Airway Clearance Therapy¶

Patrick Barney

Indications¶

- Cystic fibrosis, advanced COPD, chronic bronchitis, bronchiectasis,
    chronic neuromuscular weakness, prolonged ventilator-dependence

- Goal is to assist patients with removing/expectorating mucus from
    lungs to decrease risk of atelectasis, mucus plug, increased airway
    resistance, infection

Chest Physiotherapy (CPT)¶

- Use: pathologies w/ retained secretions and mucous plugging (CF,
    bronchiectasis)

- RT helps patient go through sequence of positions aimed at
    “draining” each of the lobes of the lung by gravity. Sometimes
    combined with percussion.

- Finding in Epic: chest physiotherapy > CPPD panel – will initiate
    RT bronchial hygiene protocol and order TID CPT

High Frequency Chest Wall Compression (HFCWC)¶

- Use: pathologies w/ retained secretions (CF, bronchiectasis, chronic
    bronchitis) or mucociliary clearance problems (lung transplant)

- RT wraps patient in inflatable vest, compressor rapidly inflates and
    deflates vest to “break up” thickened mucus from airway wall so it
    can be suctioned or expectorated

- Finding in Epic: vest > Facility List > vest physiotherapy or vest
    physiotherapy for CF under Procedures

Positive Expiratory Pressure (PEP)¶

- Use: pathologies w/ retained secretions as discussed above

- Patient exhales against fixed or fluttering resistor that allows air
    to get behind mucus, helps move mucus from airway walls, and holds
    airways open longer for improved ventilation

- Trade names- Flutter, Acapella, AerobikA

- Finding in Epic: PEP > Facility List > PEP therapy panel or
    Oscillatory PEP therapy panel under Order Sets

    - Can also find in a supply closet on 8S and bring to patient, be
        sure to teach them how to use it

Cough Assist¶

- Use: most effective in patients with neuromuscular weakness
    affecting diaphragmatic strength – muscular dystrophy, myasthenia
    gravis, spinal cord lesions, SMA

- Via mask or trach/vent connection – applies positive pressure to
    fill the lungs, then quickly switches to negative pressure to
    produce a high expiratory flow rate to simulate a cough that is
    intended to produce expectorant

- Finding in Epic: cough assist > Facility List > cough assist
    treatment panel under Order Sets