEEP DISORDERED BREATHING IN CHILDREN WITH CEREBRAL PALSY PAEDIATRIC RESPIRATORY REVIEWS 2009 MARCH10(1)18-24
bull HSIAO KH NIXON GM THE EFFECT OF TREATMENT OF OBSTRUCTIVE SLEEP APNEA ON QUALITY OF LIFE IN CHILDREN WITH CEREBRAL PALSY RES DEV DISABIL 2008 MAR-APR29(2)133-40
bull LUNDBERG A OXYGEN CONSUMPTION IN RELATION TO WORKLOAD IN STUDENTS WITH CEREBRAL PALSY J APPL PHYSIO 197640873-5
bull SULLIVAN PB ROSENBLOOM L FEEDING THE DISABLED CHILD CLINICS IN DEVELOPMENTAL MEDICINE MACKEITH PRESS 1999140
bull MARTIN TR THE RELATIONSHIP BETWEEN MALNUTRITION AND LUNG INFECTIONS CLIN CHEST MED 19878359
bull MOSTAFA SM BHANDARI S RITCHIE G ET AL CONSTIPATION AND ITS IMPLICATIONS IN THE CRITICALLY ILL PATIENT BR J ANAESTH 200391815-9 3
bull GACOUIN A CAMUS C GROS A ET AL CONSTIPATION IN LONGTERM VENTILATED PATIENTS ASSOCIATED FACTORS AND IMPACT ON INTENSIVE CARE UNIT OUTCOMES CRIT CARE MED 2010381933- 8
bull NGUYEN T FRENETTE AJ JOHANSON C ET AL IMPAIRED GASTROINTESTINAL TRANSIT AND ITS ASSOCIATED MORBIDITY IN THE INTENSIVE CARE UNIT J CRIT CARE 201328537
bull ASAI T CONSTIPATION DOES IT INCREASE MORBIDITY AND MORTALITY IN CRITICALLY ILL PATIENTS CRIT CARE MED 2007352861-2
bull UNDERSTANDING THE PHYSIOLOGICAL EFFECTS OF UNTREATED PAIN NURSING TIMES VOL 99 ISSUE 37 PAGE NO 28
bull WINFIELD ET AL NON-PHARMACEUTICAL MANAGEMENT OF RESPIRATORY MORBIDITY IN CHILDREN WITH SEVERE GLOBAL DEVELOPMENTAL DELAY THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014
bull OLOUGHLIN EV SOMERVILLE HM SOMERVILLE ER DEALING WITH MULTISYSTEM DISEASE IN PEOPLE WITH A DEVELOPMENTAL DISABILITY MEDICAL JOURNAL OF AUSTRALIA 2009 JUN 1190(11)616-7
bull MESTROVIC J KARDUM G POLIC B MESTROVIC M MARKIC J SUSTIC A ET AL THE INFLUENCE OF CHRONIC HEALTH CONDITIONS ON SUSCEPTIBILITY TO SEVERE ACUTE ILLNESS OF CHILDREN TREATED IN PICU EUROPEAN JOURNAL OF PEDIATRICS 2006 AUG165(8)526-
9
bull HEALY F PANITCH HB PULMONARY COMPLICATIONS OF PEDIATRIC NEUROLOGICAL DISEASES PEDIATR ANN 2010 APR39(4)216-24
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SRIVASTAVA R JACKSON WD BARNHART DC DYSPHAGIA AND GASTROESOPHAGEAL REFLUX DISEASE DILEMMAS IN DIAGNOSIS AND MANAGEMENT IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT PEDIATR ANN 2010 APR39(4)225-31
bull SULLIVAN PB JUSZCZAK E BACHLET AME LAMBERT B VERNON-ROBERTS A GRANT HW ET AL GASTROSTOMY TUBE FEEDING IN CHILDREN WITH CEREBRAL PALSY A PROSPECTIVE LONGITUDINAL STUDY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 2005
FEBRUARY47(2)77-85
bull SOMERVILLE H TZANNES G WOOD J SHUN A HILL C ARROWSMITH F ET AL GASTROINTESTINAL AND NUTRITIONAL PROBLEMS IN SEVERE DEVELOPMENTAL DISABILITY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 200850(9)712-6
bull TODER DS RESPIRATORY PROBLEMS IN THE ADOLESCENT WITH DEVELOPMENTAL DELAY ADOLESCENT MEDICINE 2000 3 OCTOBER 200011(3)617-31
bull LEVIN K COLON A DIPALMA J FITZPATRICK S USING THE RADIONUCLIDE SALIVAGRAM TO DETECT PULMONARY ASPIRATION AND ESOPHAGEAL DYSMOTILITY CLIN NUCL MED 1993 FEB18(2)110-4
bull SCHROEDER AS KLING T HUSS K BORGGRAEFE I KOERTE IK BLASCHEK A ET AL BOTULINUM TOXIN TYPE A AND B FOR THE REDUCTION OF HYPERSALIVATION IN CHILDREN WITH NEUROLOGICAL DISORDERS A FOCUS ON EFFECTIVENESS AND THERAPY ADHERENCE
NEUROPEDIATRICS 201243(1)27-36
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull GOEMINNE P AND DUPONT L (2010) NON-CYSTIC FIBROSIS BRONCHIECTASIS DIAGNOSIS AND MANAGEMENT IN 21ST CENTURY POSTGRADUATE MEDICAL JOURNAL 86(1018) PP493-501
bull LEE A BUTTON B AND TANNENBAUM E (2017) AIRWAY-CLEARANCE TECHNIQUES IN CHILDREN AND ADOLESCENTS WITH CHRONIC SUPPURATIVE LUNG DISEASE AND BRONCHIECTASIS FRONTIERS IN PEDIATRICS 5
bull MANDAL P SIDHU M KOPE L POLLOCK W STEVENSON L PENTLAND J TURNBULL K MAC QUARRIE S AND HILL A (2012) A PILOT STUDY OF PULMONARY REHABILITATION AND CHEST PHYSIOTHERAPY VERSUS CHEST PHYSIOTHERAPY ALONE IN
BRONCHIECTASIS RESPIRATORY MEDICINE 106(12) PP1647-1654
bull MURRAY M PENTLAND J AND HILL A (2009) A RANDOMISED CROSSOVER TRIAL OF CHEST PHYSIOTHERAPY IN NON-CYSTIC FIBROSIS BRONCHIECTASIS EUROPEAN RESPIRATORY JOURNAL 34(5) PP1086-1092
bull NEWALL C STOCKLEY R AND HILL S (2005) EXERCISE TRAINING AND INSPIRATORY MUSCLE TRAINING IN PATIENTS WITH BRONCHIECTASIS THORAX 60(11) PP943-948
bull ONG H LEE A HILL C HOLLAND A AND DENEHY L (2011) EFFECTS OF PULMONARY REHABILITATION IN BRONCHIECTASIS A RETROSPECTIVE STUDY CHRONIC RESPIRATORY DISEASE 8(1) PP21-30
bull QUINT J MILLETT E JOSHI M NAVARATNAM V THOMAS S HURST J SMEETH L AND BROWN J (2015) CHANGES IN THE INCIDENCE PREVALENCE AND MORTALITY OF BRONCHIECTASIS IN THE UK FROM 2004 TO 2013 A POPULATION-BASED COHORT
STUDY EUROPEAN RESPIRATORY JOURNAL 47(1) PP186-193
bull SNIJDERS D FERNANDEZ DOMINGUEZ B CALGARO S BERTOZZI I ESCRIBANO MONTANER A PERILONGO G AND BARBATO A (2015) MUCOCILIARY CLEARANCE TECHNIQUES FOR TREATING NON-CYSTIC FIBROSIS BRONCHIECTASIS IS THERE
EVIDENCE INTERNATIONAL JOURNAL OF IMMUNOPATHOLOGY AND PHARMACOLOGY 28(2) PP150-159
bull APCP SUCTION GUIDELINES
bull TYPESNASOPHARANGEAL OROPHARANGEAL AND TRACHEOSTOMY
bull MAIN VARIABLES SUCTION TYPE AND SIZE DEPTH OF SUCTION
PRESSURE TECHNIQUE
SUCTION
SPUTUM
bull SPUTUM bull 95 WATER bull COLOUR bull VOLUME bull CONSISTENCY bull ODOUR
bull PURPOSE bull HUMIDIFICATION bull WATERPROOFING bull PROTECTION OF EPITHELIUM
HUMIDIFICATION
bull METABOLIC AND VENTILATORY REQUIREMENTS ARE X2-3 OF ADULTS
IMPLICATION
bull HEAT AND MOISTURE LOSSES FROM RESPIRATION WILL INCREASE BY X2-3
bull CONSUME GREATER AMOUNTS OF ENERGY AND WATER
HUMIDIFICATION INHALATION
THERAPY
bull TRACHEOSTOMY HME
bull WET DRY CIRCUIT
bull NEBULISERS INHALERS MUCOLYTICS
bull HUMIDIFIERS WITH NIV
bull OXYGEN
bull SYSTEMIC HYDRATION ENVIRONMENT
NEBULISERS
bull NEBULISER CHAMBER CONVERTS LIQUID INTO
RESPIRABLE PARTICLES
bull MOISTURE DESCENDS THROUGH THE HOLES IN THE SUPERFICIAL GEL LAYER
bull INCREASES THE SOL LAYER SO THE CILIARY BEAT IS OPTIMAL FOR MUCUS TRANSPORT
bull SHORT TERM HUMIDIFICATION
bull DAILY WASHING OF NEBULISER SYSTEM
TIMING OF DRUG AND PHYSIOTHERAPY
BEFORE TREATMENT
bull DNASE (PULMOZYME)
bull SALBUTAMOL
(VENTOLIN BLUE)
bull SALINE NEBS
AFTER TREATMENT
bull SERETIDE (PURPLE)
bull BECLOMETHASONE (BECOTIDE BROWN)
bull COLISTIN (COLOMYCIN PROMIXIN)
bull TOBRAMYCIN
CONCLUSION
bull BE AWARE OF CHILDrsquoS RESPIRATORY FUNCTION
bull CHOSE ACT BEST FOR THEM bull TYPE OF KETCHUP BOTTLE bull LV SECRETION RETENTION WOB
bull EARLY RESPIRATORY REFERRAL
bull RESPIRATORY CARE COMPETENCIES
bull EFFECTIVE SECRETION CLEARANCE AT HOMERESPITESCHOOL
bull USE OF PEAK COUGH FLOWS TO AID CHOICE OF ADJUNCT
0
50
100
150
200
250
300
350
400
0
50
100
150
200
250
300
350
400
Green
Key
Additional info
(please comment) Please refer to BTSACPRC Guideline
Lothian University Hospitals NHS Trust
n PCF
gt270lmin
Breathstack
ing tri-
flow
blowing
REFERENCES bull BTSACPRC GUIDELINE IS PUBLISHED IN THORAX VOL 67 SUPPLEMENT 1
bull AVAILABLE ONLINE AT HTTPTHORAXBMJCOMCONTENTVOL64ISSUESUPPLI
bull HTTPWWWBRIT-THORACICORGUKPHYSIOGUIDE
bull BRITISH THORACIC SOCIETY REPORTS VOL 1 NO 1 2009
bull ADAPTED PRYOR AJ AND PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS3RD ED
bull HOUGH A PHYSIOTHERAPY IN RESPIRATORY CARE LONDON CHAPMAN AND HALL 1993
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1997) POSTURAL DRAINAGE AND GASTRO-OESOPHAGEAL REFLUX IN INFANTS WITH CYSTIC FIBROSIS ARCHIVES OF DISEASE IN CHILDHOOD 76 148-150
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1998) POSTURAL DRAINAGE IN CYSTIC FIBROSIS IS THERE A LINK WITH GASTRO-OESOPHAGEAL REFLUX JOURNAL OF PAEDIATRIC CHILD HEALTH 34 330-334
bull CECINS NM JENKINS SC PENGELLEY J ET AL (1999) THE ACTIVE CYCLE OF BREATHING TECHNIQUES-TO TIP OR NOT TO TIP RESPIRATORY MEDICINE 93 660-665
bull CONSTANTINI D BRIVIO A BRUSA D ET AL (2001) PEP MASK VERSUS POSTURAL DRAINAGE IN INFANTS A LONG-TERM COMPARATIVE TRIAL PEADIATRIC PULMONOLOGY
bull HOUGH A (2001) PHYSIOTHERAPY IN RESPIRATORY CARE AN EVIDENCE-BASED APPROACH TO RESPIRATORY AND CARDIAC MANAGEMENT CENGAGE LEARNING EMEA
bull INTERNATIONAL PHYSIOTHERAPY GROUP FOR CYSTIC FIBROSIS PHYSIOTHERAPY IN THE TREATMENT OF CYSTIC FIBROSIS (2009) HTTPSWWWECFSEUIPG_CFBOOKLET INTERNATIONAL PHYSIOTHERAPY GROUP ndash THE BLUE BOOKLET
bull KONSTAN MW STERN RC DOERSHUK CF (1994) EFFICACY OF THE FLUTTER DEVICE FOR AIRWAY MUCUS CLEARANCE IN PATIENTS WITH CYSTIC FIBROSIS JOURNAL OF PEDIATRICS 124 (5 (PT 1) 689-693
bull MCILWAINE M BUTTON B AND DWAN K (2015) POSITIVE EXPIRATORY PRESSURE PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 6 ART NO CD003147 DOI 10100214651858CD003147PUB4
bull MESTRINER RG FERNANDES RO STAFFEN LC ET AL (2009) OPTIMUM DESIGN PARAMETERS FOR A THERAPIST-CONSTRUCTED POSITIVE-EXPIRATORY-PRESSURE THERAPY BOTTLE DEVICE RESPIRATORY CARE 54 504-8
bull MORRISON L AND AGNEW J (2014) OSCILLATING DEVICES FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 7 ART NO CD006842 DOI 10100214651858CD006842PUB
bull OERMANN CM SOCKRIDER MM GILES D ET AL (2001) COMPARISON OF HIGH-FREQUENCY CHEST WALL OSCILLATION AND OSCILLATING POSITIVE EXPIRATORY PRESSURE IN THE HOME MANAGEMENT OF CYSTIC FIBROSIS A PILOT STUDY PEDIATRIC PULMONOLOGY 32 (5) 372-7
bull PRASAD SA AND HUSSEY J (1995) PAEDIATRIC RESPIRATORY CARE A GUIDE FOR PHYSIOTHERAPISTS AND HEALTH PROFESSIONALS CHAPMAN amp HALL
bull PRYOR J (1999) PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN ADULTS EUROPEAN RESPIRATORY JOURNAL 14 (6) 1418-1424
bull PRYOR JA amp PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS CHURCHILL LIVINGSTONE
bull PRYOR JA WEBBER BA HODSON ME ET AL (1994) THE FLUTTER VRP1 AS AN ADJUNCT TO CHEST PHYSIOTHERAPY IN CYSTIC FIBROSIS RESPIRATORY MEDICINE 88677-81
bull WEST K WALLEN M FOLLETT J (2010) ACAPELLA VS PEP MASK THERAPY A RANDOMISED TRIAL IN CHILDREN WITH CYSTIC FIBROSIS DURING RESPIRATORY EXACERBATION PHYSIOTHERAPY THEORY PRACTICE 26143-9
bull WILSONLM AGNEW J MORRISON L ET AL (2014) AIRWAY CLEARANCE TECHNIQUES FOR CYSTIC FIBROSIS AN OVERVIEW OF COCHRANE SYSTEMATIC REVIEWS COCHRANE DATABASE OF SYSTEMATIC REVIEWS DOI 10100214651858CD011231
bull VOLSKO TA DIFIORE JM CHATBURN RL (2003) PERFORMANCE COMPARISON OF TWO OSCILLATORY POSITIVE PRESSURE DEVICES ACAPELLA VERSUS FLUTTER RESPIRATORY CARE 48 (2) 124- 130
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SEDDON PC KHAN Y RESPIRATORY PROBLEMS IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT ARCHIVES OF DISEASE IN CHILDHOOD 2003 01 JAN88(1)75-8
bull MARKS JH PULMONARY CARE OF CHILDREN AND ADOLESCENTS WITH DEVELOPMENTAL DISABILITIES PEDIATR CLIN NORTH AM 2008 DECEMBER55(6)1299-314
bull ARENS R MUZUMDAR H SLEEP SLEEP DISORDERED BREATHING AND NOCTURNAL HYPOVENTILATION IN CHILDREN WITH NEUROMUSCULAR DISEASES PAEDIATRIC RESPIRATORY REVIEWS 2010 MAR11(1)24-30
bull FITZGERALD DA FOLLETT J VAN ASPEREN PP ASSESSING AND MANAGING LUNG DISEASE AND SLEEP DISORDERED BREATHING IN CHILDREN WITH CEREBRAL PALSY PAEDIATRIC RESPIRATORY REVIEWS 2009 MARCH10(1)18-24
bull HSIAO KH NIXON GM THE EFFECT OF TREATMENT OF OBSTRUCTIVE SLEEP APNEA ON QUALITY OF LIFE IN CHILDREN WITH CEREBRAL PALSY RES DEV DISABIL 2008 MAR-APR29(2)133-40
bull LUNDBERG A OXYGEN CONSUMPTION IN RELATION TO WORKLOAD IN STUDENTS WITH CEREBRAL PALSY J APPL PHYSIO 197640873-5
bull SULLIVAN PB ROSENBLOOM L FEEDING THE DISABLED CHILD CLINICS IN DEVELOPMENTAL MEDICINE MACKEITH PRESS 1999140
bull MARTIN TR THE RELATIONSHIP BETWEEN MALNUTRITION AND LUNG INFECTIONS CLIN CHEST MED 19878359
bull MOSTAFA SM BHANDARI S RITCHIE G ET AL CONSTIPATION AND ITS IMPLICATIONS IN THE CRITICALLY ILL PATIENT BR J ANAESTH 200391815-9 3
bull GACOUIN A CAMUS C GROS A ET AL CONSTIPATION IN LONGTERM VENTILATED PATIENTS ASSOCIATED FACTORS AND IMPACT ON INTENSIVE CARE UNIT OUTCOMES CRIT CARE MED 2010381933- 8
bull NGUYEN T FRENETTE AJ JOHANSON C ET AL IMPAIRED GASTROINTESTINAL TRANSIT AND ITS ASSOCIATED MORBIDITY IN THE INTENSIVE CARE UNIT J CRIT CARE 201328537
bull ASAI T CONSTIPATION DOES IT INCREASE MORBIDITY AND MORTALITY IN CRITICALLY ILL PATIENTS CRIT CARE MED 2007352861-2
bull UNDERSTANDING THE PHYSIOLOGICAL EFFECTS OF UNTREATED PAIN NURSING TIMES VOL 99 ISSUE 37 PAGE NO 28
bull WINFIELD ET AL NON-PHARMACEUTICAL MANAGEMENT OF RESPIRATORY MORBIDITY IN CHILDREN WITH SEVERE GLOBAL DEVELOPMENTAL DELAY THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014
bull OLOUGHLIN EV SOMERVILLE HM SOMERVILLE ER DEALING WITH MULTISYSTEM DISEASE IN PEOPLE WITH A DEVELOPMENTAL DISABILITY MEDICAL JOURNAL OF AUSTRALIA 2009 JUN 1190(11)616-7
bull MESTROVIC J KARDUM G POLIC B MESTROVIC M MARKIC J SUSTIC A ET AL THE INFLUENCE OF CHRONIC HEALTH CONDITIONS ON SUSCEPTIBILITY TO SEVERE ACUTE ILLNESS OF CHILDREN TREATED IN PICU EUROPEAN JOURNAL OF PEDIATRICS 2006 AUG165(8)526-
9
bull HEALY F PANITCH HB PULMONARY COMPLICATIONS OF PEDIATRIC NEUROLOGICAL DISEASES PEDIATR ANN 2010 APR39(4)216-24
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SRIVASTAVA R JACKSON WD BARNHART DC DYSPHAGIA AND GASTROESOPHAGEAL REFLUX DISEASE DILEMMAS IN DIAGNOSIS AND MANAGEMENT IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT PEDIATR ANN 2010 APR39(4)225-31
bull SULLIVAN PB JUSZCZAK E BACHLET AME LAMBERT B VERNON-ROBERTS A GRANT HW ET AL GASTROSTOMY TUBE FEEDING IN CHILDREN WITH CEREBRAL PALSY A PROSPECTIVE LONGITUDINAL STUDY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 2005
FEBRUARY47(2)77-85
bull SOMERVILLE H TZANNES G WOOD J SHUN A HILL C ARROWSMITH F ET AL GASTROINTESTINAL AND NUTRITIONAL PROBLEMS IN SEVERE DEVELOPMENTAL DISABILITY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 200850(9)712-6
bull TODER DS RESPIRATORY PROBLEMS IN THE ADOLESCENT WITH DEVELOPMENTAL DELAY ADOLESCENT MEDICINE 2000 3 OCTOBER 200011(3)617-31
bull LEVIN K COLON A DIPALMA J FITZPATRICK S USING THE RADIONUCLIDE SALIVAGRAM TO DETECT PULMONARY ASPIRATION AND ESOPHAGEAL DYSMOTILITY CLIN NUCL MED 1993 FEB18(2)110-4
bull SCHROEDER AS KLING T HUSS K BORGGRAEFE I KOERTE IK BLASCHEK A ET AL BOTULINUM TOXIN TYPE A AND B FOR THE REDUCTION OF HYPERSALIVATION IN CHILDREN WITH NEUROLOGICAL DISORDERS A FOCUS ON EFFECTIVENESS AND THERAPY ADHERENCE
NEUROPEDIATRICS 201243(1)27-36
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull GOEMINNE P AND DUPONT L (2010) NON-CYSTIC FIBROSIS BRONCHIECTASIS DIAGNOSIS AND MANAGEMENT IN 21ST CENTURY POSTGRADUATE MEDICAL JOURNAL 86(1018) PP493-501
bull LEE A BUTTON B AND TANNENBAUM E (2017) AIRWAY-CLEARANCE TECHNIQUES IN CHILDREN AND ADOLESCENTS WITH CHRONIC SUPPURATIVE LUNG DISEASE AND BRONCHIECTASIS FRONTIERS IN PEDIATRICS 5
bull MANDAL P SIDHU M KOPE L POLLOCK W STEVENSON L PENTLAND J TURNBULL K MAC QUARRIE S AND HILL A (2012) A PILOT STUDY OF PULMONARY REHABILITATION AND CHEST PHYSIOTHERAPY VERSUS CHEST PHYSIOTHERAPY ALONE IN
BRONCHIECTASIS RESPIRATORY MEDICINE 106(12) PP1647-1654
bull MURRAY M PENTLAND J AND HILL A (2009) A RANDOMISED CROSSOVER TRIAL OF CHEST PHYSIOTHERAPY IN NON-CYSTIC FIBROSIS BRONCHIECTASIS EUROPEAN RESPIRATORY JOURNAL 34(5) PP1086-1092
bull NEWALL C STOCKLEY R AND HILL S (2005) EXERCISE TRAINING AND INSPIRATORY MUSCLE TRAINING IN PATIENTS WITH BRONCHIECTASIS THORAX 60(11) PP943-948
bull ONG H LEE A HILL C HOLLAND A AND DENEHY L (2011) EFFECTS OF PULMONARY REHABILITATION IN BRONCHIECTASIS A RETROSPECTIVE STUDY CHRONIC RESPIRATORY DISEASE 8(1) PP21-30
bull QUINT J MILLETT E JOSHI M NAVARATNAM V THOMAS S HURST J SMEETH L AND BROWN J (2015) CHANGES IN THE INCIDENCE PREVALENCE AND MORTALITY OF BRONCHIECTASIS IN THE UK FROM 2004 TO 2013 A POPULATION-BASED COHORT
STUDY EUROPEAN RESPIRATORY JOURNAL 47(1) PP186-193
bull SNIJDERS D FERNANDEZ DOMINGUEZ B CALGARO S BERTOZZI I ESCRIBANO MONTANER A PERILONGO G AND BARBATO A (2015) MUCOCILIARY CLEARANCE TECHNIQUES FOR TREATING NON-CYSTIC FIBROSIS BRONCHIECTASIS IS THERE
EVIDENCE INTERNATIONAL JOURNAL OF IMMUNOPATHOLOGY AND PHARMACOLOGY 28(2) PP150-159
SPUTUM
bull SPUTUM bull 95 WATER bull COLOUR bull VOLUME bull CONSISTENCY bull ODOUR
bull PURPOSE bull HUMIDIFICATION bull WATERPROOFING bull PROTECTION OF EPITHELIUM
HUMIDIFICATION
bull METABOLIC AND VENTILATORY REQUIREMENTS ARE X2-3 OF ADULTS
IMPLICATION
bull HEAT AND MOISTURE LOSSES FROM RESPIRATION WILL INCREASE BY X2-3
bull CONSUME GREATER AMOUNTS OF ENERGY AND WATER
HUMIDIFICATION INHALATION
THERAPY
bull TRACHEOSTOMY HME
bull WET DRY CIRCUIT
bull NEBULISERS INHALERS MUCOLYTICS
bull HUMIDIFIERS WITH NIV
bull OXYGEN
bull SYSTEMIC HYDRATION ENVIRONMENT
NEBULISERS
bull NEBULISER CHAMBER CONVERTS LIQUID INTO
RESPIRABLE PARTICLES
bull MOISTURE DESCENDS THROUGH THE HOLES IN THE SUPERFICIAL GEL LAYER
bull INCREASES THE SOL LAYER SO THE CILIARY BEAT IS OPTIMAL FOR MUCUS TRANSPORT
bull SHORT TERM HUMIDIFICATION
bull DAILY WASHING OF NEBULISER SYSTEM
TIMING OF DRUG AND PHYSIOTHERAPY
BEFORE TREATMENT
bull DNASE (PULMOZYME)
bull SALBUTAMOL
(VENTOLIN BLUE)
bull SALINE NEBS
AFTER TREATMENT
bull SERETIDE (PURPLE)
bull BECLOMETHASONE (BECOTIDE BROWN)
bull COLISTIN (COLOMYCIN PROMIXIN)
bull TOBRAMYCIN
CONCLUSION
bull BE AWARE OF CHILDrsquoS RESPIRATORY FUNCTION
bull CHOSE ACT BEST FOR THEM bull TYPE OF KETCHUP BOTTLE bull LV SECRETION RETENTION WOB
bull EARLY RESPIRATORY REFERRAL
bull RESPIRATORY CARE COMPETENCIES
bull EFFECTIVE SECRETION CLEARANCE AT HOMERESPITESCHOOL
bull USE OF PEAK COUGH FLOWS TO AID CHOICE OF ADJUNCT
0
50
100
150
200
250
300
350
400
0
50
100
150
200
250
300
350
400
Green
Key
Additional info
(please comment) Please refer to BTSACPRC Guideline
Lothian University Hospitals NHS Trust
n PCF
gt270lmin
Breathstack
ing tri-
flow
blowing
REFERENCES bull BTSACPRC GUIDELINE IS PUBLISHED IN THORAX VOL 67 SUPPLEMENT 1
bull AVAILABLE ONLINE AT HTTPTHORAXBMJCOMCONTENTVOL64ISSUESUPPLI
bull HTTPWWWBRIT-THORACICORGUKPHYSIOGUIDE
bull BRITISH THORACIC SOCIETY REPORTS VOL 1 NO 1 2009
bull ADAPTED PRYOR AJ AND PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS3RD ED
bull HOUGH A PHYSIOTHERAPY IN RESPIRATORY CARE LONDON CHAPMAN AND HALL 1993
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1997) POSTURAL DRAINAGE AND GASTRO-OESOPHAGEAL REFLUX IN INFANTS WITH CYSTIC FIBROSIS ARCHIVES OF DISEASE IN CHILDHOOD 76 148-150
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1998) POSTURAL DRAINAGE IN CYSTIC FIBROSIS IS THERE A LINK WITH GASTRO-OESOPHAGEAL REFLUX JOURNAL OF PAEDIATRIC CHILD HEALTH 34 330-334
bull CECINS NM JENKINS SC PENGELLEY J ET AL (1999) THE ACTIVE CYCLE OF BREATHING TECHNIQUES-TO TIP OR NOT TO TIP RESPIRATORY MEDICINE 93 660-665
bull CONSTANTINI D BRIVIO A BRUSA D ET AL (2001) PEP MASK VERSUS POSTURAL DRAINAGE IN INFANTS A LONG-TERM COMPARATIVE TRIAL PEADIATRIC PULMONOLOGY
bull HOUGH A (2001) PHYSIOTHERAPY IN RESPIRATORY CARE AN EVIDENCE-BASED APPROACH TO RESPIRATORY AND CARDIAC MANAGEMENT CENGAGE LEARNING EMEA
bull INTERNATIONAL PHYSIOTHERAPY GROUP FOR CYSTIC FIBROSIS PHYSIOTHERAPY IN THE TREATMENT OF CYSTIC FIBROSIS (2009) HTTPSWWWECFSEUIPG_CFBOOKLET INTERNATIONAL PHYSIOTHERAPY GROUP ndash THE BLUE BOOKLET
bull KONSTAN MW STERN RC DOERSHUK CF (1994) EFFICACY OF THE FLUTTER DEVICE FOR AIRWAY MUCUS CLEARANCE IN PATIENTS WITH CYSTIC FIBROSIS JOURNAL OF PEDIATRICS 124 (5 (PT 1) 689-693
bull MCILWAINE M BUTTON B AND DWAN K (2015) POSITIVE EXPIRATORY PRESSURE PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 6 ART NO CD003147 DOI 10100214651858CD003147PUB4
bull MESTRINER RG FERNANDES RO STAFFEN LC ET AL (2009) OPTIMUM DESIGN PARAMETERS FOR A THERAPIST-CONSTRUCTED POSITIVE-EXPIRATORY-PRESSURE THERAPY BOTTLE DEVICE RESPIRATORY CARE 54 504-8
bull MORRISON L AND AGNEW J (2014) OSCILLATING DEVICES FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 7 ART NO CD006842 DOI 10100214651858CD006842PUB
bull OERMANN CM SOCKRIDER MM GILES D ET AL (2001) COMPARISON OF HIGH-FREQUENCY CHEST WALL OSCILLATION AND OSCILLATING POSITIVE EXPIRATORY PRESSURE IN THE HOME MANAGEMENT OF CYSTIC FIBROSIS A PILOT STUDY PEDIATRIC PULMONOLOGY 32 (5) 372-7
bull PRASAD SA AND HUSSEY J (1995) PAEDIATRIC RESPIRATORY CARE A GUIDE FOR PHYSIOTHERAPISTS AND HEALTH PROFESSIONALS CHAPMAN amp HALL
bull PRYOR J (1999) PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN ADULTS EUROPEAN RESPIRATORY JOURNAL 14 (6) 1418-1424
bull PRYOR JA amp PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS CHURCHILL LIVINGSTONE
bull PRYOR JA WEBBER BA HODSON ME ET AL (1994) THE FLUTTER VRP1 AS AN ADJUNCT TO CHEST PHYSIOTHERAPY IN CYSTIC FIBROSIS RESPIRATORY MEDICINE 88677-81
bull WEST K WALLEN M FOLLETT J (2010) ACAPELLA VS PEP MASK THERAPY A RANDOMISED TRIAL IN CHILDREN WITH CYSTIC FIBROSIS DURING RESPIRATORY EXACERBATION PHYSIOTHERAPY THEORY PRACTICE 26143-9
bull WILSONLM AGNEW J MORRISON L ET AL (2014) AIRWAY CLEARANCE TECHNIQUES FOR CYSTIC FIBROSIS AN OVERVIEW OF COCHRANE SYSTEMATIC REVIEWS COCHRANE DATABASE OF SYSTEMATIC REVIEWS DOI 10100214651858CD011231
bull VOLSKO TA DIFIORE JM CHATBURN RL (2003) PERFORMANCE COMPARISON OF TWO OSCILLATORY POSITIVE PRESSURE DEVICES ACAPELLA VERSUS FLUTTER RESPIRATORY CARE 48 (2) 124- 130
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SEDDON PC KHAN Y RESPIRATORY PROBLEMS IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT ARCHIVES OF DISEASE IN CHILDHOOD 2003 01 JAN88(1)75-8
bull MARKS JH PULMONARY CARE OF CHILDREN AND ADOLESCENTS WITH DEVELOPMENTAL DISABILITIES PEDIATR CLIN NORTH AM 2008 DECEMBER55(6)1299-314
bull ARENS R MUZUMDAR H SLEEP SLEEP DISORDERED BREATHING AND NOCTURNAL HYPOVENTILATION IN CHILDREN WITH NEUROMUSCULAR DISEASES PAEDIATRIC RESPIRATORY REVIEWS 2010 MAR11(1)24-30
bull FITZGERALD DA FOLLETT J VAN ASPEREN PP ASSESSING AND MANAGING LUNG DISEASE AND SLEEP DISORDERED BREATHING IN CHILDREN WITH CEREBRAL PALSY PAEDIATRIC RESPIRATORY REVIEWS 2009 MARCH10(1)18-24
bull HSIAO KH NIXON GM THE EFFECT OF TREATMENT OF OBSTRUCTIVE SLEEP APNEA ON QUALITY OF LIFE IN CHILDREN WITH CEREBRAL PALSY RES DEV DISABIL 2008 MAR-APR29(2)133-40
bull LUNDBERG A OXYGEN CONSUMPTION IN RELATION TO WORKLOAD IN STUDENTS WITH CEREBRAL PALSY J APPL PHYSIO 197640873-5
bull SULLIVAN PB ROSENBLOOM L FEEDING THE DISABLED CHILD CLINICS IN DEVELOPMENTAL MEDICINE MACKEITH PRESS 1999140
bull MARTIN TR THE RELATIONSHIP BETWEEN MALNUTRITION AND LUNG INFECTIONS CLIN CHEST MED 19878359
bull MOSTAFA SM BHANDARI S RITCHIE G ET AL CONSTIPATION AND ITS IMPLICATIONS IN THE CRITICALLY ILL PATIENT BR J ANAESTH 200391815-9 3
bull GACOUIN A CAMUS C GROS A ET AL CONSTIPATION IN LONGTERM VENTILATED PATIENTS ASSOCIATED FACTORS AND IMPACT ON INTENSIVE CARE UNIT OUTCOMES CRIT CARE MED 2010381933- 8
bull NGUYEN T FRENETTE AJ JOHANSON C ET AL IMPAIRED GASTROINTESTINAL TRANSIT AND ITS ASSOCIATED MORBIDITY IN THE INTENSIVE CARE UNIT J CRIT CARE 201328537
bull ASAI T CONSTIPATION DOES IT INCREASE MORBIDITY AND MORTALITY IN CRITICALLY ILL PATIENTS CRIT CARE MED 2007352861-2
bull UNDERSTANDING THE PHYSIOLOGICAL EFFECTS OF UNTREATED PAIN NURSING TIMES VOL 99 ISSUE 37 PAGE NO 28
bull WINFIELD ET AL NON-PHARMACEUTICAL MANAGEMENT OF RESPIRATORY MORBIDITY IN CHILDREN WITH SEVERE GLOBAL DEVELOPMENTAL DELAY THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014
bull OLOUGHLIN EV SOMERVILLE HM SOMERVILLE ER DEALING WITH MULTISYSTEM DISEASE IN PEOPLE WITH A DEVELOPMENTAL DISABILITY MEDICAL JOURNAL OF AUSTRALIA 2009 JUN 1190(11)616-7
bull MESTROVIC J KARDUM G POLIC B MESTROVIC M MARKIC J SUSTIC A ET AL THE INFLUENCE OF CHRONIC HEALTH CONDITIONS ON SUSCEPTIBILITY TO SEVERE ACUTE ILLNESS OF CHILDREN TREATED IN PICU EUROPEAN JOURNAL OF PEDIATRICS 2006 AUG165(8)526-
9
bull HEALY F PANITCH HB PULMONARY COMPLICATIONS OF PEDIATRIC NEUROLOGICAL DISEASES PEDIATR ANN 2010 APR39(4)216-24
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SRIVASTAVA R JACKSON WD BARNHART DC DYSPHAGIA AND GASTROESOPHAGEAL REFLUX DISEASE DILEMMAS IN DIAGNOSIS AND MANAGEMENT IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT PEDIATR ANN 2010 APR39(4)225-31
bull SULLIVAN PB JUSZCZAK E BACHLET AME LAMBERT B VERNON-ROBERTS A GRANT HW ET AL GASTROSTOMY TUBE FEEDING IN CHILDREN WITH CEREBRAL PALSY A PROSPECTIVE LONGITUDINAL STUDY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 2005
FEBRUARY47(2)77-85
bull SOMERVILLE H TZANNES G WOOD J SHUN A HILL C ARROWSMITH F ET AL GASTROINTESTINAL AND NUTRITIONAL PROBLEMS IN SEVERE DEVELOPMENTAL DISABILITY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 200850(9)712-6
bull TODER DS RESPIRATORY PROBLEMS IN THE ADOLESCENT WITH DEVELOPMENTAL DELAY ADOLESCENT MEDICINE 2000 3 OCTOBER 200011(3)617-31
bull LEVIN K COLON A DIPALMA J FITZPATRICK S USING THE RADIONUCLIDE SALIVAGRAM TO DETECT PULMONARY ASPIRATION AND ESOPHAGEAL DYSMOTILITY CLIN NUCL MED 1993 FEB18(2)110-4
bull SCHROEDER AS KLING T HUSS K BORGGRAEFE I KOERTE IK BLASCHEK A ET AL BOTULINUM TOXIN TYPE A AND B FOR THE REDUCTION OF HYPERSALIVATION IN CHILDREN WITH NEUROLOGICAL DISORDERS A FOCUS ON EFFECTIVENESS AND THERAPY ADHERENCE
NEUROPEDIATRICS 201243(1)27-36
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull GOEMINNE P AND DUPONT L (2010) NON-CYSTIC FIBROSIS BRONCHIECTASIS DIAGNOSIS AND MANAGEMENT IN 21ST CENTURY POSTGRADUATE MEDICAL JOURNAL 86(1018) PP493-501
bull LEE A BUTTON B AND TANNENBAUM E (2017) AIRWAY-CLEARANCE TECHNIQUES IN CHILDREN AND ADOLESCENTS WITH CHRONIC SUPPURATIVE LUNG DISEASE AND BRONCHIECTASIS FRONTIERS IN PEDIATRICS 5
bull MANDAL P SIDHU M KOPE L POLLOCK W STEVENSON L PENTLAND J TURNBULL K MAC QUARRIE S AND HILL A (2012) A PILOT STUDY OF PULMONARY REHABILITATION AND CHEST PHYSIOTHERAPY VERSUS CHEST PHYSIOTHERAPY ALONE IN
BRONCHIECTASIS RESPIRATORY MEDICINE 106(12) PP1647-1654
bull MURRAY M PENTLAND J AND HILL A (2009) A RANDOMISED CROSSOVER TRIAL OF CHEST PHYSIOTHERAPY IN NON-CYSTIC FIBROSIS BRONCHIECTASIS EUROPEAN RESPIRATORY JOURNAL 34(5) PP1086-1092
bull NEWALL C STOCKLEY R AND HILL S (2005) EXERCISE TRAINING AND INSPIRATORY MUSCLE TRAINING IN PATIENTS WITH BRONCHIECTASIS THORAX 60(11) PP943-948
bull ONG H LEE A HILL C HOLLAND A AND DENEHY L (2011) EFFECTS OF PULMONARY REHABILITATION IN BRONCHIECTASIS A RETROSPECTIVE STUDY CHRONIC RESPIRATORY DISEASE 8(1) PP21-30
bull QUINT J MILLETT E JOSHI M NAVARATNAM V THOMAS S HURST J SMEETH L AND BROWN J (2015) CHANGES IN THE INCIDENCE PREVALENCE AND MORTALITY OF BRONCHIECTASIS IN THE UK FROM 2004 TO 2013 A POPULATION-BASED COHORT
STUDY EUROPEAN RESPIRATORY JOURNAL 47(1) PP186-193
bull SNIJDERS D FERNANDEZ DOMINGUEZ B CALGARO S BERTOZZI I ESCRIBANO MONTANER A PERILONGO G AND BARBATO A (2015) MUCOCILIARY CLEARANCE TECHNIQUES FOR TREATING NON-CYSTIC FIBROSIS BRONCHIECTASIS IS THERE
EVIDENCE INTERNATIONAL JOURNAL OF IMMUNOPATHOLOGY AND PHARMACOLOGY 28(2) PP150-159
HUMIDIFICATION
bull METABOLIC AND VENTILATORY REQUIREMENTS ARE X2-3 OF ADULTS
IMPLICATION
bull HEAT AND MOISTURE LOSSES FROM RESPIRATION WILL INCREASE BY X2-3
bull CONSUME GREATER AMOUNTS OF ENERGY AND WATER
HUMIDIFICATION INHALATION
THERAPY
bull TRACHEOSTOMY HME
bull WET DRY CIRCUIT
bull NEBULISERS INHALERS MUCOLYTICS
bull HUMIDIFIERS WITH NIV
bull OXYGEN
bull SYSTEMIC HYDRATION ENVIRONMENT
NEBULISERS
bull NEBULISER CHAMBER CONVERTS LIQUID INTO
RESPIRABLE PARTICLES
bull MOISTURE DESCENDS THROUGH THE HOLES IN THE SUPERFICIAL GEL LAYER
bull INCREASES THE SOL LAYER SO THE CILIARY BEAT IS OPTIMAL FOR MUCUS TRANSPORT
bull SHORT TERM HUMIDIFICATION
bull DAILY WASHING OF NEBULISER SYSTEM
TIMING OF DRUG AND PHYSIOTHERAPY
BEFORE TREATMENT
bull DNASE (PULMOZYME)
bull SALBUTAMOL
(VENTOLIN BLUE)
bull SALINE NEBS
AFTER TREATMENT
bull SERETIDE (PURPLE)
bull BECLOMETHASONE (BECOTIDE BROWN)
bull COLISTIN (COLOMYCIN PROMIXIN)
bull TOBRAMYCIN
CONCLUSION
bull BE AWARE OF CHILDrsquoS RESPIRATORY FUNCTION
bull CHOSE ACT BEST FOR THEM bull TYPE OF KETCHUP BOTTLE bull LV SECRETION RETENTION WOB
bull EARLY RESPIRATORY REFERRAL
bull RESPIRATORY CARE COMPETENCIES
bull EFFECTIVE SECRETION CLEARANCE AT HOMERESPITESCHOOL
bull USE OF PEAK COUGH FLOWS TO AID CHOICE OF ADJUNCT
0
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250
300
350
400
0
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250
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350
400
Green
Key
Additional info
(please comment) Please refer to BTSACPRC Guideline
Lothian University Hospitals NHS Trust
n PCF
gt270lmin
Breathstack
ing tri-
flow
blowing
REFERENCES bull BTSACPRC GUIDELINE IS PUBLISHED IN THORAX VOL 67 SUPPLEMENT 1
bull AVAILABLE ONLINE AT HTTPTHORAXBMJCOMCONTENTVOL64ISSUESUPPLI
bull HTTPWWWBRIT-THORACICORGUKPHYSIOGUIDE
bull BRITISH THORACIC SOCIETY REPORTS VOL 1 NO 1 2009
bull ADAPTED PRYOR AJ AND PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS3RD ED
bull HOUGH A PHYSIOTHERAPY IN RESPIRATORY CARE LONDON CHAPMAN AND HALL 1993
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1997) POSTURAL DRAINAGE AND GASTRO-OESOPHAGEAL REFLUX IN INFANTS WITH CYSTIC FIBROSIS ARCHIVES OF DISEASE IN CHILDHOOD 76 148-150
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1998) POSTURAL DRAINAGE IN CYSTIC FIBROSIS IS THERE A LINK WITH GASTRO-OESOPHAGEAL REFLUX JOURNAL OF PAEDIATRIC CHILD HEALTH 34 330-334
bull CECINS NM JENKINS SC PENGELLEY J ET AL (1999) THE ACTIVE CYCLE OF BREATHING TECHNIQUES-TO TIP OR NOT TO TIP RESPIRATORY MEDICINE 93 660-665
bull CONSTANTINI D BRIVIO A BRUSA D ET AL (2001) PEP MASK VERSUS POSTURAL DRAINAGE IN INFANTS A LONG-TERM COMPARATIVE TRIAL PEADIATRIC PULMONOLOGY
bull HOUGH A (2001) PHYSIOTHERAPY IN RESPIRATORY CARE AN EVIDENCE-BASED APPROACH TO RESPIRATORY AND CARDIAC MANAGEMENT CENGAGE LEARNING EMEA
bull INTERNATIONAL PHYSIOTHERAPY GROUP FOR CYSTIC FIBROSIS PHYSIOTHERAPY IN THE TREATMENT OF CYSTIC FIBROSIS (2009) HTTPSWWWECFSEUIPG_CFBOOKLET INTERNATIONAL PHYSIOTHERAPY GROUP ndash THE BLUE BOOKLET
bull KONSTAN MW STERN RC DOERSHUK CF (1994) EFFICACY OF THE FLUTTER DEVICE FOR AIRWAY MUCUS CLEARANCE IN PATIENTS WITH CYSTIC FIBROSIS JOURNAL OF PEDIATRICS 124 (5 (PT 1) 689-693
bull MCILWAINE M BUTTON B AND DWAN K (2015) POSITIVE EXPIRATORY PRESSURE PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 6 ART NO CD003147 DOI 10100214651858CD003147PUB4
bull MESTRINER RG FERNANDES RO STAFFEN LC ET AL (2009) OPTIMUM DESIGN PARAMETERS FOR A THERAPIST-CONSTRUCTED POSITIVE-EXPIRATORY-PRESSURE THERAPY BOTTLE DEVICE RESPIRATORY CARE 54 504-8
bull MORRISON L AND AGNEW J (2014) OSCILLATING DEVICES FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 7 ART NO CD006842 DOI 10100214651858CD006842PUB
bull OERMANN CM SOCKRIDER MM GILES D ET AL (2001) COMPARISON OF HIGH-FREQUENCY CHEST WALL OSCILLATION AND OSCILLATING POSITIVE EXPIRATORY PRESSURE IN THE HOME MANAGEMENT OF CYSTIC FIBROSIS A PILOT STUDY PEDIATRIC PULMONOLOGY 32 (5) 372-7
bull PRASAD SA AND HUSSEY J (1995) PAEDIATRIC RESPIRATORY CARE A GUIDE FOR PHYSIOTHERAPISTS AND HEALTH PROFESSIONALS CHAPMAN amp HALL
bull PRYOR J (1999) PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN ADULTS EUROPEAN RESPIRATORY JOURNAL 14 (6) 1418-1424
bull PRYOR JA amp PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS CHURCHILL LIVINGSTONE
bull PRYOR JA WEBBER BA HODSON ME ET AL (1994) THE FLUTTER VRP1 AS AN ADJUNCT TO CHEST PHYSIOTHERAPY IN CYSTIC FIBROSIS RESPIRATORY MEDICINE 88677-81
bull WEST K WALLEN M FOLLETT J (2010) ACAPELLA VS PEP MASK THERAPY A RANDOMISED TRIAL IN CHILDREN WITH CYSTIC FIBROSIS DURING RESPIRATORY EXACERBATION PHYSIOTHERAPY THEORY PRACTICE 26143-9
bull WILSONLM AGNEW J MORRISON L ET AL (2014) AIRWAY CLEARANCE TECHNIQUES FOR CYSTIC FIBROSIS AN OVERVIEW OF COCHRANE SYSTEMATIC REVIEWS COCHRANE DATABASE OF SYSTEMATIC REVIEWS DOI 10100214651858CD011231
bull VOLSKO TA DIFIORE JM CHATBURN RL (2003) PERFORMANCE COMPARISON OF TWO OSCILLATORY POSITIVE PRESSURE DEVICES ACAPELLA VERSUS FLUTTER RESPIRATORY CARE 48 (2) 124- 130
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SEDDON PC KHAN Y RESPIRATORY PROBLEMS IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT ARCHIVES OF DISEASE IN CHILDHOOD 2003 01 JAN88(1)75-8
bull MARKS JH PULMONARY CARE OF CHILDREN AND ADOLESCENTS WITH DEVELOPMENTAL DISABILITIES PEDIATR CLIN NORTH AM 2008 DECEMBER55(6)1299-314
bull ARENS R MUZUMDAR H SLEEP SLEEP DISORDERED BREATHING AND NOCTURNAL HYPOVENTILATION IN CHILDREN WITH NEUROMUSCULAR DISEASES PAEDIATRIC RESPIRATORY REVIEWS 2010 MAR11(1)24-30
bull FITZGERALD DA FOLLETT J VAN ASPEREN PP ASSESSING AND MANAGING LUNG DISEASE AND SLEEP DISORDERED BREATHING IN CHILDREN WITH CEREBRAL PALSY PAEDIATRIC RESPIRATORY REVIEWS 2009 MARCH10(1)18-24
bull HSIAO KH NIXON GM THE EFFECT OF TREATMENT OF OBSTRUCTIVE SLEEP APNEA ON QUALITY OF LIFE IN CHILDREN WITH CEREBRAL PALSY RES DEV DISABIL 2008 MAR-APR29(2)133-40
bull LUNDBERG A OXYGEN CONSUMPTION IN RELATION TO WORKLOAD IN STUDENTS WITH CEREBRAL PALSY J APPL PHYSIO 197640873-5
bull SULLIVAN PB ROSENBLOOM L FEEDING THE DISABLED CHILD CLINICS IN DEVELOPMENTAL MEDICINE MACKEITH PRESS 1999140
bull MARTIN TR THE RELATIONSHIP BETWEEN MALNUTRITION AND LUNG INFECTIONS CLIN CHEST MED 19878359
bull MOSTAFA SM BHANDARI S RITCHIE G ET AL CONSTIPATION AND ITS IMPLICATIONS IN THE CRITICALLY ILL PATIENT BR J ANAESTH 200391815-9 3
bull GACOUIN A CAMUS C GROS A ET AL CONSTIPATION IN LONGTERM VENTILATED PATIENTS ASSOCIATED FACTORS AND IMPACT ON INTENSIVE CARE UNIT OUTCOMES CRIT CARE MED 2010381933- 8
bull NGUYEN T FRENETTE AJ JOHANSON C ET AL IMPAIRED GASTROINTESTINAL TRANSIT AND ITS ASSOCIATED MORBIDITY IN THE INTENSIVE CARE UNIT J CRIT CARE 201328537
bull ASAI T CONSTIPATION DOES IT INCREASE MORBIDITY AND MORTALITY IN CRITICALLY ILL PATIENTS CRIT CARE MED 2007352861-2
bull UNDERSTANDING THE PHYSIOLOGICAL EFFECTS OF UNTREATED PAIN NURSING TIMES VOL 99 ISSUE 37 PAGE NO 28
bull WINFIELD ET AL NON-PHARMACEUTICAL MANAGEMENT OF RESPIRATORY MORBIDITY IN CHILDREN WITH SEVERE GLOBAL DEVELOPMENTAL DELAY THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014
bull OLOUGHLIN EV SOMERVILLE HM SOMERVILLE ER DEALING WITH MULTISYSTEM DISEASE IN PEOPLE WITH A DEVELOPMENTAL DISABILITY MEDICAL JOURNAL OF AUSTRALIA 2009 JUN 1190(11)616-7
bull MESTROVIC J KARDUM G POLIC B MESTROVIC M MARKIC J SUSTIC A ET AL THE INFLUENCE OF CHRONIC HEALTH CONDITIONS ON SUSCEPTIBILITY TO SEVERE ACUTE ILLNESS OF CHILDREN TREATED IN PICU EUROPEAN JOURNAL OF PEDIATRICS 2006 AUG165(8)526-
9
bull HEALY F PANITCH HB PULMONARY COMPLICATIONS OF PEDIATRIC NEUROLOGICAL DISEASES PEDIATR ANN 2010 APR39(4)216-24
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SRIVASTAVA R JACKSON WD BARNHART DC DYSPHAGIA AND GASTROESOPHAGEAL REFLUX DISEASE DILEMMAS IN DIAGNOSIS AND MANAGEMENT IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT PEDIATR ANN 2010 APR39(4)225-31
bull SULLIVAN PB JUSZCZAK E BACHLET AME LAMBERT B VERNON-ROBERTS A GRANT HW ET AL GASTROSTOMY TUBE FEEDING IN CHILDREN WITH CEREBRAL PALSY A PROSPECTIVE LONGITUDINAL STUDY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 2005
FEBRUARY47(2)77-85
bull SOMERVILLE H TZANNES G WOOD J SHUN A HILL C ARROWSMITH F ET AL GASTROINTESTINAL AND NUTRITIONAL PROBLEMS IN SEVERE DEVELOPMENTAL DISABILITY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 200850(9)712-6
bull TODER DS RESPIRATORY PROBLEMS IN THE ADOLESCENT WITH DEVELOPMENTAL DELAY ADOLESCENT MEDICINE 2000 3 OCTOBER 200011(3)617-31
bull LEVIN K COLON A DIPALMA J FITZPATRICK S USING THE RADIONUCLIDE SALIVAGRAM TO DETECT PULMONARY ASPIRATION AND ESOPHAGEAL DYSMOTILITY CLIN NUCL MED 1993 FEB18(2)110-4
bull SCHROEDER AS KLING T HUSS K BORGGRAEFE I KOERTE IK BLASCHEK A ET AL BOTULINUM TOXIN TYPE A AND B FOR THE REDUCTION OF HYPERSALIVATION IN CHILDREN WITH NEUROLOGICAL DISORDERS A FOCUS ON EFFECTIVENESS AND THERAPY ADHERENCE
NEUROPEDIATRICS 201243(1)27-36
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull GOEMINNE P AND DUPONT L (2010) NON-CYSTIC FIBROSIS BRONCHIECTASIS DIAGNOSIS AND MANAGEMENT IN 21ST CENTURY POSTGRADUATE MEDICAL JOURNAL 86(1018) PP493-501
bull LEE A BUTTON B AND TANNENBAUM E (2017) AIRWAY-CLEARANCE TECHNIQUES IN CHILDREN AND ADOLESCENTS WITH CHRONIC SUPPURATIVE LUNG DISEASE AND BRONCHIECTASIS FRONTIERS IN PEDIATRICS 5
bull MANDAL P SIDHU M KOPE L POLLOCK W STEVENSON L PENTLAND J TURNBULL K MAC QUARRIE S AND HILL A (2012) A PILOT STUDY OF PULMONARY REHABILITATION AND CHEST PHYSIOTHERAPY VERSUS CHEST PHYSIOTHERAPY ALONE IN
BRONCHIECTASIS RESPIRATORY MEDICINE 106(12) PP1647-1654
bull MURRAY M PENTLAND J AND HILL A (2009) A RANDOMISED CROSSOVER TRIAL OF CHEST PHYSIOTHERAPY IN NON-CYSTIC FIBROSIS BRONCHIECTASIS EUROPEAN RESPIRATORY JOURNAL 34(5) PP1086-1092
bull NEWALL C STOCKLEY R AND HILL S (2005) EXERCISE TRAINING AND INSPIRATORY MUSCLE TRAINING IN PATIENTS WITH BRONCHIECTASIS THORAX 60(11) PP943-948
bull ONG H LEE A HILL C HOLLAND A AND DENEHY L (2011) EFFECTS OF PULMONARY REHABILITATION IN BRONCHIECTASIS A RETROSPECTIVE STUDY CHRONIC RESPIRATORY DISEASE 8(1) PP21-30
bull QUINT J MILLETT E JOSHI M NAVARATNAM V THOMAS S HURST J SMEETH L AND BROWN J (2015) CHANGES IN THE INCIDENCE PREVALENCE AND MORTALITY OF BRONCHIECTASIS IN THE UK FROM 2004 TO 2013 A POPULATION-BASED COHORT
STUDY EUROPEAN RESPIRATORY JOURNAL 47(1) PP186-193
bull SNIJDERS D FERNANDEZ DOMINGUEZ B CALGARO S BERTOZZI I ESCRIBANO MONTANER A PERILONGO G AND BARBATO A (2015) MUCOCILIARY CLEARANCE TECHNIQUES FOR TREATING NON-CYSTIC FIBROSIS BRONCHIECTASIS IS THERE
EVIDENCE INTERNATIONAL JOURNAL OF IMMUNOPATHOLOGY AND PHARMACOLOGY 28(2) PP150-159
HUMIDIFICATION INHALATION
THERAPY
bull TRACHEOSTOMY HME
bull WET DRY CIRCUIT
bull NEBULISERS INHALERS MUCOLYTICS
bull HUMIDIFIERS WITH NIV
bull OXYGEN
bull SYSTEMIC HYDRATION ENVIRONMENT
NEBULISERS
bull NEBULISER CHAMBER CONVERTS LIQUID INTO
RESPIRABLE PARTICLES
bull MOISTURE DESCENDS THROUGH THE HOLES IN THE SUPERFICIAL GEL LAYER
bull INCREASES THE SOL LAYER SO THE CILIARY BEAT IS OPTIMAL FOR MUCUS TRANSPORT
bull SHORT TERM HUMIDIFICATION
bull DAILY WASHING OF NEBULISER SYSTEM
TIMING OF DRUG AND PHYSIOTHERAPY
BEFORE TREATMENT
bull DNASE (PULMOZYME)
bull SALBUTAMOL
(VENTOLIN BLUE)
bull SALINE NEBS
AFTER TREATMENT
bull SERETIDE (PURPLE)
bull BECLOMETHASONE (BECOTIDE BROWN)
bull COLISTIN (COLOMYCIN PROMIXIN)
bull TOBRAMYCIN
CONCLUSION
bull BE AWARE OF CHILDrsquoS RESPIRATORY FUNCTION
bull CHOSE ACT BEST FOR THEM bull TYPE OF KETCHUP BOTTLE bull LV SECRETION RETENTION WOB
bull EARLY RESPIRATORY REFERRAL
bull RESPIRATORY CARE COMPETENCIES
bull EFFECTIVE SECRETION CLEARANCE AT HOMERESPITESCHOOL
bull USE OF PEAK COUGH FLOWS TO AID CHOICE OF ADJUNCT
0
50
100
150
200
250
300
350
400
0
50
100
150
200
250
300
350
400
Green
Key
Additional info
(please comment) Please refer to BTSACPRC Guideline
Lothian University Hospitals NHS Trust
n PCF
gt270lmin
Breathstack
ing tri-
flow
blowing
REFERENCES bull BTSACPRC GUIDELINE IS PUBLISHED IN THORAX VOL 67 SUPPLEMENT 1
bull AVAILABLE ONLINE AT HTTPTHORAXBMJCOMCONTENTVOL64ISSUESUPPLI
bull HTTPWWWBRIT-THORACICORGUKPHYSIOGUIDE
bull BRITISH THORACIC SOCIETY REPORTS VOL 1 NO 1 2009
bull ADAPTED PRYOR AJ AND PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS3RD ED
bull HOUGH A PHYSIOTHERAPY IN RESPIRATORY CARE LONDON CHAPMAN AND HALL 1993
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1997) POSTURAL DRAINAGE AND GASTRO-OESOPHAGEAL REFLUX IN INFANTS WITH CYSTIC FIBROSIS ARCHIVES OF DISEASE IN CHILDHOOD 76 148-150
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1998) POSTURAL DRAINAGE IN CYSTIC FIBROSIS IS THERE A LINK WITH GASTRO-OESOPHAGEAL REFLUX JOURNAL OF PAEDIATRIC CHILD HEALTH 34 330-334
bull CECINS NM JENKINS SC PENGELLEY J ET AL (1999) THE ACTIVE CYCLE OF BREATHING TECHNIQUES-TO TIP OR NOT TO TIP RESPIRATORY MEDICINE 93 660-665
bull CONSTANTINI D BRIVIO A BRUSA D ET AL (2001) PEP MASK VERSUS POSTURAL DRAINAGE IN INFANTS A LONG-TERM COMPARATIVE TRIAL PEADIATRIC PULMONOLOGY
bull HOUGH A (2001) PHYSIOTHERAPY IN RESPIRATORY CARE AN EVIDENCE-BASED APPROACH TO RESPIRATORY AND CARDIAC MANAGEMENT CENGAGE LEARNING EMEA
bull INTERNATIONAL PHYSIOTHERAPY GROUP FOR CYSTIC FIBROSIS PHYSIOTHERAPY IN THE TREATMENT OF CYSTIC FIBROSIS (2009) HTTPSWWWECFSEUIPG_CFBOOKLET INTERNATIONAL PHYSIOTHERAPY GROUP ndash THE BLUE BOOKLET
bull KONSTAN MW STERN RC DOERSHUK CF (1994) EFFICACY OF THE FLUTTER DEVICE FOR AIRWAY MUCUS CLEARANCE IN PATIENTS WITH CYSTIC FIBROSIS JOURNAL OF PEDIATRICS 124 (5 (PT 1) 689-693
bull MCILWAINE M BUTTON B AND DWAN K (2015) POSITIVE EXPIRATORY PRESSURE PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 6 ART NO CD003147 DOI 10100214651858CD003147PUB4
bull MESTRINER RG FERNANDES RO STAFFEN LC ET AL (2009) OPTIMUM DESIGN PARAMETERS FOR A THERAPIST-CONSTRUCTED POSITIVE-EXPIRATORY-PRESSURE THERAPY BOTTLE DEVICE RESPIRATORY CARE 54 504-8
bull MORRISON L AND AGNEW J (2014) OSCILLATING DEVICES FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 7 ART NO CD006842 DOI 10100214651858CD006842PUB
bull OERMANN CM SOCKRIDER MM GILES D ET AL (2001) COMPARISON OF HIGH-FREQUENCY CHEST WALL OSCILLATION AND OSCILLATING POSITIVE EXPIRATORY PRESSURE IN THE HOME MANAGEMENT OF CYSTIC FIBROSIS A PILOT STUDY PEDIATRIC PULMONOLOGY 32 (5) 372-7
bull PRASAD SA AND HUSSEY J (1995) PAEDIATRIC RESPIRATORY CARE A GUIDE FOR PHYSIOTHERAPISTS AND HEALTH PROFESSIONALS CHAPMAN amp HALL
bull PRYOR J (1999) PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN ADULTS EUROPEAN RESPIRATORY JOURNAL 14 (6) 1418-1424
bull PRYOR JA amp PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS CHURCHILL LIVINGSTONE
bull PRYOR JA WEBBER BA HODSON ME ET AL (1994) THE FLUTTER VRP1 AS AN ADJUNCT TO CHEST PHYSIOTHERAPY IN CYSTIC FIBROSIS RESPIRATORY MEDICINE 88677-81
bull WEST K WALLEN M FOLLETT J (2010) ACAPELLA VS PEP MASK THERAPY A RANDOMISED TRIAL IN CHILDREN WITH CYSTIC FIBROSIS DURING RESPIRATORY EXACERBATION PHYSIOTHERAPY THEORY PRACTICE 26143-9
bull WILSONLM AGNEW J MORRISON L ET AL (2014) AIRWAY CLEARANCE TECHNIQUES FOR CYSTIC FIBROSIS AN OVERVIEW OF COCHRANE SYSTEMATIC REVIEWS COCHRANE DATABASE OF SYSTEMATIC REVIEWS DOI 10100214651858CD011231
bull VOLSKO TA DIFIORE JM CHATBURN RL (2003) PERFORMANCE COMPARISON OF TWO OSCILLATORY POSITIVE PRESSURE DEVICES ACAPELLA VERSUS FLUTTER RESPIRATORY CARE 48 (2) 124- 130
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SEDDON PC KHAN Y RESPIRATORY PROBLEMS IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT ARCHIVES OF DISEASE IN CHILDHOOD 2003 01 JAN88(1)75-8
bull MARKS JH PULMONARY CARE OF CHILDREN AND ADOLESCENTS WITH DEVELOPMENTAL DISABILITIES PEDIATR CLIN NORTH AM 2008 DECEMBER55(6)1299-314
bull ARENS R MUZUMDAR H SLEEP SLEEP DISORDERED BREATHING AND NOCTURNAL HYPOVENTILATION IN CHILDREN WITH NEUROMUSCULAR DISEASES PAEDIATRIC RESPIRATORY REVIEWS 2010 MAR11(1)24-30
bull FITZGERALD DA FOLLETT J VAN ASPEREN PP ASSESSING AND MANAGING LUNG DISEASE AND SLEEP DISORDERED BREATHING IN CHILDREN WITH CEREBRAL PALSY PAEDIATRIC RESPIRATORY REVIEWS 2009 MARCH10(1)18-24
bull HSIAO KH NIXON GM THE EFFECT OF TREATMENT OF OBSTRUCTIVE SLEEP APNEA ON QUALITY OF LIFE IN CHILDREN WITH CEREBRAL PALSY RES DEV DISABIL 2008 MAR-APR29(2)133-40
bull LUNDBERG A OXYGEN CONSUMPTION IN RELATION TO WORKLOAD IN STUDENTS WITH CEREBRAL PALSY J APPL PHYSIO 197640873-5
bull SULLIVAN PB ROSENBLOOM L FEEDING THE DISABLED CHILD CLINICS IN DEVELOPMENTAL MEDICINE MACKEITH PRESS 1999140
bull MARTIN TR THE RELATIONSHIP BETWEEN MALNUTRITION AND LUNG INFECTIONS CLIN CHEST MED 19878359
bull MOSTAFA SM BHANDARI S RITCHIE G ET AL CONSTIPATION AND ITS IMPLICATIONS IN THE CRITICALLY ILL PATIENT BR J ANAESTH 200391815-9 3
bull GACOUIN A CAMUS C GROS A ET AL CONSTIPATION IN LONGTERM VENTILATED PATIENTS ASSOCIATED FACTORS AND IMPACT ON INTENSIVE CARE UNIT OUTCOMES CRIT CARE MED 2010381933- 8
bull NGUYEN T FRENETTE AJ JOHANSON C ET AL IMPAIRED GASTROINTESTINAL TRANSIT AND ITS ASSOCIATED MORBIDITY IN THE INTENSIVE CARE UNIT J CRIT CARE 201328537
bull ASAI T CONSTIPATION DOES IT INCREASE MORBIDITY AND MORTALITY IN CRITICALLY ILL PATIENTS CRIT CARE MED 2007352861-2
bull UNDERSTANDING THE PHYSIOLOGICAL EFFECTS OF UNTREATED PAIN NURSING TIMES VOL 99 ISSUE 37 PAGE NO 28
bull WINFIELD ET AL NON-PHARMACEUTICAL MANAGEMENT OF RESPIRATORY MORBIDITY IN CHILDREN WITH SEVERE GLOBAL DEVELOPMENTAL DELAY THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014
bull OLOUGHLIN EV SOMERVILLE HM SOMERVILLE ER DEALING WITH MULTISYSTEM DISEASE IN PEOPLE WITH A DEVELOPMENTAL DISABILITY MEDICAL JOURNAL OF AUSTRALIA 2009 JUN 1190(11)616-7
bull MESTROVIC J KARDUM G POLIC B MESTROVIC M MARKIC J SUSTIC A ET AL THE INFLUENCE OF CHRONIC HEALTH CONDITIONS ON SUSCEPTIBILITY TO SEVERE ACUTE ILLNESS OF CHILDREN TREATED IN PICU EUROPEAN JOURNAL OF PEDIATRICS 2006 AUG165(8)526-
9
bull HEALY F PANITCH HB PULMONARY COMPLICATIONS OF PEDIATRIC NEUROLOGICAL DISEASES PEDIATR ANN 2010 APR39(4)216-24
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SRIVASTAVA R JACKSON WD BARNHART DC DYSPHAGIA AND GASTROESOPHAGEAL REFLUX DISEASE DILEMMAS IN DIAGNOSIS AND MANAGEMENT IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT PEDIATR ANN 2010 APR39(4)225-31
bull SULLIVAN PB JUSZCZAK E BACHLET AME LAMBERT B VERNON-ROBERTS A GRANT HW ET AL GASTROSTOMY TUBE FEEDING IN CHILDREN WITH CEREBRAL PALSY A PROSPECTIVE LONGITUDINAL STUDY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 2005
FEBRUARY47(2)77-85
bull SOMERVILLE H TZANNES G WOOD J SHUN A HILL C ARROWSMITH F ET AL GASTROINTESTINAL AND NUTRITIONAL PROBLEMS IN SEVERE DEVELOPMENTAL DISABILITY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 200850(9)712-6
bull TODER DS RESPIRATORY PROBLEMS IN THE ADOLESCENT WITH DEVELOPMENTAL DELAY ADOLESCENT MEDICINE 2000 3 OCTOBER 200011(3)617-31
bull LEVIN K COLON A DIPALMA J FITZPATRICK S USING THE RADIONUCLIDE SALIVAGRAM TO DETECT PULMONARY ASPIRATION AND ESOPHAGEAL DYSMOTILITY CLIN NUCL MED 1993 FEB18(2)110-4
bull SCHROEDER AS KLING T HUSS K BORGGRAEFE I KOERTE IK BLASCHEK A ET AL BOTULINUM TOXIN TYPE A AND B FOR THE REDUCTION OF HYPERSALIVATION IN CHILDREN WITH NEUROLOGICAL DISORDERS A FOCUS ON EFFECTIVENESS AND THERAPY ADHERENCE
NEUROPEDIATRICS 201243(1)27-36
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull GOEMINNE P AND DUPONT L (2010) NON-CYSTIC FIBROSIS BRONCHIECTASIS DIAGNOSIS AND MANAGEMENT IN 21ST CENTURY POSTGRADUATE MEDICAL JOURNAL 86(1018) PP493-501
bull LEE A BUTTON B AND TANNENBAUM E (2017) AIRWAY-CLEARANCE TECHNIQUES IN CHILDREN AND ADOLESCENTS WITH CHRONIC SUPPURATIVE LUNG DISEASE AND BRONCHIECTASIS FRONTIERS IN PEDIATRICS 5
bull MANDAL P SIDHU M KOPE L POLLOCK W STEVENSON L PENTLAND J TURNBULL K MAC QUARRIE S AND HILL A (2012) A PILOT STUDY OF PULMONARY REHABILITATION AND CHEST PHYSIOTHERAPY VERSUS CHEST PHYSIOTHERAPY ALONE IN
BRONCHIECTASIS RESPIRATORY MEDICINE 106(12) PP1647-1654
bull MURRAY M PENTLAND J AND HILL A (2009) A RANDOMISED CROSSOVER TRIAL OF CHEST PHYSIOTHERAPY IN NON-CYSTIC FIBROSIS BRONCHIECTASIS EUROPEAN RESPIRATORY JOURNAL 34(5) PP1086-1092
bull NEWALL C STOCKLEY R AND HILL S (2005) EXERCISE TRAINING AND INSPIRATORY MUSCLE TRAINING IN PATIENTS WITH BRONCHIECTASIS THORAX 60(11) PP943-948
bull ONG H LEE A HILL C HOLLAND A AND DENEHY L (2011) EFFECTS OF PULMONARY REHABILITATION IN BRONCHIECTASIS A RETROSPECTIVE STUDY CHRONIC RESPIRATORY DISEASE 8(1) PP21-30
bull QUINT J MILLETT E JOSHI M NAVARATNAM V THOMAS S HURST J SMEETH L AND BROWN J (2015) CHANGES IN THE INCIDENCE PREVALENCE AND MORTALITY OF BRONCHIECTASIS IN THE UK FROM 2004 TO 2013 A POPULATION-BASED COHORT
STUDY EUROPEAN RESPIRATORY JOURNAL 47(1) PP186-193
bull SNIJDERS D FERNANDEZ DOMINGUEZ B CALGARO S BERTOZZI I ESCRIBANO MONTANER A PERILONGO G AND BARBATO A (2015) MUCOCILIARY CLEARANCE TECHNIQUES FOR TREATING NON-CYSTIC FIBROSIS BRONCHIECTASIS IS THERE
EVIDENCE INTERNATIONAL JOURNAL OF IMMUNOPATHOLOGY AND PHARMACOLOGY 28(2) PP150-159
NEBULISERS
bull NEBULISER CHAMBER CONVERTS LIQUID INTO
RESPIRABLE PARTICLES
bull MOISTURE DESCENDS THROUGH THE HOLES IN THE SUPERFICIAL GEL LAYER
bull INCREASES THE SOL LAYER SO THE CILIARY BEAT IS OPTIMAL FOR MUCUS TRANSPORT
bull SHORT TERM HUMIDIFICATION
bull DAILY WASHING OF NEBULISER SYSTEM
TIMING OF DRUG AND PHYSIOTHERAPY
BEFORE TREATMENT
bull DNASE (PULMOZYME)
bull SALBUTAMOL
(VENTOLIN BLUE)
bull SALINE NEBS
AFTER TREATMENT
bull SERETIDE (PURPLE)
bull BECLOMETHASONE (BECOTIDE BROWN)
bull COLISTIN (COLOMYCIN PROMIXIN)
bull TOBRAMYCIN
CONCLUSION
bull BE AWARE OF CHILDrsquoS RESPIRATORY FUNCTION
bull CHOSE ACT BEST FOR THEM bull TYPE OF KETCHUP BOTTLE bull LV SECRETION RETENTION WOB
bull EARLY RESPIRATORY REFERRAL
bull RESPIRATORY CARE COMPETENCIES
bull EFFECTIVE SECRETION CLEARANCE AT HOMERESPITESCHOOL
bull USE OF PEAK COUGH FLOWS TO AID CHOICE OF ADJUNCT
0
50
100
150
200
250
300
350
400
0
50
100
150
200
250
300
350
400
Green
Key
Additional info
(please comment) Please refer to BTSACPRC Guideline
Lothian University Hospitals NHS Trust
n PCF
gt270lmin
Breathstack
ing tri-
flow
blowing
REFERENCES bull BTSACPRC GUIDELINE IS PUBLISHED IN THORAX VOL 67 SUPPLEMENT 1
bull AVAILABLE ONLINE AT HTTPTHORAXBMJCOMCONTENTVOL64ISSUESUPPLI
bull HTTPWWWBRIT-THORACICORGUKPHYSIOGUIDE
bull BRITISH THORACIC SOCIETY REPORTS VOL 1 NO 1 2009
bull ADAPTED PRYOR AJ AND PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS3RD ED
bull HOUGH A PHYSIOTHERAPY IN RESPIRATORY CARE LONDON CHAPMAN AND HALL 1993
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1997) POSTURAL DRAINAGE AND GASTRO-OESOPHAGEAL REFLUX IN INFANTS WITH CYSTIC FIBROSIS ARCHIVES OF DISEASE IN CHILDHOOD 76 148-150
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1998) POSTURAL DRAINAGE IN CYSTIC FIBROSIS IS THERE A LINK WITH GASTRO-OESOPHAGEAL REFLUX JOURNAL OF PAEDIATRIC CHILD HEALTH 34 330-334
bull CECINS NM JENKINS SC PENGELLEY J ET AL (1999) THE ACTIVE CYCLE OF BREATHING TECHNIQUES-TO TIP OR NOT TO TIP RESPIRATORY MEDICINE 93 660-665
bull CONSTANTINI D BRIVIO A BRUSA D ET AL (2001) PEP MASK VERSUS POSTURAL DRAINAGE IN INFANTS A LONG-TERM COMPARATIVE TRIAL PEADIATRIC PULMONOLOGY
bull HOUGH A (2001) PHYSIOTHERAPY IN RESPIRATORY CARE AN EVIDENCE-BASED APPROACH TO RESPIRATORY AND CARDIAC MANAGEMENT CENGAGE LEARNING EMEA
bull INTERNATIONAL PHYSIOTHERAPY GROUP FOR CYSTIC FIBROSIS PHYSIOTHERAPY IN THE TREATMENT OF CYSTIC FIBROSIS (2009) HTTPSWWWECFSEUIPG_CFBOOKLET INTERNATIONAL PHYSIOTHERAPY GROUP ndash THE BLUE BOOKLET
bull KONSTAN MW STERN RC DOERSHUK CF (1994) EFFICACY OF THE FLUTTER DEVICE FOR AIRWAY MUCUS CLEARANCE IN PATIENTS WITH CYSTIC FIBROSIS JOURNAL OF PEDIATRICS 124 (5 (PT 1) 689-693
bull MCILWAINE M BUTTON B AND DWAN K (2015) POSITIVE EXPIRATORY PRESSURE PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 6 ART NO CD003147 DOI 10100214651858CD003147PUB4
bull MESTRINER RG FERNANDES RO STAFFEN LC ET AL (2009) OPTIMUM DESIGN PARAMETERS FOR A THERAPIST-CONSTRUCTED POSITIVE-EXPIRATORY-PRESSURE THERAPY BOTTLE DEVICE RESPIRATORY CARE 54 504-8
bull MORRISON L AND AGNEW J (2014) OSCILLATING DEVICES FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 7 ART NO CD006842 DOI 10100214651858CD006842PUB
bull OERMANN CM SOCKRIDER MM GILES D ET AL (2001) COMPARISON OF HIGH-FREQUENCY CHEST WALL OSCILLATION AND OSCILLATING POSITIVE EXPIRATORY PRESSURE IN THE HOME MANAGEMENT OF CYSTIC FIBROSIS A PILOT STUDY PEDIATRIC PULMONOLOGY 32 (5) 372-7
bull PRASAD SA AND HUSSEY J (1995) PAEDIATRIC RESPIRATORY CARE A GUIDE FOR PHYSIOTHERAPISTS AND HEALTH PROFESSIONALS CHAPMAN amp HALL
bull PRYOR J (1999) PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN ADULTS EUROPEAN RESPIRATORY JOURNAL 14 (6) 1418-1424
bull PRYOR JA amp PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS CHURCHILL LIVINGSTONE
bull PRYOR JA WEBBER BA HODSON ME ET AL (1994) THE FLUTTER VRP1 AS AN ADJUNCT TO CHEST PHYSIOTHERAPY IN CYSTIC FIBROSIS RESPIRATORY MEDICINE 88677-81
bull WEST K WALLEN M FOLLETT J (2010) ACAPELLA VS PEP MASK THERAPY A RANDOMISED TRIAL IN CHILDREN WITH CYSTIC FIBROSIS DURING RESPIRATORY EXACERBATION PHYSIOTHERAPY THEORY PRACTICE 26143-9
bull WILSONLM AGNEW J MORRISON L ET AL (2014) AIRWAY CLEARANCE TECHNIQUES FOR CYSTIC FIBROSIS AN OVERVIEW OF COCHRANE SYSTEMATIC REVIEWS COCHRANE DATABASE OF SYSTEMATIC REVIEWS DOI 10100214651858CD011231
bull VOLSKO TA DIFIORE JM CHATBURN RL (2003) PERFORMANCE COMPARISON OF TWO OSCILLATORY POSITIVE PRESSURE DEVICES ACAPELLA VERSUS FLUTTER RESPIRATORY CARE 48 (2) 124- 130
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SEDDON PC KHAN Y RESPIRATORY PROBLEMS IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT ARCHIVES OF DISEASE IN CHILDHOOD 2003 01 JAN88(1)75-8
bull MARKS JH PULMONARY CARE OF CHILDREN AND ADOLESCENTS WITH DEVELOPMENTAL DISABILITIES PEDIATR CLIN NORTH AM 2008 DECEMBER55(6)1299-314
bull ARENS R MUZUMDAR H SLEEP SLEEP DISORDERED BREATHING AND NOCTURNAL HYPOVENTILATION IN CHILDREN WITH NEUROMUSCULAR DISEASES PAEDIATRIC RESPIRATORY REVIEWS 2010 MAR11(1)24-30
bull FITZGERALD DA FOLLETT J VAN ASPEREN PP ASSESSING AND MANAGING LUNG DISEASE AND SLEEP DISORDERED BREATHING IN CHILDREN WITH CEREBRAL PALSY PAEDIATRIC RESPIRATORY REVIEWS 2009 MARCH10(1)18-24
bull HSIAO KH NIXON GM THE EFFECT OF TREATMENT OF OBSTRUCTIVE SLEEP APNEA ON QUALITY OF LIFE IN CHILDREN WITH CEREBRAL PALSY RES DEV DISABIL 2008 MAR-APR29(2)133-40
bull LUNDBERG A OXYGEN CONSUMPTION IN RELATION TO WORKLOAD IN STUDENTS WITH CEREBRAL PALSY J APPL PHYSIO 197640873-5
bull SULLIVAN PB ROSENBLOOM L FEEDING THE DISABLED CHILD CLINICS IN DEVELOPMENTAL MEDICINE MACKEITH PRESS 1999140
bull MARTIN TR THE RELATIONSHIP BETWEEN MALNUTRITION AND LUNG INFECTIONS CLIN CHEST MED 19878359
bull MOSTAFA SM BHANDARI S RITCHIE G ET AL CONSTIPATION AND ITS IMPLICATIONS IN THE CRITICALLY ILL PATIENT BR J ANAESTH 200391815-9 3
bull GACOUIN A CAMUS C GROS A ET AL CONSTIPATION IN LONGTERM VENTILATED PATIENTS ASSOCIATED FACTORS AND IMPACT ON INTENSIVE CARE UNIT OUTCOMES CRIT CARE MED 2010381933- 8
bull NGUYEN T FRENETTE AJ JOHANSON C ET AL IMPAIRED GASTROINTESTINAL TRANSIT AND ITS ASSOCIATED MORBIDITY IN THE INTENSIVE CARE UNIT J CRIT CARE 201328537
bull ASAI T CONSTIPATION DOES IT INCREASE MORBIDITY AND MORTALITY IN CRITICALLY ILL PATIENTS CRIT CARE MED 2007352861-2
bull UNDERSTANDING THE PHYSIOLOGICAL EFFECTS OF UNTREATED PAIN NURSING TIMES VOL 99 ISSUE 37 PAGE NO 28
bull WINFIELD ET AL NON-PHARMACEUTICAL MANAGEMENT OF RESPIRATORY MORBIDITY IN CHILDREN WITH SEVERE GLOBAL DEVELOPMENTAL DELAY THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014
bull OLOUGHLIN EV SOMERVILLE HM SOMERVILLE ER DEALING WITH MULTISYSTEM DISEASE IN PEOPLE WITH A DEVELOPMENTAL DISABILITY MEDICAL JOURNAL OF AUSTRALIA 2009 JUN 1190(11)616-7
bull MESTROVIC J KARDUM G POLIC B MESTROVIC M MARKIC J SUSTIC A ET AL THE INFLUENCE OF CHRONIC HEALTH CONDITIONS ON SUSCEPTIBILITY TO SEVERE ACUTE ILLNESS OF CHILDREN TREATED IN PICU EUROPEAN JOURNAL OF PEDIATRICS 2006 AUG165(8)526-
9
bull HEALY F PANITCH HB PULMONARY COMPLICATIONS OF PEDIATRIC NEUROLOGICAL DISEASES PEDIATR ANN 2010 APR39(4)216-24
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SRIVASTAVA R JACKSON WD BARNHART DC DYSPHAGIA AND GASTROESOPHAGEAL REFLUX DISEASE DILEMMAS IN DIAGNOSIS AND MANAGEMENT IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT PEDIATR ANN 2010 APR39(4)225-31
bull SULLIVAN PB JUSZCZAK E BACHLET AME LAMBERT B VERNON-ROBERTS A GRANT HW ET AL GASTROSTOMY TUBE FEEDING IN CHILDREN WITH CEREBRAL PALSY A PROSPECTIVE LONGITUDINAL STUDY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 2005
FEBRUARY47(2)77-85
bull SOMERVILLE H TZANNES G WOOD J SHUN A HILL C ARROWSMITH F ET AL GASTROINTESTINAL AND NUTRITIONAL PROBLEMS IN SEVERE DEVELOPMENTAL DISABILITY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 200850(9)712-6
bull TODER DS RESPIRATORY PROBLEMS IN THE ADOLESCENT WITH DEVELOPMENTAL DELAY ADOLESCENT MEDICINE 2000 3 OCTOBER 200011(3)617-31
bull LEVIN K COLON A DIPALMA J FITZPATRICK S USING THE RADIONUCLIDE SALIVAGRAM TO DETECT PULMONARY ASPIRATION AND ESOPHAGEAL DYSMOTILITY CLIN NUCL MED 1993 FEB18(2)110-4
bull SCHROEDER AS KLING T HUSS K BORGGRAEFE I KOERTE IK BLASCHEK A ET AL BOTULINUM TOXIN TYPE A AND B FOR THE REDUCTION OF HYPERSALIVATION IN CHILDREN WITH NEUROLOGICAL DISORDERS A FOCUS ON EFFECTIVENESS AND THERAPY ADHERENCE
NEUROPEDIATRICS 201243(1)27-36
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull GOEMINNE P AND DUPONT L (2010) NON-CYSTIC FIBROSIS BRONCHIECTASIS DIAGNOSIS AND MANAGEMENT IN 21ST CENTURY POSTGRADUATE MEDICAL JOURNAL 86(1018) PP493-501
bull LEE A BUTTON B AND TANNENBAUM E (2017) AIRWAY-CLEARANCE TECHNIQUES IN CHILDREN AND ADOLESCENTS WITH CHRONIC SUPPURATIVE LUNG DISEASE AND BRONCHIECTASIS FRONTIERS IN PEDIATRICS 5
bull MANDAL P SIDHU M KOPE L POLLOCK W STEVENSON L PENTLAND J TURNBULL K MAC QUARRIE S AND HILL A (2012) A PILOT STUDY OF PULMONARY REHABILITATION AND CHEST PHYSIOTHERAPY VERSUS CHEST PHYSIOTHERAPY ALONE IN
BRONCHIECTASIS RESPIRATORY MEDICINE 106(12) PP1647-1654
bull MURRAY M PENTLAND J AND HILL A (2009) A RANDOMISED CROSSOVER TRIAL OF CHEST PHYSIOTHERAPY IN NON-CYSTIC FIBROSIS BRONCHIECTASIS EUROPEAN RESPIRATORY JOURNAL 34(5) PP1086-1092
bull NEWALL C STOCKLEY R AND HILL S (2005) EXERCISE TRAINING AND INSPIRATORY MUSCLE TRAINING IN PATIENTS WITH BRONCHIECTASIS THORAX 60(11) PP943-948
bull ONG H LEE A HILL C HOLLAND A AND DENEHY L (2011) EFFECTS OF PULMONARY REHABILITATION IN BRONCHIECTASIS A RETROSPECTIVE STUDY CHRONIC RESPIRATORY DISEASE 8(1) PP21-30
bull QUINT J MILLETT E JOSHI M NAVARATNAM V THOMAS S HURST J SMEETH L AND BROWN J (2015) CHANGES IN THE INCIDENCE PREVALENCE AND MORTALITY OF BRONCHIECTASIS IN THE UK FROM 2004 TO 2013 A POPULATION-BASED COHORT
STUDY EUROPEAN RESPIRATORY JOURNAL 47(1) PP186-193
bull SNIJDERS D FERNANDEZ DOMINGUEZ B CALGARO S BERTOZZI I ESCRIBANO MONTANER A PERILONGO G AND BARBATO A (2015) MUCOCILIARY CLEARANCE TECHNIQUES FOR TREATING NON-CYSTIC FIBROSIS BRONCHIECTASIS IS THERE
EVIDENCE INTERNATIONAL JOURNAL OF IMMUNOPATHOLOGY AND PHARMACOLOGY 28(2) PP150-159
TIMING OF DRUG AND PHYSIOTHERAPY
BEFORE TREATMENT
bull DNASE (PULMOZYME)
bull SALBUTAMOL
(VENTOLIN BLUE)
bull SALINE NEBS
AFTER TREATMENT
bull SERETIDE (PURPLE)
bull BECLOMETHASONE (BECOTIDE BROWN)
bull COLISTIN (COLOMYCIN PROMIXIN)
bull TOBRAMYCIN
CONCLUSION
bull BE AWARE OF CHILDrsquoS RESPIRATORY FUNCTION
bull CHOSE ACT BEST FOR THEM bull TYPE OF KETCHUP BOTTLE bull LV SECRETION RETENTION WOB
bull EARLY RESPIRATORY REFERRAL
bull RESPIRATORY CARE COMPETENCIES
bull EFFECTIVE SECRETION CLEARANCE AT HOMERESPITESCHOOL
bull USE OF PEAK COUGH FLOWS TO AID CHOICE OF ADJUNCT
0
50
100
150
200
250
300
350
400
0
50
100
150
200
250
300
350
400
Green
Key
Additional info
(please comment) Please refer to BTSACPRC Guideline
Lothian University Hospitals NHS Trust
n PCF
gt270lmin
Breathstack
ing tri-
flow
blowing
REFERENCES bull BTSACPRC GUIDELINE IS PUBLISHED IN THORAX VOL 67 SUPPLEMENT 1
bull AVAILABLE ONLINE AT HTTPTHORAXBMJCOMCONTENTVOL64ISSUESUPPLI
bull HTTPWWWBRIT-THORACICORGUKPHYSIOGUIDE
bull BRITISH THORACIC SOCIETY REPORTS VOL 1 NO 1 2009
bull ADAPTED PRYOR AJ AND PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS3RD ED
bull HOUGH A PHYSIOTHERAPY IN RESPIRATORY CARE LONDON CHAPMAN AND HALL 1993
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1997) POSTURAL DRAINAGE AND GASTRO-OESOPHAGEAL REFLUX IN INFANTS WITH CYSTIC FIBROSIS ARCHIVES OF DISEASE IN CHILDHOOD 76 148-150
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1998) POSTURAL DRAINAGE IN CYSTIC FIBROSIS IS THERE A LINK WITH GASTRO-OESOPHAGEAL REFLUX JOURNAL OF PAEDIATRIC CHILD HEALTH 34 330-334
bull CECINS NM JENKINS SC PENGELLEY J ET AL (1999) THE ACTIVE CYCLE OF BREATHING TECHNIQUES-TO TIP OR NOT TO TIP RESPIRATORY MEDICINE 93 660-665
bull CONSTANTINI D BRIVIO A BRUSA D ET AL (2001) PEP MASK VERSUS POSTURAL DRAINAGE IN INFANTS A LONG-TERM COMPARATIVE TRIAL PEADIATRIC PULMONOLOGY
bull HOUGH A (2001) PHYSIOTHERAPY IN RESPIRATORY CARE AN EVIDENCE-BASED APPROACH TO RESPIRATORY AND CARDIAC MANAGEMENT CENGAGE LEARNING EMEA
bull INTERNATIONAL PHYSIOTHERAPY GROUP FOR CYSTIC FIBROSIS PHYSIOTHERAPY IN THE TREATMENT OF CYSTIC FIBROSIS (2009) HTTPSWWWECFSEUIPG_CFBOOKLET INTERNATIONAL PHYSIOTHERAPY GROUP ndash THE BLUE BOOKLET
bull KONSTAN MW STERN RC DOERSHUK CF (1994) EFFICACY OF THE FLUTTER DEVICE FOR AIRWAY MUCUS CLEARANCE IN PATIENTS WITH CYSTIC FIBROSIS JOURNAL OF PEDIATRICS 124 (5 (PT 1) 689-693
bull MCILWAINE M BUTTON B AND DWAN K (2015) POSITIVE EXPIRATORY PRESSURE PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 6 ART NO CD003147 DOI 10100214651858CD003147PUB4
bull MESTRINER RG FERNANDES RO STAFFEN LC ET AL (2009) OPTIMUM DESIGN PARAMETERS FOR A THERAPIST-CONSTRUCTED POSITIVE-EXPIRATORY-PRESSURE THERAPY BOTTLE DEVICE RESPIRATORY CARE 54 504-8
bull MORRISON L AND AGNEW J (2014) OSCILLATING DEVICES FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 7 ART NO CD006842 DOI 10100214651858CD006842PUB
bull OERMANN CM SOCKRIDER MM GILES D ET AL (2001) COMPARISON OF HIGH-FREQUENCY CHEST WALL OSCILLATION AND OSCILLATING POSITIVE EXPIRATORY PRESSURE IN THE HOME MANAGEMENT OF CYSTIC FIBROSIS A PILOT STUDY PEDIATRIC PULMONOLOGY 32 (5) 372-7
bull PRASAD SA AND HUSSEY J (1995) PAEDIATRIC RESPIRATORY CARE A GUIDE FOR PHYSIOTHERAPISTS AND HEALTH PROFESSIONALS CHAPMAN amp HALL
bull PRYOR J (1999) PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN ADULTS EUROPEAN RESPIRATORY JOURNAL 14 (6) 1418-1424
bull PRYOR JA amp PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS CHURCHILL LIVINGSTONE
bull PRYOR JA WEBBER BA HODSON ME ET AL (1994) THE FLUTTER VRP1 AS AN ADJUNCT TO CHEST PHYSIOTHERAPY IN CYSTIC FIBROSIS RESPIRATORY MEDICINE 88677-81
bull WEST K WALLEN M FOLLETT J (2010) ACAPELLA VS PEP MASK THERAPY A RANDOMISED TRIAL IN CHILDREN WITH CYSTIC FIBROSIS DURING RESPIRATORY EXACERBATION PHYSIOTHERAPY THEORY PRACTICE 26143-9
bull WILSONLM AGNEW J MORRISON L ET AL (2014) AIRWAY CLEARANCE TECHNIQUES FOR CYSTIC FIBROSIS AN OVERVIEW OF COCHRANE SYSTEMATIC REVIEWS COCHRANE DATABASE OF SYSTEMATIC REVIEWS DOI 10100214651858CD011231
bull VOLSKO TA DIFIORE JM CHATBURN RL (2003) PERFORMANCE COMPARISON OF TWO OSCILLATORY POSITIVE PRESSURE DEVICES ACAPELLA VERSUS FLUTTER RESPIRATORY CARE 48 (2) 124- 130
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SEDDON PC KHAN Y RESPIRATORY PROBLEMS IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT ARCHIVES OF DISEASE IN CHILDHOOD 2003 01 JAN88(1)75-8
bull MARKS JH PULMONARY CARE OF CHILDREN AND ADOLESCENTS WITH DEVELOPMENTAL DISABILITIES PEDIATR CLIN NORTH AM 2008 DECEMBER55(6)1299-314
bull ARENS R MUZUMDAR H SLEEP SLEEP DISORDERED BREATHING AND NOCTURNAL HYPOVENTILATION IN CHILDREN WITH NEUROMUSCULAR DISEASES PAEDIATRIC RESPIRATORY REVIEWS 2010 MAR11(1)24-30
bull FITZGERALD DA FOLLETT J VAN ASPEREN PP ASSESSING AND MANAGING LUNG DISEASE AND SLEEP DISORDERED BREATHING IN CHILDREN WITH CEREBRAL PALSY PAEDIATRIC RESPIRATORY REVIEWS 2009 MARCH10(1)18-24
bull HSIAO KH NIXON GM THE EFFECT OF TREATMENT OF OBSTRUCTIVE SLEEP APNEA ON QUALITY OF LIFE IN CHILDREN WITH CEREBRAL PALSY RES DEV DISABIL 2008 MAR-APR29(2)133-40
bull LUNDBERG A OXYGEN CONSUMPTION IN RELATION TO WORKLOAD IN STUDENTS WITH CEREBRAL PALSY J APPL PHYSIO 197640873-5
bull SULLIVAN PB ROSENBLOOM L FEEDING THE DISABLED CHILD CLINICS IN DEVELOPMENTAL MEDICINE MACKEITH PRESS 1999140
bull MARTIN TR THE RELATIONSHIP BETWEEN MALNUTRITION AND LUNG INFECTIONS CLIN CHEST MED 19878359
bull MOSTAFA SM BHANDARI S RITCHIE G ET AL CONSTIPATION AND ITS IMPLICATIONS IN THE CRITICALLY ILL PATIENT BR J ANAESTH 200391815-9 3
bull GACOUIN A CAMUS C GROS A ET AL CONSTIPATION IN LONGTERM VENTILATED PATIENTS ASSOCIATED FACTORS AND IMPACT ON INTENSIVE CARE UNIT OUTCOMES CRIT CARE MED 2010381933- 8
bull NGUYEN T FRENETTE AJ JOHANSON C ET AL IMPAIRED GASTROINTESTINAL TRANSIT AND ITS ASSOCIATED MORBIDITY IN THE INTENSIVE CARE UNIT J CRIT CARE 201328537
bull ASAI T CONSTIPATION DOES IT INCREASE MORBIDITY AND MORTALITY IN CRITICALLY ILL PATIENTS CRIT CARE MED 2007352861-2
bull UNDERSTANDING THE PHYSIOLOGICAL EFFECTS OF UNTREATED PAIN NURSING TIMES VOL 99 ISSUE 37 PAGE NO 28
bull WINFIELD ET AL NON-PHARMACEUTICAL MANAGEMENT OF RESPIRATORY MORBIDITY IN CHILDREN WITH SEVERE GLOBAL DEVELOPMENTAL DELAY THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014
bull OLOUGHLIN EV SOMERVILLE HM SOMERVILLE ER DEALING WITH MULTISYSTEM DISEASE IN PEOPLE WITH A DEVELOPMENTAL DISABILITY MEDICAL JOURNAL OF AUSTRALIA 2009 JUN 1190(11)616-7
bull MESTROVIC J KARDUM G POLIC B MESTROVIC M MARKIC J SUSTIC A ET AL THE INFLUENCE OF CHRONIC HEALTH CONDITIONS ON SUSCEPTIBILITY TO SEVERE ACUTE ILLNESS OF CHILDREN TREATED IN PICU EUROPEAN JOURNAL OF PEDIATRICS 2006 AUG165(8)526-
9
bull HEALY F PANITCH HB PULMONARY COMPLICATIONS OF PEDIATRIC NEUROLOGICAL DISEASES PEDIATR ANN 2010 APR39(4)216-24
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SRIVASTAVA R JACKSON WD BARNHART DC DYSPHAGIA AND GASTROESOPHAGEAL REFLUX DISEASE DILEMMAS IN DIAGNOSIS AND MANAGEMENT IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT PEDIATR ANN 2010 APR39(4)225-31
bull SULLIVAN PB JUSZCZAK E BACHLET AME LAMBERT B VERNON-ROBERTS A GRANT HW ET AL GASTROSTOMY TUBE FEEDING IN CHILDREN WITH CEREBRAL PALSY A PROSPECTIVE LONGITUDINAL STUDY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 2005
FEBRUARY47(2)77-85
bull SOMERVILLE H TZANNES G WOOD J SHUN A HILL C ARROWSMITH F ET AL GASTROINTESTINAL AND NUTRITIONAL PROBLEMS IN SEVERE DEVELOPMENTAL DISABILITY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 200850(9)712-6
bull TODER DS RESPIRATORY PROBLEMS IN THE ADOLESCENT WITH DEVELOPMENTAL DELAY ADOLESCENT MEDICINE 2000 3 OCTOBER 200011(3)617-31
bull LEVIN K COLON A DIPALMA J FITZPATRICK S USING THE RADIONUCLIDE SALIVAGRAM TO DETECT PULMONARY ASPIRATION AND ESOPHAGEAL DYSMOTILITY CLIN NUCL MED 1993 FEB18(2)110-4
bull SCHROEDER AS KLING T HUSS K BORGGRAEFE I KOERTE IK BLASCHEK A ET AL BOTULINUM TOXIN TYPE A AND B FOR THE REDUCTION OF HYPERSALIVATION IN CHILDREN WITH NEUROLOGICAL DISORDERS A FOCUS ON EFFECTIVENESS AND THERAPY ADHERENCE
NEUROPEDIATRICS 201243(1)27-36
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull GOEMINNE P AND DUPONT L (2010) NON-CYSTIC FIBROSIS BRONCHIECTASIS DIAGNOSIS AND MANAGEMENT IN 21ST CENTURY POSTGRADUATE MEDICAL JOURNAL 86(1018) PP493-501
bull LEE A BUTTON B AND TANNENBAUM E (2017) AIRWAY-CLEARANCE TECHNIQUES IN CHILDREN AND ADOLESCENTS WITH CHRONIC SUPPURATIVE LUNG DISEASE AND BRONCHIECTASIS FRONTIERS IN PEDIATRICS 5
bull MANDAL P SIDHU M KOPE L POLLOCK W STEVENSON L PENTLAND J TURNBULL K MAC QUARRIE S AND HILL A (2012) A PILOT STUDY OF PULMONARY REHABILITATION AND CHEST PHYSIOTHERAPY VERSUS CHEST PHYSIOTHERAPY ALONE IN
BRONCHIECTASIS RESPIRATORY MEDICINE 106(12) PP1647-1654
bull MURRAY M PENTLAND J AND HILL A (2009) A RANDOMISED CROSSOVER TRIAL OF CHEST PHYSIOTHERAPY IN NON-CYSTIC FIBROSIS BRONCHIECTASIS EUROPEAN RESPIRATORY JOURNAL 34(5) PP1086-1092
bull NEWALL C STOCKLEY R AND HILL S (2005) EXERCISE TRAINING AND INSPIRATORY MUSCLE TRAINING IN PATIENTS WITH BRONCHIECTASIS THORAX 60(11) PP943-948
bull ONG H LEE A HILL C HOLLAND A AND DENEHY L (2011) EFFECTS OF PULMONARY REHABILITATION IN BRONCHIECTASIS A RETROSPECTIVE STUDY CHRONIC RESPIRATORY DISEASE 8(1) PP21-30
bull QUINT J MILLETT E JOSHI M NAVARATNAM V THOMAS S HURST J SMEETH L AND BROWN J (2015) CHANGES IN THE INCIDENCE PREVALENCE AND MORTALITY OF BRONCHIECTASIS IN THE UK FROM 2004 TO 2013 A POPULATION-BASED COHORT
STUDY EUROPEAN RESPIRATORY JOURNAL 47(1) PP186-193
bull SNIJDERS D FERNANDEZ DOMINGUEZ B CALGARO S BERTOZZI I ESCRIBANO MONTANER A PERILONGO G AND BARBATO A (2015) MUCOCILIARY CLEARANCE TECHNIQUES FOR TREATING NON-CYSTIC FIBROSIS BRONCHIECTASIS IS THERE
EVIDENCE INTERNATIONAL JOURNAL OF IMMUNOPATHOLOGY AND PHARMACOLOGY 28(2) PP150-159
CONCLUSION
bull BE AWARE OF CHILDrsquoS RESPIRATORY FUNCTION
bull CHOSE ACT BEST FOR THEM bull TYPE OF KETCHUP BOTTLE bull LV SECRETION RETENTION WOB
bull EARLY RESPIRATORY REFERRAL
bull RESPIRATORY CARE COMPETENCIES
bull EFFECTIVE SECRETION CLEARANCE AT HOMERESPITESCHOOL
bull USE OF PEAK COUGH FLOWS TO AID CHOICE OF ADJUNCT
0
50
100
150
200
250
300
350
400
0
50
100
150
200
250
300
350
400
Green
Key
Additional info
(please comment) Please refer to BTSACPRC Guideline
Lothian University Hospitals NHS Trust
n PCF
gt270lmin
Breathstack
ing tri-
flow
blowing
REFERENCES bull BTSACPRC GUIDELINE IS PUBLISHED IN THORAX VOL 67 SUPPLEMENT 1
bull AVAILABLE ONLINE AT HTTPTHORAXBMJCOMCONTENTVOL64ISSUESUPPLI
bull HTTPWWWBRIT-THORACICORGUKPHYSIOGUIDE
bull BRITISH THORACIC SOCIETY REPORTS VOL 1 NO 1 2009
bull ADAPTED PRYOR AJ AND PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS3RD ED
bull HOUGH A PHYSIOTHERAPY IN RESPIRATORY CARE LONDON CHAPMAN AND HALL 1993
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1997) POSTURAL DRAINAGE AND GASTRO-OESOPHAGEAL REFLUX IN INFANTS WITH CYSTIC FIBROSIS ARCHIVES OF DISEASE IN CHILDHOOD 76 148-150
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1998) POSTURAL DRAINAGE IN CYSTIC FIBROSIS IS THERE A LINK WITH GASTRO-OESOPHAGEAL REFLUX JOURNAL OF PAEDIATRIC CHILD HEALTH 34 330-334
bull CECINS NM JENKINS SC PENGELLEY J ET AL (1999) THE ACTIVE CYCLE OF BREATHING TECHNIQUES-TO TIP OR NOT TO TIP RESPIRATORY MEDICINE 93 660-665
bull CONSTANTINI D BRIVIO A BRUSA D ET AL (2001) PEP MASK VERSUS POSTURAL DRAINAGE IN INFANTS A LONG-TERM COMPARATIVE TRIAL PEADIATRIC PULMONOLOGY
bull HOUGH A (2001) PHYSIOTHERAPY IN RESPIRATORY CARE AN EVIDENCE-BASED APPROACH TO RESPIRATORY AND CARDIAC MANAGEMENT CENGAGE LEARNING EMEA
bull INTERNATIONAL PHYSIOTHERAPY GROUP FOR CYSTIC FIBROSIS PHYSIOTHERAPY IN THE TREATMENT OF CYSTIC FIBROSIS (2009) HTTPSWWWECFSEUIPG_CFBOOKLET INTERNATIONAL PHYSIOTHERAPY GROUP ndash THE BLUE BOOKLET
bull KONSTAN MW STERN RC DOERSHUK CF (1994) EFFICACY OF THE FLUTTER DEVICE FOR AIRWAY MUCUS CLEARANCE IN PATIENTS WITH CYSTIC FIBROSIS JOURNAL OF PEDIATRICS 124 (5 (PT 1) 689-693
bull MCILWAINE M BUTTON B AND DWAN K (2015) POSITIVE EXPIRATORY PRESSURE PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 6 ART NO CD003147 DOI 10100214651858CD003147PUB4
bull MESTRINER RG FERNANDES RO STAFFEN LC ET AL (2009) OPTIMUM DESIGN PARAMETERS FOR A THERAPIST-CONSTRUCTED POSITIVE-EXPIRATORY-PRESSURE THERAPY BOTTLE DEVICE RESPIRATORY CARE 54 504-8
bull MORRISON L AND AGNEW J (2014) OSCILLATING DEVICES FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 7 ART NO CD006842 DOI 10100214651858CD006842PUB
bull OERMANN CM SOCKRIDER MM GILES D ET AL (2001) COMPARISON OF HIGH-FREQUENCY CHEST WALL OSCILLATION AND OSCILLATING POSITIVE EXPIRATORY PRESSURE IN THE HOME MANAGEMENT OF CYSTIC FIBROSIS A PILOT STUDY PEDIATRIC PULMONOLOGY 32 (5) 372-7
bull PRASAD SA AND HUSSEY J (1995) PAEDIATRIC RESPIRATORY CARE A GUIDE FOR PHYSIOTHERAPISTS AND HEALTH PROFESSIONALS CHAPMAN amp HALL
bull PRYOR J (1999) PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN ADULTS EUROPEAN RESPIRATORY JOURNAL 14 (6) 1418-1424
bull PRYOR JA amp PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS CHURCHILL LIVINGSTONE
bull PRYOR JA WEBBER BA HODSON ME ET AL (1994) THE FLUTTER VRP1 AS AN ADJUNCT TO CHEST PHYSIOTHERAPY IN CYSTIC FIBROSIS RESPIRATORY MEDICINE 88677-81
bull WEST K WALLEN M FOLLETT J (2010) ACAPELLA VS PEP MASK THERAPY A RANDOMISED TRIAL IN CHILDREN WITH CYSTIC FIBROSIS DURING RESPIRATORY EXACERBATION PHYSIOTHERAPY THEORY PRACTICE 26143-9
bull WILSONLM AGNEW J MORRISON L ET AL (2014) AIRWAY CLEARANCE TECHNIQUES FOR CYSTIC FIBROSIS AN OVERVIEW OF COCHRANE SYSTEMATIC REVIEWS COCHRANE DATABASE OF SYSTEMATIC REVIEWS DOI 10100214651858CD011231
bull VOLSKO TA DIFIORE JM CHATBURN RL (2003) PERFORMANCE COMPARISON OF TWO OSCILLATORY POSITIVE PRESSURE DEVICES ACAPELLA VERSUS FLUTTER RESPIRATORY CARE 48 (2) 124- 130
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SEDDON PC KHAN Y RESPIRATORY PROBLEMS IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT ARCHIVES OF DISEASE IN CHILDHOOD 2003 01 JAN88(1)75-8
bull MARKS JH PULMONARY CARE OF CHILDREN AND ADOLESCENTS WITH DEVELOPMENTAL DISABILITIES PEDIATR CLIN NORTH AM 2008 DECEMBER55(6)1299-314
bull ARENS R MUZUMDAR H SLEEP SLEEP DISORDERED BREATHING AND NOCTURNAL HYPOVENTILATION IN CHILDREN WITH NEUROMUSCULAR DISEASES PAEDIATRIC RESPIRATORY REVIEWS 2010 MAR11(1)24-30
bull FITZGERALD DA FOLLETT J VAN ASPEREN PP ASSESSING AND MANAGING LUNG DISEASE AND SLEEP DISORDERED BREATHING IN CHILDREN WITH CEREBRAL PALSY PAEDIATRIC RESPIRATORY REVIEWS 2009 MARCH10(1)18-24
bull HSIAO KH NIXON GM THE EFFECT OF TREATMENT OF OBSTRUCTIVE SLEEP APNEA ON QUALITY OF LIFE IN CHILDREN WITH CEREBRAL PALSY RES DEV DISABIL 2008 MAR-APR29(2)133-40
bull LUNDBERG A OXYGEN CONSUMPTION IN RELATION TO WORKLOAD IN STUDENTS WITH CEREBRAL PALSY J APPL PHYSIO 197640873-5
bull SULLIVAN PB ROSENBLOOM L FEEDING THE DISABLED CHILD CLINICS IN DEVELOPMENTAL MEDICINE MACKEITH PRESS 1999140
bull MARTIN TR THE RELATIONSHIP BETWEEN MALNUTRITION AND LUNG INFECTIONS CLIN CHEST MED 19878359
bull MOSTAFA SM BHANDARI S RITCHIE G ET AL CONSTIPATION AND ITS IMPLICATIONS IN THE CRITICALLY ILL PATIENT BR J ANAESTH 200391815-9 3
bull GACOUIN A CAMUS C GROS A ET AL CONSTIPATION IN LONGTERM VENTILATED PATIENTS ASSOCIATED FACTORS AND IMPACT ON INTENSIVE CARE UNIT OUTCOMES CRIT CARE MED 2010381933- 8
bull NGUYEN T FRENETTE AJ JOHANSON C ET AL IMPAIRED GASTROINTESTINAL TRANSIT AND ITS ASSOCIATED MORBIDITY IN THE INTENSIVE CARE UNIT J CRIT CARE 201328537
bull ASAI T CONSTIPATION DOES IT INCREASE MORBIDITY AND MORTALITY IN CRITICALLY ILL PATIENTS CRIT CARE MED 2007352861-2
bull UNDERSTANDING THE PHYSIOLOGICAL EFFECTS OF UNTREATED PAIN NURSING TIMES VOL 99 ISSUE 37 PAGE NO 28
bull WINFIELD ET AL NON-PHARMACEUTICAL MANAGEMENT OF RESPIRATORY MORBIDITY IN CHILDREN WITH SEVERE GLOBAL DEVELOPMENTAL DELAY THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014
bull OLOUGHLIN EV SOMERVILLE HM SOMERVILLE ER DEALING WITH MULTISYSTEM DISEASE IN PEOPLE WITH A DEVELOPMENTAL DISABILITY MEDICAL JOURNAL OF AUSTRALIA 2009 JUN 1190(11)616-7
bull MESTROVIC J KARDUM G POLIC B MESTROVIC M MARKIC J SUSTIC A ET AL THE INFLUENCE OF CHRONIC HEALTH CONDITIONS ON SUSCEPTIBILITY TO SEVERE ACUTE ILLNESS OF CHILDREN TREATED IN PICU EUROPEAN JOURNAL OF PEDIATRICS 2006 AUG165(8)526-
9
bull HEALY F PANITCH HB PULMONARY COMPLICATIONS OF PEDIATRIC NEUROLOGICAL DISEASES PEDIATR ANN 2010 APR39(4)216-24
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SRIVASTAVA R JACKSON WD BARNHART DC DYSPHAGIA AND GASTROESOPHAGEAL REFLUX DISEASE DILEMMAS IN DIAGNOSIS AND MANAGEMENT IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT PEDIATR ANN 2010 APR39(4)225-31
bull SULLIVAN PB JUSZCZAK E BACHLET AME LAMBERT B VERNON-ROBERTS A GRANT HW ET AL GASTROSTOMY TUBE FEEDING IN CHILDREN WITH CEREBRAL PALSY A PROSPECTIVE LONGITUDINAL STUDY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 2005
FEBRUARY47(2)77-85
bull SOMERVILLE H TZANNES G WOOD J SHUN A HILL C ARROWSMITH F ET AL GASTROINTESTINAL AND NUTRITIONAL PROBLEMS IN SEVERE DEVELOPMENTAL DISABILITY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 200850(9)712-6
bull TODER DS RESPIRATORY PROBLEMS IN THE ADOLESCENT WITH DEVELOPMENTAL DELAY ADOLESCENT MEDICINE 2000 3 OCTOBER 200011(3)617-31
bull LEVIN K COLON A DIPALMA J FITZPATRICK S USING THE RADIONUCLIDE SALIVAGRAM TO DETECT PULMONARY ASPIRATION AND ESOPHAGEAL DYSMOTILITY CLIN NUCL MED 1993 FEB18(2)110-4
bull SCHROEDER AS KLING T HUSS K BORGGRAEFE I KOERTE IK BLASCHEK A ET AL BOTULINUM TOXIN TYPE A AND B FOR THE REDUCTION OF HYPERSALIVATION IN CHILDREN WITH NEUROLOGICAL DISORDERS A FOCUS ON EFFECTIVENESS AND THERAPY ADHERENCE
NEUROPEDIATRICS 201243(1)27-36
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull GOEMINNE P AND DUPONT L (2010) NON-CYSTIC FIBROSIS BRONCHIECTASIS DIAGNOSIS AND MANAGEMENT IN 21ST CENTURY POSTGRADUATE MEDICAL JOURNAL 86(1018) PP493-501
bull LEE A BUTTON B AND TANNENBAUM E (2017) AIRWAY-CLEARANCE TECHNIQUES IN CHILDREN AND ADOLESCENTS WITH CHRONIC SUPPURATIVE LUNG DISEASE AND BRONCHIECTASIS FRONTIERS IN PEDIATRICS 5
bull MANDAL P SIDHU M KOPE L POLLOCK W STEVENSON L PENTLAND J TURNBULL K MAC QUARRIE S AND HILL A (2012) A PILOT STUDY OF PULMONARY REHABILITATION AND CHEST PHYSIOTHERAPY VERSUS CHEST PHYSIOTHERAPY ALONE IN
BRONCHIECTASIS RESPIRATORY MEDICINE 106(12) PP1647-1654
bull MURRAY M PENTLAND J AND HILL A (2009) A RANDOMISED CROSSOVER TRIAL OF CHEST PHYSIOTHERAPY IN NON-CYSTIC FIBROSIS BRONCHIECTASIS EUROPEAN RESPIRATORY JOURNAL 34(5) PP1086-1092
bull NEWALL C STOCKLEY R AND HILL S (2005) EXERCISE TRAINING AND INSPIRATORY MUSCLE TRAINING IN PATIENTS WITH BRONCHIECTASIS THORAX 60(11) PP943-948
bull ONG H LEE A HILL C HOLLAND A AND DENEHY L (2011) EFFECTS OF PULMONARY REHABILITATION IN BRONCHIECTASIS A RETROSPECTIVE STUDY CHRONIC RESPIRATORY DISEASE 8(1) PP21-30
bull QUINT J MILLETT E JOSHI M NAVARATNAM V THOMAS S HURST J SMEETH L AND BROWN J (2015) CHANGES IN THE INCIDENCE PREVALENCE AND MORTALITY OF BRONCHIECTASIS IN THE UK FROM 2004 TO 2013 A POPULATION-BASED COHORT
STUDY EUROPEAN RESPIRATORY JOURNAL 47(1) PP186-193
bull SNIJDERS D FERNANDEZ DOMINGUEZ B CALGARO S BERTOZZI I ESCRIBANO MONTANER A PERILONGO G AND BARBATO A (2015) MUCOCILIARY CLEARANCE TECHNIQUES FOR TREATING NON-CYSTIC FIBROSIS BRONCHIECTASIS IS THERE
EVIDENCE INTERNATIONAL JOURNAL OF IMMUNOPATHOLOGY AND PHARMACOLOGY 28(2) PP150-159
REFERENCES bull BTSACPRC GUIDELINE IS PUBLISHED IN THORAX VOL 67 SUPPLEMENT 1
bull AVAILABLE ONLINE AT HTTPTHORAXBMJCOMCONTENTVOL64ISSUESUPPLI
bull HTTPWWWBRIT-THORACICORGUKPHYSIOGUIDE
bull BRITISH THORACIC SOCIETY REPORTS VOL 1 NO 1 2009
bull ADAPTED PRYOR AJ AND PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS3RD ED
bull HOUGH A PHYSIOTHERAPY IN RESPIRATORY CARE LONDON CHAPMAN AND HALL 1993
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1997) POSTURAL DRAINAGE AND GASTRO-OESOPHAGEAL REFLUX IN INFANTS WITH CYSTIC FIBROSIS ARCHIVES OF DISEASE IN CHILDHOOD 76 148-150
bull BUTTON BM HEINE RG CATTO-SMITH AG ET AL (1998) POSTURAL DRAINAGE IN CYSTIC FIBROSIS IS THERE A LINK WITH GASTRO-OESOPHAGEAL REFLUX JOURNAL OF PAEDIATRIC CHILD HEALTH 34 330-334
bull CECINS NM JENKINS SC PENGELLEY J ET AL (1999) THE ACTIVE CYCLE OF BREATHING TECHNIQUES-TO TIP OR NOT TO TIP RESPIRATORY MEDICINE 93 660-665
bull CONSTANTINI D BRIVIO A BRUSA D ET AL (2001) PEP MASK VERSUS POSTURAL DRAINAGE IN INFANTS A LONG-TERM COMPARATIVE TRIAL PEADIATRIC PULMONOLOGY
bull HOUGH A (2001) PHYSIOTHERAPY IN RESPIRATORY CARE AN EVIDENCE-BASED APPROACH TO RESPIRATORY AND CARDIAC MANAGEMENT CENGAGE LEARNING EMEA
bull INTERNATIONAL PHYSIOTHERAPY GROUP FOR CYSTIC FIBROSIS PHYSIOTHERAPY IN THE TREATMENT OF CYSTIC FIBROSIS (2009) HTTPSWWWECFSEUIPG_CFBOOKLET INTERNATIONAL PHYSIOTHERAPY GROUP ndash THE BLUE BOOKLET
bull KONSTAN MW STERN RC DOERSHUK CF (1994) EFFICACY OF THE FLUTTER DEVICE FOR AIRWAY MUCUS CLEARANCE IN PATIENTS WITH CYSTIC FIBROSIS JOURNAL OF PEDIATRICS 124 (5 (PT 1) 689-693
bull MCILWAINE M BUTTON B AND DWAN K (2015) POSITIVE EXPIRATORY PRESSURE PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 6 ART NO CD003147 DOI 10100214651858CD003147PUB4
bull MESTRINER RG FERNANDES RO STAFFEN LC ET AL (2009) OPTIMUM DESIGN PARAMETERS FOR A THERAPIST-CONSTRUCTED POSITIVE-EXPIRATORY-PRESSURE THERAPY BOTTLE DEVICE RESPIRATORY CARE 54 504-8
bull MORRISON L AND AGNEW J (2014) OSCILLATING DEVICES FOR AIRWAY CLEARANCE IN PEOPLE WITH CYSTIC FIBROSIS COCHRANE DATABASE OF SYSTEMATIC REVIEWS ISSUE 7 ART NO CD006842 DOI 10100214651858CD006842PUB
bull OERMANN CM SOCKRIDER MM GILES D ET AL (2001) COMPARISON OF HIGH-FREQUENCY CHEST WALL OSCILLATION AND OSCILLATING POSITIVE EXPIRATORY PRESSURE IN THE HOME MANAGEMENT OF CYSTIC FIBROSIS A PILOT STUDY PEDIATRIC PULMONOLOGY 32 (5) 372-7
bull PRASAD SA AND HUSSEY J (1995) PAEDIATRIC RESPIRATORY CARE A GUIDE FOR PHYSIOTHERAPISTS AND HEALTH PROFESSIONALS CHAPMAN amp HALL
bull PRYOR J (1999) PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN ADULTS EUROPEAN RESPIRATORY JOURNAL 14 (6) 1418-1424
bull PRYOR JA amp PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS CHURCHILL LIVINGSTONE
bull PRYOR JA WEBBER BA HODSON ME ET AL (1994) THE FLUTTER VRP1 AS AN ADJUNCT TO CHEST PHYSIOTHERAPY IN CYSTIC FIBROSIS RESPIRATORY MEDICINE 88677-81
bull WEST K WALLEN M FOLLETT J (2010) ACAPELLA VS PEP MASK THERAPY A RANDOMISED TRIAL IN CHILDREN WITH CYSTIC FIBROSIS DURING RESPIRATORY EXACERBATION PHYSIOTHERAPY THEORY PRACTICE 26143-9
bull WILSONLM AGNEW J MORRISON L ET AL (2014) AIRWAY CLEARANCE TECHNIQUES FOR CYSTIC FIBROSIS AN OVERVIEW OF COCHRANE SYSTEMATIC REVIEWS COCHRANE DATABASE OF SYSTEMATIC REVIEWS DOI 10100214651858CD011231
bull VOLSKO TA DIFIORE JM CHATBURN RL (2003) PERFORMANCE COMPARISON OF TWO OSCILLATORY POSITIVE PRESSURE DEVICES ACAPELLA VERSUS FLUTTER RESPIRATORY CARE 48 (2) 124- 130
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SEDDON PC KHAN Y RESPIRATORY PROBLEMS IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT ARCHIVES OF DISEASE IN CHILDHOOD 2003 01 JAN88(1)75-8
bull MARKS JH PULMONARY CARE OF CHILDREN AND ADOLESCENTS WITH DEVELOPMENTAL DISABILITIES PEDIATR CLIN NORTH AM 2008 DECEMBER55(6)1299-314
bull ARENS R MUZUMDAR H SLEEP SLEEP DISORDERED BREATHING AND NOCTURNAL HYPOVENTILATION IN CHILDREN WITH NEUROMUSCULAR DISEASES PAEDIATRIC RESPIRATORY REVIEWS 2010 MAR11(1)24-30
bull FITZGERALD DA FOLLETT J VAN ASPEREN PP ASSESSING AND MANAGING LUNG DISEASE AND SLEEP DISORDERED BREATHING IN CHILDREN WITH CEREBRAL PALSY PAEDIATRIC RESPIRATORY REVIEWS 2009 MARCH10(1)18-24
bull HSIAO KH NIXON GM THE EFFECT OF TREATMENT OF OBSTRUCTIVE SLEEP APNEA ON QUALITY OF LIFE IN CHILDREN WITH CEREBRAL PALSY RES DEV DISABIL 2008 MAR-APR29(2)133-40
bull LUNDBERG A OXYGEN CONSUMPTION IN RELATION TO WORKLOAD IN STUDENTS WITH CEREBRAL PALSY J APPL PHYSIO 197640873-5
bull SULLIVAN PB ROSENBLOOM L FEEDING THE DISABLED CHILD CLINICS IN DEVELOPMENTAL MEDICINE MACKEITH PRESS 1999140
bull MARTIN TR THE RELATIONSHIP BETWEEN MALNUTRITION AND LUNG INFECTIONS CLIN CHEST MED 19878359
bull MOSTAFA SM BHANDARI S RITCHIE G ET AL CONSTIPATION AND ITS IMPLICATIONS IN THE CRITICALLY ILL PATIENT BR J ANAESTH 200391815-9 3
bull GACOUIN A CAMUS C GROS A ET AL CONSTIPATION IN LONGTERM VENTILATED PATIENTS ASSOCIATED FACTORS AND IMPACT ON INTENSIVE CARE UNIT OUTCOMES CRIT CARE MED 2010381933- 8
bull NGUYEN T FRENETTE AJ JOHANSON C ET AL IMPAIRED GASTROINTESTINAL TRANSIT AND ITS ASSOCIATED MORBIDITY IN THE INTENSIVE CARE UNIT J CRIT CARE 201328537
bull ASAI T CONSTIPATION DOES IT INCREASE MORBIDITY AND MORTALITY IN CRITICALLY ILL PATIENTS CRIT CARE MED 2007352861-2
bull UNDERSTANDING THE PHYSIOLOGICAL EFFECTS OF UNTREATED PAIN NURSING TIMES VOL 99 ISSUE 37 PAGE NO 28
bull WINFIELD ET AL NON-PHARMACEUTICAL MANAGEMENT OF RESPIRATORY MORBIDITY IN CHILDREN WITH SEVERE GLOBAL DEVELOPMENTAL DELAY THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014
bull OLOUGHLIN EV SOMERVILLE HM SOMERVILLE ER DEALING WITH MULTISYSTEM DISEASE IN PEOPLE WITH A DEVELOPMENTAL DISABILITY MEDICAL JOURNAL OF AUSTRALIA 2009 JUN 1190(11)616-7
bull MESTROVIC J KARDUM G POLIC B MESTROVIC M MARKIC J SUSTIC A ET AL THE INFLUENCE OF CHRONIC HEALTH CONDITIONS ON SUSCEPTIBILITY TO SEVERE ACUTE ILLNESS OF CHILDREN TREATED IN PICU EUROPEAN JOURNAL OF PEDIATRICS 2006 AUG165(8)526-
9
bull HEALY F PANITCH HB PULMONARY COMPLICATIONS OF PEDIATRIC NEUROLOGICAL DISEASES PEDIATR ANN 2010 APR39(4)216-24
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SRIVASTAVA R JACKSON WD BARNHART DC DYSPHAGIA AND GASTROESOPHAGEAL REFLUX DISEASE DILEMMAS IN DIAGNOSIS AND MANAGEMENT IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT PEDIATR ANN 2010 APR39(4)225-31
bull SULLIVAN PB JUSZCZAK E BACHLET AME LAMBERT B VERNON-ROBERTS A GRANT HW ET AL GASTROSTOMY TUBE FEEDING IN CHILDREN WITH CEREBRAL PALSY A PROSPECTIVE LONGITUDINAL STUDY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 2005
FEBRUARY47(2)77-85
bull SOMERVILLE H TZANNES G WOOD J SHUN A HILL C ARROWSMITH F ET AL GASTROINTESTINAL AND NUTRITIONAL PROBLEMS IN SEVERE DEVELOPMENTAL DISABILITY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 200850(9)712-6
bull TODER DS RESPIRATORY PROBLEMS IN THE ADOLESCENT WITH DEVELOPMENTAL DELAY ADOLESCENT MEDICINE 2000 3 OCTOBER 200011(3)617-31
bull LEVIN K COLON A DIPALMA J FITZPATRICK S USING THE RADIONUCLIDE SALIVAGRAM TO DETECT PULMONARY ASPIRATION AND ESOPHAGEAL DYSMOTILITY CLIN NUCL MED 1993 FEB18(2)110-4
bull SCHROEDER AS KLING T HUSS K BORGGRAEFE I KOERTE IK BLASCHEK A ET AL BOTULINUM TOXIN TYPE A AND B FOR THE REDUCTION OF HYPERSALIVATION IN CHILDREN WITH NEUROLOGICAL DISORDERS A FOCUS ON EFFECTIVENESS AND THERAPY ADHERENCE
NEUROPEDIATRICS 201243(1)27-36
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull GOEMINNE P AND DUPONT L (2010) NON-CYSTIC FIBROSIS BRONCHIECTASIS DIAGNOSIS AND MANAGEMENT IN 21ST CENTURY POSTGRADUATE MEDICAL JOURNAL 86(1018) PP493-501
bull LEE A BUTTON B AND TANNENBAUM E (2017) AIRWAY-CLEARANCE TECHNIQUES IN CHILDREN AND ADOLESCENTS WITH CHRONIC SUPPURATIVE LUNG DISEASE AND BRONCHIECTASIS FRONTIERS IN PEDIATRICS 5
bull MANDAL P SIDHU M KOPE L POLLOCK W STEVENSON L PENTLAND J TURNBULL K MAC QUARRIE S AND HILL A (2012) A PILOT STUDY OF PULMONARY REHABILITATION AND CHEST PHYSIOTHERAPY VERSUS CHEST PHYSIOTHERAPY ALONE IN
BRONCHIECTASIS RESPIRATORY MEDICINE 106(12) PP1647-1654
bull MURRAY M PENTLAND J AND HILL A (2009) A RANDOMISED CROSSOVER TRIAL OF CHEST PHYSIOTHERAPY IN NON-CYSTIC FIBROSIS BRONCHIECTASIS EUROPEAN RESPIRATORY JOURNAL 34(5) PP1086-1092
bull NEWALL C STOCKLEY R AND HILL S (2005) EXERCISE TRAINING AND INSPIRATORY MUSCLE TRAINING IN PATIENTS WITH BRONCHIECTASIS THORAX 60(11) PP943-948
bull ONG H LEE A HILL C HOLLAND A AND DENEHY L (2011) EFFECTS OF PULMONARY REHABILITATION IN BRONCHIECTASIS A RETROSPECTIVE STUDY CHRONIC RESPIRATORY DISEASE 8(1) PP21-30
bull QUINT J MILLETT E JOSHI M NAVARATNAM V THOMAS S HURST J SMEETH L AND BROWN J (2015) CHANGES IN THE INCIDENCE PREVALENCE AND MORTALITY OF BRONCHIECTASIS IN THE UK FROM 2004 TO 2013 A POPULATION-BASED COHORT
STUDY EUROPEAN RESPIRATORY JOURNAL 47(1) PP186-193
bull SNIJDERS D FERNANDEZ DOMINGUEZ B CALGARO S BERTOZZI I ESCRIBANO MONTANER A PERILONGO G AND BARBATO A (2015) MUCOCILIARY CLEARANCE TECHNIQUES FOR TREATING NON-CYSTIC FIBROSIS BRONCHIECTASIS IS THERE
EVIDENCE INTERNATIONAL JOURNAL OF IMMUNOPATHOLOGY AND PHARMACOLOGY 28(2) PP150-159
bull OERMANN CM SOCKRIDER MM GILES D ET AL (2001) COMPARISON OF HIGH-FREQUENCY CHEST WALL OSCILLATION AND OSCILLATING POSITIVE EXPIRATORY PRESSURE IN THE HOME MANAGEMENT OF CYSTIC FIBROSIS A PILOT STUDY PEDIATRIC PULMONOLOGY 32 (5) 372-7
bull PRASAD SA AND HUSSEY J (1995) PAEDIATRIC RESPIRATORY CARE A GUIDE FOR PHYSIOTHERAPISTS AND HEALTH PROFESSIONALS CHAPMAN amp HALL
bull PRYOR J (1999) PHYSIOTHERAPY FOR AIRWAY CLEARANCE IN ADULTS EUROPEAN RESPIRATORY JOURNAL 14 (6) 1418-1424
bull PRYOR JA amp PRASAD SA (2002) PHYSIOTHERAPY FOR RESPIRATORY AND CARDIAC PROBLEMS ADULTS AND PAEDIATRICS CHURCHILL LIVINGSTONE
bull PRYOR JA WEBBER BA HODSON ME ET AL (1994) THE FLUTTER VRP1 AS AN ADJUNCT TO CHEST PHYSIOTHERAPY IN CYSTIC FIBROSIS RESPIRATORY MEDICINE 88677-81
bull WEST K WALLEN M FOLLETT J (2010) ACAPELLA VS PEP MASK THERAPY A RANDOMISED TRIAL IN CHILDREN WITH CYSTIC FIBROSIS DURING RESPIRATORY EXACERBATION PHYSIOTHERAPY THEORY PRACTICE 26143-9
bull WILSONLM AGNEW J MORRISON L ET AL (2014) AIRWAY CLEARANCE TECHNIQUES FOR CYSTIC FIBROSIS AN OVERVIEW OF COCHRANE SYSTEMATIC REVIEWS COCHRANE DATABASE OF SYSTEMATIC REVIEWS DOI 10100214651858CD011231
bull VOLSKO TA DIFIORE JM CHATBURN RL (2003) PERFORMANCE COMPARISON OF TWO OSCILLATORY POSITIVE PRESSURE DEVICES ACAPELLA VERSUS FLUTTER RESPIRATORY CARE 48 (2) 124- 130
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SEDDON PC KHAN Y RESPIRATORY PROBLEMS IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT ARCHIVES OF DISEASE IN CHILDHOOD 2003 01 JAN88(1)75-8
bull MARKS JH PULMONARY CARE OF CHILDREN AND ADOLESCENTS WITH DEVELOPMENTAL DISABILITIES PEDIATR CLIN NORTH AM 2008 DECEMBER55(6)1299-314
bull ARENS R MUZUMDAR H SLEEP SLEEP DISORDERED BREATHING AND NOCTURNAL HYPOVENTILATION IN CHILDREN WITH NEUROMUSCULAR DISEASES PAEDIATRIC RESPIRATORY REVIEWS 2010 MAR11(1)24-30
bull FITZGERALD DA FOLLETT J VAN ASPEREN PP ASSESSING AND MANAGING LUNG DISEASE AND SLEEP DISORDERED BREATHING IN CHILDREN WITH CEREBRAL PALSY PAEDIATRIC RESPIRATORY REVIEWS 2009 MARCH10(1)18-24
bull HSIAO KH NIXON GM THE EFFECT OF TREATMENT OF OBSTRUCTIVE SLEEP APNEA ON QUALITY OF LIFE IN CHILDREN WITH CEREBRAL PALSY RES DEV DISABIL 2008 MAR-APR29(2)133-40
bull LUNDBERG A OXYGEN CONSUMPTION IN RELATION TO WORKLOAD IN STUDENTS WITH CEREBRAL PALSY J APPL PHYSIO 197640873-5
bull SULLIVAN PB ROSENBLOOM L FEEDING THE DISABLED CHILD CLINICS IN DEVELOPMENTAL MEDICINE MACKEITH PRESS 1999140
bull MARTIN TR THE RELATIONSHIP BETWEEN MALNUTRITION AND LUNG INFECTIONS CLIN CHEST MED 19878359
bull MOSTAFA SM BHANDARI S RITCHIE G ET AL CONSTIPATION AND ITS IMPLICATIONS IN THE CRITICALLY ILL PATIENT BR J ANAESTH 200391815-9 3
bull GACOUIN A CAMUS C GROS A ET AL CONSTIPATION IN LONGTERM VENTILATED PATIENTS ASSOCIATED FACTORS AND IMPACT ON INTENSIVE CARE UNIT OUTCOMES CRIT CARE MED 2010381933- 8
bull NGUYEN T FRENETTE AJ JOHANSON C ET AL IMPAIRED GASTROINTESTINAL TRANSIT AND ITS ASSOCIATED MORBIDITY IN THE INTENSIVE CARE UNIT J CRIT CARE 201328537
bull ASAI T CONSTIPATION DOES IT INCREASE MORBIDITY AND MORTALITY IN CRITICALLY ILL PATIENTS CRIT CARE MED 2007352861-2
bull UNDERSTANDING THE PHYSIOLOGICAL EFFECTS OF UNTREATED PAIN NURSING TIMES VOL 99 ISSUE 37 PAGE NO 28
bull WINFIELD ET AL NON-PHARMACEUTICAL MANAGEMENT OF RESPIRATORY MORBIDITY IN CHILDREN WITH SEVERE GLOBAL DEVELOPMENTAL DELAY THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014
bull OLOUGHLIN EV SOMERVILLE HM SOMERVILLE ER DEALING WITH MULTISYSTEM DISEASE IN PEOPLE WITH A DEVELOPMENTAL DISABILITY MEDICAL JOURNAL OF AUSTRALIA 2009 JUN 1190(11)616-7
bull MESTROVIC J KARDUM G POLIC B MESTROVIC M MARKIC J SUSTIC A ET AL THE INFLUENCE OF CHRONIC HEALTH CONDITIONS ON SUSCEPTIBILITY TO SEVERE ACUTE ILLNESS OF CHILDREN TREATED IN PICU EUROPEAN JOURNAL OF PEDIATRICS 2006 AUG165(8)526-
9
bull HEALY F PANITCH HB PULMONARY COMPLICATIONS OF PEDIATRIC NEUROLOGICAL DISEASES PEDIATR ANN 2010 APR39(4)216-24
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SRIVASTAVA R JACKSON WD BARNHART DC DYSPHAGIA AND GASTROESOPHAGEAL REFLUX DISEASE DILEMMAS IN DIAGNOSIS AND MANAGEMENT IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT PEDIATR ANN 2010 APR39(4)225-31
bull SULLIVAN PB JUSZCZAK E BACHLET AME LAMBERT B VERNON-ROBERTS A GRANT HW ET AL GASTROSTOMY TUBE FEEDING IN CHILDREN WITH CEREBRAL PALSY A PROSPECTIVE LONGITUDINAL STUDY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 2005
FEBRUARY47(2)77-85
bull SOMERVILLE H TZANNES G WOOD J SHUN A HILL C ARROWSMITH F ET AL GASTROINTESTINAL AND NUTRITIONAL PROBLEMS IN SEVERE DEVELOPMENTAL DISABILITY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 200850(9)712-6
bull TODER DS RESPIRATORY PROBLEMS IN THE ADOLESCENT WITH DEVELOPMENTAL DELAY ADOLESCENT MEDICINE 2000 3 OCTOBER 200011(3)617-31
bull LEVIN K COLON A DIPALMA J FITZPATRICK S USING THE RADIONUCLIDE SALIVAGRAM TO DETECT PULMONARY ASPIRATION AND ESOPHAGEAL DYSMOTILITY CLIN NUCL MED 1993 FEB18(2)110-4
bull SCHROEDER AS KLING T HUSS K BORGGRAEFE I KOERTE IK BLASCHEK A ET AL BOTULINUM TOXIN TYPE A AND B FOR THE REDUCTION OF HYPERSALIVATION IN CHILDREN WITH NEUROLOGICAL DISORDERS A FOCUS ON EFFECTIVENESS AND THERAPY ADHERENCE
NEUROPEDIATRICS 201243(1)27-36
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull GOEMINNE P AND DUPONT L (2010) NON-CYSTIC FIBROSIS BRONCHIECTASIS DIAGNOSIS AND MANAGEMENT IN 21ST CENTURY POSTGRADUATE MEDICAL JOURNAL 86(1018) PP493-501
bull LEE A BUTTON B AND TANNENBAUM E (2017) AIRWAY-CLEARANCE TECHNIQUES IN CHILDREN AND ADOLESCENTS WITH CHRONIC SUPPURATIVE LUNG DISEASE AND BRONCHIECTASIS FRONTIERS IN PEDIATRICS 5
bull MANDAL P SIDHU M KOPE L POLLOCK W STEVENSON L PENTLAND J TURNBULL K MAC QUARRIE S AND HILL A (2012) A PILOT STUDY OF PULMONARY REHABILITATION AND CHEST PHYSIOTHERAPY VERSUS CHEST PHYSIOTHERAPY ALONE IN
BRONCHIECTASIS RESPIRATORY MEDICINE 106(12) PP1647-1654
bull MURRAY M PENTLAND J AND HILL A (2009) A RANDOMISED CROSSOVER TRIAL OF CHEST PHYSIOTHERAPY IN NON-CYSTIC FIBROSIS BRONCHIECTASIS EUROPEAN RESPIRATORY JOURNAL 34(5) PP1086-1092
bull NEWALL C STOCKLEY R AND HILL S (2005) EXERCISE TRAINING AND INSPIRATORY MUSCLE TRAINING IN PATIENTS WITH BRONCHIECTASIS THORAX 60(11) PP943-948
bull ONG H LEE A HILL C HOLLAND A AND DENEHY L (2011) EFFECTS OF PULMONARY REHABILITATION IN BRONCHIECTASIS A RETROSPECTIVE STUDY CHRONIC RESPIRATORY DISEASE 8(1) PP21-30
bull QUINT J MILLETT E JOSHI M NAVARATNAM V THOMAS S HURST J SMEETH L AND BROWN J (2015) CHANGES IN THE INCIDENCE PREVALENCE AND MORTALITY OF BRONCHIECTASIS IN THE UK FROM 2004 TO 2013 A POPULATION-BASED COHORT
STUDY EUROPEAN RESPIRATORY JOURNAL 47(1) PP186-193
bull SNIJDERS D FERNANDEZ DOMINGUEZ B CALGARO S BERTOZZI I ESCRIBANO MONTANER A PERILONGO G AND BARBATO A (2015) MUCOCILIARY CLEARANCE TECHNIQUES FOR TREATING NON-CYSTIC FIBROSIS BRONCHIECTASIS IS THERE
EVIDENCE INTERNATIONAL JOURNAL OF IMMUNOPATHOLOGY AND PHARMACOLOGY 28(2) PP150-159
bull WINFIELD ET AL NON-PHARMACEUTICAL MANAGEMENT OF RESPIRATORY MORBIDITY IN CHILDREN WITH SEVERE GLOBAL DEVELOPMENTAL DELAY THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014
bull OLOUGHLIN EV SOMERVILLE HM SOMERVILLE ER DEALING WITH MULTISYSTEM DISEASE IN PEOPLE WITH A DEVELOPMENTAL DISABILITY MEDICAL JOURNAL OF AUSTRALIA 2009 JUN 1190(11)616-7
bull MESTROVIC J KARDUM G POLIC B MESTROVIC M MARKIC J SUSTIC A ET AL THE INFLUENCE OF CHRONIC HEALTH CONDITIONS ON SUSCEPTIBILITY TO SEVERE ACUTE ILLNESS OF CHILDREN TREATED IN PICU EUROPEAN JOURNAL OF PEDIATRICS 2006 AUG165(8)526-
9
bull HEALY F PANITCH HB PULMONARY COMPLICATIONS OF PEDIATRIC NEUROLOGICAL DISEASES PEDIATR ANN 2010 APR39(4)216-24
bull SCHRAMM CM CURRENT CONCEPTS OF RESPIRATORY COMPLICATIONS OF NEUROMUSCULAR DISEASE IN CHILDREN CURRENT OPINION IN PEDIATRICS 200012(3)203-7
bull SRIVASTAVA R JACKSON WD BARNHART DC DYSPHAGIA AND GASTROESOPHAGEAL REFLUX DISEASE DILEMMAS IN DIAGNOSIS AND MANAGEMENT IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT PEDIATR ANN 2010 APR39(4)225-31
bull SULLIVAN PB JUSZCZAK E BACHLET AME LAMBERT B VERNON-ROBERTS A GRANT HW ET AL GASTROSTOMY TUBE FEEDING IN CHILDREN WITH CEREBRAL PALSY A PROSPECTIVE LONGITUDINAL STUDY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 2005
FEBRUARY47(2)77-85
bull SOMERVILLE H TZANNES G WOOD J SHUN A HILL C ARROWSMITH F ET AL GASTROINTESTINAL AND NUTRITIONAL PROBLEMS IN SEVERE DEVELOPMENTAL DISABILITY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 200850(9)712-6
bull TODER DS RESPIRATORY PROBLEMS IN THE ADOLESCENT WITH DEVELOPMENTAL DELAY ADOLESCENT MEDICINE 2000 3 OCTOBER 200011(3)617-31
bull LEVIN K COLON A DIPALMA J FITZPATRICK S USING THE RADIONUCLIDE SALIVAGRAM TO DETECT PULMONARY ASPIRATION AND ESOPHAGEAL DYSMOTILITY CLIN NUCL MED 1993 FEB18(2)110-4
bull SCHROEDER AS KLING T HUSS K BORGGRAEFE I KOERTE IK BLASCHEK A ET AL BOTULINUM TOXIN TYPE A AND B FOR THE REDUCTION OF HYPERSALIVATION IN CHILDREN WITH NEUROLOGICAL DISORDERS A FOCUS ON EFFECTIVENESS AND THERAPY ADHERENCE
NEUROPEDIATRICS 201243(1)27-36
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull MANRIQUE D SATO J SALIVARY GLAND SURGERY FOR CONTROL OF CHRONIC PULMONARY ASPIRATION IN CHILDREN WITH CEREBRAL PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2009 SEPTEMBER73(9)1192-4
bull GOEMINNE P AND DUPONT L (2010) NON-CYSTIC FIBROSIS BRONCHIECTASIS DIAGNOSIS AND MANAGEMENT IN 21ST CENTURY POSTGRADUATE MEDICAL JOURNAL 86(1018) PP493-501
bull LEE A BUTTON B AND TANNENBAUM E (2017) AIRWAY-CLEARANCE TECHNIQUES IN CHILDREN AND ADOLESCENTS WITH CHRONIC SUPPURATIVE LUNG DISEASE AND BRONCHIECTASIS FRONTIERS IN PEDIATRICS 5
bull MANDAL P SIDHU M KOPE L POLLOCK W STEVENSON L PENTLAND J TURNBULL K MAC QUARRIE S AND HILL A (2012) A PILOT STUDY OF PULMONARY REHABILITATION AND CHEST PHYSIOTHERAPY VERSUS CHEST PHYSIOTHERAPY ALONE IN
BRONCHIECTASIS RESPIRATORY MEDICINE 106(12) PP1647-1654
bull MURRAY M PENTLAND J AND HILL A (2009) A RANDOMISED CROSSOVER TRIAL OF CHEST PHYSIOTHERAPY IN NON-CYSTIC FIBROSIS BRONCHIECTASIS EUROPEAN RESPIRATORY JOURNAL 34(5) PP1086-1092
bull NEWALL C STOCKLEY R AND HILL S (2005) EXERCISE TRAINING AND INSPIRATORY MUSCLE TRAINING IN PATIENTS WITH BRONCHIECTASIS THORAX 60(11) PP943-948
bull ONG H LEE A HILL C HOLLAND A AND DENEHY L (2011) EFFECTS OF PULMONARY REHABILITATION IN BRONCHIECTASIS A RETROSPECTIVE STUDY CHRONIC RESPIRATORY DISEASE 8(1) PP21-30
bull QUINT J MILLETT E JOSHI M NAVARATNAM V THOMAS S HURST J SMEETH L AND BROWN J (2015) CHANGES IN THE INCIDENCE PREVALENCE AND MORTALITY OF BRONCHIECTASIS IN THE UK FROM 2004 TO 2013 A POPULATION-BASED COHORT
STUDY EUROPEAN RESPIRATORY JOURNAL 47(1) PP186-193
bull SNIJDERS D FERNANDEZ DOMINGUEZ B CALGARO S BERTOZZI I ESCRIBANO MONTANER A PERILONGO G AND BARBATO A (2015) MUCOCILIARY CLEARANCE TECHNIQUES FOR TREATING NON-CYSTIC FIBROSIS BRONCHIECTASIS IS THERE
EVIDENCE INTERNATIONAL JOURNAL OF IMMUNOPATHOLOGY AND PHARMACOLOGY 28(2) PP150-159
