Respiratory Therapy Techniques & Definitions

• Respiratory therapy is important for a variety of conditions

Definitions

• Biot's breathing: Rapid, deep breaths followed by periods of apnea, often seen in patients with neurological or neuromuscular diseases
• Cheyne-Stokes respiration: Breathing pattern characterized by periods of increasing and decreasing depth, followed by apnea; often associated with cardiac damage like myocardial infarction or angina

Lung Expansion Techniques

• IS (Incentive Spirometry): Coaching the patient to take sustained maximal inspirations to increase Ppl (pleural pressure) and airway patency to prevent lung closure

Airway Clearance Techniques

• Autogenic drainage: Uses different lung volumes to mobilize secretions; low volumes for small airways, normal volumes to mobilize secretions, and large volumes to expectorate
• Active cycle breathing: Repeated deep breaths held with forced expiration
• MIE (Mechanical Insufflation-Exsufflation): Uses a mask to provide negative pressure inspiration to meet the patient's tidal volume, then switches to positive pressure to expel secretions; used in neuromuscular disease

Chest Wall Oscillation

• HFCWO (High-Frequency Chest Wall Oscillation): A vest placed around the patient's chest delivers small-volume air pulses at 5-25 Hz (300-1500 cycles)

Auscultation

• Wheezing: A continuous, low-pitched sound during expiration

Positive Expiratory Pressure (PEP)

• PEP: Achieved by having the patient exhale through a mask or mouthpiece with a resistance valve; PEP levels of 10 to 20 cm H2O are typically used
• Flutter valve: A pipe-shaped oscillatory PEP device through which the patient exhales to produce a PEP of 10-25 cm H2O; the angle at which the device is held determines the PEP (more upright = higher PEP)

Ventilation

• Assisted breath: Initiated by the patient, then controlled by the ventilator

Conditions

• GBS (Guillain-Barré Syndrome): Starts from Ground to Mind (ascending paralysis)
• Myasthenia gravis: Starts from Mind to Ground (descending paralysis)
• Kyphosis: Anteroposterior (AP) curvature of the upper spine
• Scoliosis: Lateral curvature of the spine

Vibrations

• Vibrations are increased over areas with atelectasis, pneumonia, and lung masses
• Decreased tactile fremitus is associated with pneumothorax, pleural effusion, and pulmonary edema
• Increased tactile fremitus is associated with atelectasis and consolidation

Heart Sounds

• S1: Closure of the mitral and tricuspid valves at the beginning of ventricular contraction
• S2: Occurs when systole ends, and the ventricles relax; pulmonic and aortic valves close
• Systolic murmurs: Occur between S1 and S2 when the ventricles contract; often due to valve narrowing or leaking
• Diastolic murmurs: Occur between S2 and S1, when the ventricles relax

Level of Consciousness

• Lethargic: The patient appears sleepy but responds appropriately when stimulated

Lung Volumes

• VT (Tidal Volume): The volume of air inhaled or exhaled from the lungs during effortless breathing
• RV (Residual Volume): The volume of gas remaining in the lungs after a complete exhalation
• IRV (Inspiratory Reserve Volume): The maximum volume of air that can be inhaled after a normal inspiration
• ERV (Expiratory Reserve Volume): The total amount of gas that can be exhaled after a normal exhalation
• VC (Vital Capacity): The total amount of air that can be exhaled after a maximum inspiration (IRV + VT + ERV)
• IC (Inspiratory Capacity): The maximum volume of air that can be inhaled after a normal inspiration
• FVC (Forced Vital Capacity): The maximum volume of gas that can be exhaled as forcefully and quickly as possible
• FRC (Functional Residual Capacity): The total amount of gas left in the lungs after a resting expiration
• TLC (Total Lung Capacity): The total amount of gas in the lungs after a maximum inspiration

Medications

• Pseudomonas infection: Tobramycin or Gentamicin
• Fungal infections (e.g., Pneumocystis jirovecii in HIV patients): Pentamidine via Respirgard II nebulizer (one-way valve)
• RSV (Antiviral): Ribavirin via SPAG nebulizer
• Tuberculosis (TB): Rifampin
• Agitation: High-dose sedation with recuronium
• Cystic Fibrosis (CF): Dornase alfa (mucolytic)
• Pulmonary Hypertension (treated by vasodilation): Iloprost (I-neb) or prostacyclin/prostaglandin
• Pulmonary Edema (Diuretics): Furosemide
• Long-term Asthma: LABA (Salmeterol or Formoterol)
• Asthma with Tachycardia: Ipratropium
• Asthma Prevention: Cromolyn sodium
• Angina: Nitroglycerin
• Myasthenia Gravis: Neostigmine (reverses neuromuscular blockade)