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Questions and Answers
What is the primary purpose of the Intermittent Positive Pressure Breathing (IPPB) therapy?
What is the primary purpose of the Intermittent Positive Pressure Breathing (IPPB) therapy?
Which of the following devices uses a flexible bellows to assist with patient inspiration?
Which of the following devices uses a flexible bellows to assist with patient inspiration?
What is a key characteristic of the Flutter Valve therapy device?
What is a key characteristic of the Flutter Valve therapy device?
In Inspiratory Muscle Training, how is resistance to gas flow typically adjusted?
In Inspiratory Muscle Training, how is resistance to gas flow typically adjusted?
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What does the Acapella Oscillating PEP device utilize to adjust the frequency and amplitude of the expiratory pressure wave?
What does the Acapella Oscillating PEP device utilize to adjust the frequency and amplitude of the expiratory pressure wave?
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Which of the following is NOT considered a primary indication for using positive airway pressure therapies?
Which of the following is NOT considered a primary indication for using positive airway pressure therapies?
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During Flutter Valve therapy, how many active exhalations should be performed before encouraging a vigorous cough?
During Flutter Valve therapy, how many active exhalations should be performed before encouraging a vigorous cough?
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A patient using the Monaghan Spirocare device will benefit from which operation principle?
A patient using the Monaghan Spirocare device will benefit from which operation principle?
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What is an important contraindication that should be considered when using positive airway pressure adjuncts?
What is an important contraindication that should be considered when using positive airway pressure adjuncts?
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What is the goal for the Triflo II spirometer in terms of floats achieved during use?
What is the goal for the Triflo II spirometer in terms of floats achieved during use?
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What is the primary goal of hyperinflation therapy?
What is the primary goal of hyperinflation therapy?
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Which device is specifically mentioned as a positive airway pressure adjunct for aiding hyperinflation?
Which device is specifically mentioned as a positive airway pressure adjunct for aiding hyperinflation?
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What type of device measures inspired volumes based on flow?
What type of device measures inspired volumes based on flow?
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Which condition would NOT indicate the use of incentive spirometry?
Which condition would NOT indicate the use of incentive spirometry?
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What is a vital contraindication for the use of incentive spirometry?
What is a vital contraindication for the use of incentive spirometry?
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Which device promotes lung expansion through voluntary effort?
Which device promotes lung expansion through voluntary effort?
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What is a crucial characteristic of the Voldyne incentive spirometer?
What is a crucial characteristic of the Voldyne incentive spirometer?
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Which of the following is NOT a method for measuring inspired volumes?
Which of the following is NOT a method for measuring inspired volumes?
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Which of the following interventions is primarily designed to promote the clearance of secretions in the lungs?
Which of the following interventions is primarily designed to promote the clearance of secretions in the lungs?
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What does the presence of atelectasis typically indicate regarding patient care?
What does the presence of atelectasis typically indicate regarding patient care?
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Which of the following accurately describes the components of High Frequency Chest Wall Oscillation (HFCWO) Therapy?
Which of the following accurately describes the components of High Frequency Chest Wall Oscillation (HFCWO) Therapy?
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What is the primary purpose of Intermittent Positive Pressure Breathing (IPPB)?
What is the primary purpose of Intermittent Positive Pressure Breathing (IPPB)?
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Which of the following ventilators is NOT categorized as a Bird IPPB ventilator?
Which of the following ventilators is NOT categorized as a Bird IPPB ventilator?
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What are the primary indications for using the Vest in HFCWO Therapy?
What are the primary indications for using the Vest in HFCWO Therapy?
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In the context of high frequency pulsed gas delivery, which venting equipment is identified?
In the context of high frequency pulsed gas delivery, which venting equipment is identified?
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Which statement correctly identifies a contraindication for HFCWO Therapy?
Which statement correctly identifies a contraindication for HFCWO Therapy?
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Which device utilizes magnetic attraction to control pressure in the Bird Mark 7 IPPB ventilator?
Which device utilizes magnetic attraction to control pressure in the Bird Mark 7 IPPB ventilator?
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What is the primary function of the Emerson Coughassist MI-E Device?
What is the primary function of the Emerson Coughassist MI-E Device?
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What is the role of a low-pressure reducing valve in devices like the Puritan Bennett?
What is the role of a low-pressure reducing valve in devices like the Puritan Bennett?
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What maximum pressure can the Emerson Coughassist MI-E Device generate?
What maximum pressure can the Emerson Coughassist MI-E Device generate?
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Which percussor is known for being electrically powered with adjustable timer and frequency controls?
Which percussor is known for being electrically powered with adjustable timer and frequency controls?
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What is a significant feature of the HFCWO Therapy Vest regarding frequency?
What is a significant feature of the HFCWO Therapy Vest regarding frequency?
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Which of the following options lists a benefit of using Palm Cups in manual chest percussion therapy?
Which of the following options lists a benefit of using Palm Cups in manual chest percussion therapy?
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What characteristic distinguishes the IPV® technology in ventilation?
What characteristic distinguishes the IPV® technology in ventilation?
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What is a common misconception regarding the use of flutter valves in respiratory therapy?
What is a common misconception regarding the use of flutter valves in respiratory therapy?
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How does the Ballard Manual Percussor alleviate fatigue during manual chest percussion?
How does the Ballard Manual Percussor alleviate fatigue during manual chest percussion?
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What characteristic is unique to the MJ Percussor compared to other devices?
What characteristic is unique to the MJ Percussor compared to other devices?
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Which type of therapy primarily benefits from devices like the Acapella oscillating PEP device?
Which type of therapy primarily benefits from devices like the Acapella oscillating PEP device?
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What is the main function of percussors in respiratory therapy?
What is the main function of percussors in respiratory therapy?
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What is the recommended air pressure for the MJ Percussor to avoid potential hazards?
What is the recommended air pressure for the MJ Percussor to avoid potential hazards?
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Triflo II operates using true volume displacement.
Triflo II operates using true volume displacement.
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Flutter Valve therapy utilizes a single weighted ball valve that opens and closes with exhalation.
Flutter Valve therapy utilizes a single weighted ball valve that opens and closes with exhalation.
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The Acapella Oscillating PEP device operates on a battery-powered system.
The Acapella Oscillating PEP device operates on a battery-powered system.
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Inspiratory Muscle Training Devices provide variable resistance to gas flow during expiration.
Inspiratory Muscle Training Devices provide variable resistance to gas flow during expiration.
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Intermittent Positive Pressure Breathing Therapy augments breath taken on expiration only.
Intermittent Positive Pressure Breathing Therapy augments breath taken on expiration only.
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The main objective of incentive spirometry is to reduce lung volume.
The main objective of incentive spirometry is to reduce lung volume.
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The Voldyne device operates based on flow measurement exclusively, without converting this flow to volume.
The Voldyne device operates based on flow measurement exclusively, without converting this flow to volume.
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Positive Expiratory Pressure (PEP) therapy is utilized primarily during inhalation maneuvers.
Positive Expiratory Pressure (PEP) therapy is utilized primarily during inhalation maneuvers.
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Incentive spirometry can be contraindicated for patients with a vital capacity less than 10 mL/kg.
Incentive spirometry can be contraindicated for patients with a vital capacity less than 10 mL/kg.
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An incentive spirometer can be used for patients recovering from lower abdominal surgery.
An incentive spirometer can be used for patients recovering from lower abdominal surgery.
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Study Notes
Incentive Spirometry Equipment
- Voldyne (Hudson RCI): A disposable device that applies sub-ambient pressure above a piston, converting flow to volume. It has a marker on the side to set a goal for patient tolerance.
- TrifloTM II (Hudson RCI): A disposable, flow-dependent device similar to Voldyne. Flow rates are measured based on "floats" with 800mL/sec = 1 float, 1000mL/sec = 2 floats, and 1200mL/sec = 3 floats. The goal is to achieve 3 floats for 3 seconds.
- Volurex (DHD Medical): A disposable device that operates using true volume displacement. It utilizes a flexible bellows that fills as the patient inspires.
- Monaghan Spirocare: Comes in two models (battery-powered or 110-volt) and operates using a photoelectric principle. A spinning turbine interrupts the flow of light, and the speed of the turbine is converted into inspiratory flow, which is then converted into volume.
Positive Airway Pressure Adjuncts to Bronchial Hygiene Therapy
-
Indications:
- Reduce air trapping (asthma, COPD)
- Help mobilize secretions (CF, chronic bronchitis)
- Prevent/reverse atelectasis
- Optimize delivery of bronchodilators
-
Contraindications:
- While there are no absolute contraindications, consider these factors:
- Inability of pt to tolerate increased work of breathing (WOB)
- Intracranial pressure (ICP) > 20 mmHg
- Hemodynamic instability
- Facial, oral, or skull surgery or trauma
- Acute sinusitis
- Epistaxis
- Esophageal surgery
- Active hemoptysis
- Nausea
- Tympanic membrane issues
- Untreated pneumothorax
- While there are no absolute contraindications, consider these factors:
Positive-Expiratory-Pressure Therapy Equipment
-
Consists of:
- Mouthpiece
- One-way valves
- T-assembly
- Manometer
- Adjustable resistance valve (optional: nebulizer & reservoir)
-
Method:
- Deep breath
- Actively exhale (10-20 times)
- Forcefully cough
Oscillating PEP Therapy Devices
-
Two types on the market:
- Flutter valve
- Acapella
Inspiratory Muscle Training Devices
- Strengthen inspiratory muscles by providing variable resistance (R) to gas flow during inspiration.
- Varies the size of the orifice to vary the resistance to flow (orifice size = R to flow).
- Nose clips discourage "cheating."
Intermittent Positive Pressure Breathing (IPPB) Therapy
- Utilizes positive pressure on inspiration and expiration.
- Augments breath taken on inspiration.
- Stents open on expiration.
Intermittent Positive Pressure Breathing (IPPB) Equipment
-
Bird IPPB Ventilators:
- Bird Mark 7 and Mark 7A
- Bird Mark 8
-
Bennett IPPB Ventilators:
- AP-5
- PR-2
Percussors Used for Chest Physiotherapy
-
Vibramatic Percussor:
- Electrically powered
- Timer/frequency controls
-
Flimm Fighter:
- Electrically powered
- Primarily for home use
- Suitable for self-therapy
- Limited controls: on/off only
-
MJ Percussor:
- Pneumatically powered off of 50 psi (air is recommended, as there is one documented case of fire)
- Electrically powered timing mechanism uses a 9v battery
Adjunctive Equipment for Manual Chest Percussion
-
DHD Healthcare Palm Cups:
- 4 sizes
- Soft vinyl rubber
- Add consistency to the technique for manual chest physiotherapy (CPT)
-
Ballard® Manual Percussor for Neonatal Use:
- Soft vinyl on plastic wand
- Alleviates fatigue
- You can make one yourself with a tongue blade
High Frequency Chest Wall Oscillation (HFCWO) Therapy
- Application of external chest wall compression using a self-inflating/deflating pneumatic vest.
-
Components:
- Air-pulse generator
- Two hoses
- A vest that the patient applies
The Vest (HFCWO)
- Frequencies of 5 to 25 per second
- Patient controls frequency and amplitude for comfort and effectiveness.
-
Indications:
- Mucous plugging, retained secretions, and disease
-
Contraindications:
- Unstable thoracic cage injuries
- The foot switch must be depressed to operate!
The Emerson Coughassist MI-E Device
- Electrically powered pneumatic insufflation/exsufflation device
- Assists with providing inspired volumes and expiratory flow
- Generates pressures of +/-60 cmH2O
- Maximum flow of 10 LPS
- Can be used with a mouthpiece, mask, or connected to an artificial airway
- Primarily indicated for neuromuscular disorders and quadriplegia
Hyperinflation Therapy
- Goal = hyperinflation/lung expansion
- Ways to hyper-expand:
- Inhalation:
- Patient produces negative pressure, draws in a larger volume to recruit atelectatic/consolidated areas.
- Incentive spirometer
- Positive pressure adjuncts
- Exhalation:
- PEP (Positive Expiratory Pressure)
- Inhalation:
Physics of Hyperinflation Therapy Equipment
- Measurement of Inspired Volumes:
- Incentive spirometry (IS) relies on voluntary effort to perform a hyperinflation maneuver.
- Prevention of atelectasis
- Cough promotion
-
Methods:
- Flow dependent
- Volume displacement
- Photoelectric measurement
Indications for Incentive Spirometry & Positive Airway Pressure Adjuncts
- AARC's Clinical Practice Guidelines
- Goal = hyperinflation/lung expansion
-
Incentive Spirometry (a.k.a. SMI):
-
Indications:
- Predisposed to/presence of atelectasis
- Upper-abdominal surgery
- Thoracic surgery
- COPD + surgery
- Presence of restrictive lung defect with quadriplegia/dysfunctional diaphragm
-
Contraindications:
- Patient cannot be supervised or instructed
- Inability of patient to use the device properly
- VC < 10mL/kg, IC < 1/3 of predicted
-
Indications:
Flow-Dependent IS
-
Examples:
- Voldyne
- Triflo II
Volume Displacement IS
-
Examples:
- Volurex
Photoelectric Measurement IS
-
Examples:
- Monaghan Spirocare
Indications for Hyperinflation Therapy
- See CPG in book
- Patients unable to do IS
- Short-term therapy
Hyperinflation Therapy
- Goal of hyperinflation therapy is to increase lung volume
- Two main methods:
- Inhalation: Patient draws in a larger volume of air to open collapsed alveoli
- Exhalation: Positive expiratory pressure (PEP)
Measuring Inspired Volumes
- Incentive spirometry relies on patient effort to hyperinflate lungs.
- Methods for measuring volume:
- Flow dependent: Measures the rate of air flow
- Volume displacement: Measures the volume of air displaced
- Photoelectric measurement: Measures light passing through a turbine
Incentive Spirometry
-
Indications:
- Patients at risk for or with atelectasis
- Post-upper abdominal surgery
- Post-thoracic surgery
- COPD patients undergoing surgery
- Restrictive lung disease with quadriplegia or dysfunctional diaphragm
-
Contraindications:
- Patient cannot be supervised or instructed
- Patient unable to use the device correctly
- Vital capacity (VC) less than 10 mL/kg, inspiratory capacity (IC) less than 1/3 of predicted
Types of Incentive Spirometers
- Voldyne: Disposable, applies sub-ambient pressure above a piston
- Triflo II: Disposable, flow-dependent, uses floats to indicate flow
- Volurex: Disposable, uses volume displacement, utilizes a flexible bellows that fills with inspiration
- Monaghan Spirocare: Two models, battery-powered or 110-volt, uses photoelectric principle
Patient Instructions for Incentive Spirometer
- Sit in a chair
- Exhale fully
- Create a seal around the mouthpiece
- Inhale slowly and deeply
- Hold your breath for 5 seconds
- Repeat 10 times
Positive Airway Pressure Adjuncts
-
Indications:
- Reduce air trapping
- Mobilize secretions
- Prevent or reverse atelectasis
- Optimize delivery of bronchodilators
-
Contraindications:
- No absolute contraindications, but consider:
- Intolerance to increased work of breathing
- Increased intracranial pressure
- Hemodynamic instability
- Facial, oral, or skull surgery/trauma
- Acute sinusitis
- Epistaxis
- Esophageal surgery
- Active hemoptysis
- Nausea
- Tympanic membrane issues
- Untreated pneumothorax
- No absolute contraindications, but consider:
Positive Expiratory Pressure (PEP) Therapy
- Equipment: Mouthpiece, one-way valve, T-assembly, manometer, adjustable resistance valve
- Method: Deep breath, exhale actively (10-20 times), then forcefully cough
Oscillating PEP Therapy Devices
- Flutter valve: Single weighted ball valve that opens and closes rapidly with exhalation
- Acapella: Counterweighted lever and magnet adjusts the frequency and amplitude of expiratory pressure wave
Inspiratory Muscle Training Devices
- Strengthen inspiratory muscles by providing variable resistance to airflow during inspiration
- Varies the size of the orifice to adjust resistance
Intermittent Positive Pressure Breathing (IPPB) Therapy
- Utilizes positive pressure on both inspiration and expiration
-
Indications:
- Patients unable to use incentive spirometry
- Short-term therapy
Intermittent Positive Pressure Breathing (IPPB) Equipment
- Bird IPPB ventilators: Mark 7, Mark 7A, Mark 8
- Bennett IPPB ventilators: AP-5, PR-2
Percussionaire Corporation IPV® Ventilators
- Delivers high-frequency pulsed gas with a dense aerosol
- Ventilators: IPV®-2, IPV®-1C
Chest Percussion Devices
-
Percussors:
- Vibramatic
- Flimm Fighter
- MJ Percussor
-
Adjunctive equipment:
- DHD Healthcare Palm Cups®
- Ballard® Manual Percussor (Neonatal Use)
High Frequency Chest Wall Oscillation (HFCWO) Therapy
- Uses a self-inflating/deflating pneumatic vest to apply external chest wall compression
-
Components:
- Air-pulse generator
- Two hoses
- Vest
- Frequency: 5 to 25 cycles per second
-
Indications:
- Mucous plugging, retained secretions, disease
-
Contraindications:
- Unstable thoracic cage injuries
Emerson Coughassist MI-E Device
- Electrically powered pneumatic insufflation/exsufflation device
- Assists with providing inspired volumes and expiratory flow
- Indicated primarily for neuromuscular disorders and quadriplegia
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Description
This quiz covers various types of incentive spirometry devices used in respiratory therapy, including the Voldyne, Triflo II, Volurex, and Monaghan Spirocare. Each device's function, mechanism, and operational characteristics are highlighted, providing essential knowledge for effective patient care in bronchial hygiene therapy.
