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PHYSIOTHERAPY ADJUNCTS Billie Hurst Part-Time Lecturer QMUC.

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Presentation on theme: "PHYSIOTHERAPY ADJUNCTS Billie Hurst Part-Time Lecturer QMUC."— Presentation transcript:

1 PHYSIOTHERAPY ADJUNCTS Billie Hurst Part-Time Lecturer QMUC

2 Content Oxygen therapy Humidification Non Invasive ventilation - BIPAP/CPAP Bronchoscopy

3 Oxygen therapy For over 200 years oxygen therapy has often been used and sometimes misused (Hough 2001)

4 Oxygen Therapy Should be prescribed Acute and chronic respiratory conditions Personnel should be trained in its use Protocols

5 Oxygen therapy - Indications Hypoxaemia (PaO2<8KPA, O2sats<90%) Acute or chronic respiratory condition Pre and post suction Routinely post operatively Optimise oxygen delivery

6 Oxygen therapy - limitations Giving oxygen does not guarantee it’s arrival at the mitochondria Oxygen does not improve ventilation directly (Hough 2001)

7 Oxygen therapy – complications/cautions Respiratory depression if hypoxic drive Pulmonary oxygen toxicity Tracheobronchitis Absorption atelectasis Fire Variable delivery

8 Oxygen Therapy - Monitoring Oxygen saturations continuous/intermittent Arterial blood gases Observation


10 Oxygen Therapy - Delivery Piped oxygen Portable oxygen Compressors/concentrators

11 Oxygen therapy – delivery devices Low Flow masks (variable performance) High flow masks (fixed flow)/venturi Nasal cannulae Mask and reservoir bag Tracheal mask/t-piece Tracheal speaking valves Mechanical ventilator

12 Oxygen Therapy - low flow masks Commonly used Variable performance


14 Oxygen therapy – high flow masks Guaranteed percentage of oxygen Venturi system More expensive Up to 60%



17 Nasal cannulae 1l/min 24% oxygen 2l/min28% oxygen 3l/min32% oxygen 4l/min36% oxygen


19 Oxygen therapy – bag and mask High concentrations of oxygen Mask and reservoir bag 55-90%

20 Oxygen Therapy tracheostomy T-piece Mask Swedish nose Speaking valve


22 Long term oxygen therapy Chronic hypoxaemia Increases survival Aim to raise PaO2 to >8Kpa Worn as much as possible >15hours Cylinders/concentrators/liquid

23 Oxygen Therapy - Implications Assessment Limitations to physiotherapy techniques


25 Humidification Mucocillary escalator Adequate hydration is vital Bacterial contamination!!!

26 Humidification - indications URT bypassed Thick retained secretions High flow oxygen/non-invasive mechanical aids

27 Humidification - Cautions Hyper-reactive airways - bronchospasm Infection Burns

28 Humidification - Types Nebulisers Large/Small/Ultrasonic Steam



31 Humidification - Humidifiers Hot - Increases moisture content - Increases risk of infection Cold - Poor moisture content


33 Humidification - HME Heat moisture exchangers Hygroscopic Hydrophobic Swedish nose Tracheostomy bibs


35 Non-invasive ventilation BiPAP CPAP IPPB

36 Contraindications/Cautions to non- invasive ventilation Undrained pneumothorax,surgical emphysema Unstable Cardiovascular system Frank haemoptysis Facial fractures Vomiting Raised ICP Active TB Lung abcess Recent GI surgery Pneumonectomy/lobectomy with poor stump

37 Continuous Positive Airway Pressure Constant flow of gas through inspiration and expiration Invasive/non-invasive Endotracheal/tacheostomy/mask Improve oxygenation not ventilation

38 CPAP - indications Type I respiratory failure Volume loss Sleep apnoea Pulmonary oedema Flail segment

39 CPAP - Problems Tolerance Discomfort/fit Air swallowing Difficulty coughing Aspiration Mild haemodynamic changes Note pneumothorax

40 Bilevel positive airway pressure BiPAP Invasive/Non-invasive ventilation Endotracheal tube/tracheostomy/mask Constant pressure with independent inspiratory pressure and expiratory pressure

41 BiPAP - Indications Respiratory type II failure Weaning

42 BiPAP - Problems Tolerance Discomfort/mask fit Air swallowing Mild haemodynamic changes Expectoration


44 NIV – Implications for treatment YES Positioning Manual techniques Thoracic expansion exercises ACBT? NO Mobilisation Incentive spirometry


46 Bronchoscopy Fiberoptic bronchoscope Diagnostic Therapeutic Bronchial lavage


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