Respiratory therapy. Anja Raab. Doktorandin Clinical Trial Unit. Anja Raab, MSc. Physiotherapist and Phd-student SPZ Nottwil. June 17th of

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1 Respiratory therapy Anja Raab Anja Raab, MSc Doktorandin Clinical Trial Unit Physiotherapist and Phd-student SPZ Nottwil 1

2 Content Basis for an effective respiratory therapy Posture Interaction of 3 essential domes Positioning Inhalation Retention of secretion Coughing Abdominal binder Respiratory muscle training Impressions of respiratory therapy. 2

3 Observe 3

4 Basis for an effective respiratory therapy. 4

5 5

6 Basis for an effective respiratory therapy Ascend of the diaphragm due to obstipation or swollen abdomen limited movement of the diaphragm reduced spirometry Procedure: defecation control parameter of ventilation physical therapy like colon massage nutrition therapy medication drinking quantity.. 6

7 Posture Head Trunk Tone Stability 7

8 Interaction of 3 essential domes Glottis (vocal fold) diaphragm pelvic floor Postural control extends from the vocal folds on top to the pelvic floor on the bottom. (Massery et al., 2013) The trunk muscles, including the diaphragm, function simultaneously as postural and respiratory muscles. (Hodges et al., 2000; Hamaoui et al., 2014; Hudson et al., 2010) out of Massery et al.,

9 T Vocal diaphragm Thoracic diaphragm Pelvic diaphragm The Breathing Book by Donna Farhi. Owl books 1996 pages

10 Positioning Due to the changing of the positions of the body automatically a relocation of the secretion occurs Changing of the position every 2-4hours is recommended Positions need to be comfortable for the patients (Raab AM, 2014) 10

11 Inhalation Secretion mobilisation Preparation for respiratory therapy Technique: 2 normal breaths followed by a deep inspiration and an end-expiratory break 11

12 Retention of secretion Mucociliary clearance functional destroyed Ciliated epithelium destroyed by: - smoking - recurring infections - absent humectation and warming with ventilator - high inspiratory oxygen-concentration within 6-24h contaminants can be transported out of the airways by the cilia 12

13 Airstacking by.. nasal stacking (via glottic closure) resuscitator bag (till maximal insufflation capacity) glossopharyngeal breathing Indication: atelectasis-prophylaxis to improve inspiratoy volume (e.g. for coughing) to maintain thorax-mobility to maintain vital-capacity Typically dosage is 3-5 trials of manual insufflation followed by augmented coughing. (Cleary et al., 2013) 13

14 Retention of secretion Manual techniques 14

15 Retention of secretion Manual techniques 15

16 Retention of secretion Manual techniques 16

17 Retention of secretion Manual techniques 17

18 Acapella for management of secretion (Mueller et al., 2013) 18

19 Coughing to increase intra-abdominal pressure secretion needs to be proximal time-point for coughing fatigue! 19

20 Assisted coughing with 1 person 20

21 Assisted coughing with 2 persons 21

22 Peak Cough Flow < 160 l/min associated with problems by extubation/decanulation (Bach and Sapporito, 1996) <270 l/min cough support necessary esp. with resp. infections (Boitano et al., 2006) >270 l/min 22

23 Abdominal binder

24 Abdominal binder 24

25 Abdominal binder Abdominal muscles: paralyzed or weak? the diaphragm goes down the position for the inspiration is not optimal Abdominal binder improves the mechanic of respiration the abdominal binder increases the intra-abdominal pressure the diaphragm will be pressed towards cranial direction increased tension of the diaphragm improved position for the inspiration (Urmey W. et al. 1986, Brown B. 2006) 25

26 Abdominal binder improved coughing (peak expiratory flow / peak cough flow) (Julia et al., 2011) improved lung function (FVC, VC, FEV1, PImax, PEmax) (West et al., 2012; Wadswort et al., 2012) voice (longer sound pressure level) (Wadswort et al., 2012) Important: Abdominal binder tighten closely! 26

27 Respiratory resistance training Training of the respiratory muscles with high intensity and low volume! (Müller et al., 2013; Raab et al., 2016 ready for submission) Indication: - reduced inspiratory and expiratory strength Inspiratory training improves PImax and PEmax Expiratory training improves PImax and PEmax (Raab et al., 2016 ready for submission) With inspiratory muscle training respiratory complications can probably be avoided! (Raab et al., 2016 publication summer 2016) 27

28 Preparation is already best respiratory therapy (e.g. blow one`s nose, defecation, inhalation). By continous positioning a relocation of the secretion occurs. Airstacking is simple and effective. Abdominal binder can improve the lungfunction and coughing. With inspiratory muscle training respiratory complications can probably be avoided. 28

29 Thank you for your attention 29