Definition: Exercises and Procedures to Help Clear Airway Secretions and Mucous

• Also Referred to as Airway Clearance Techniques (ACT)

Goals

• Clearance of Secretions and Mucous
• Promotes Adequate Oxygenation and Pulmonary Function
• Often Used for Traumatic Rib Fractures, COPD, Asthma, Pneumonia, or Other Pulmonary Pathology
  • These Conditions Decrease Mucociliary Clearance and Cough Increasing Risk for Infection and Pulmonary Complications

Basic Methods

• Deep Breathing Exercise
  • Can Be Relaxed with Slow Exhalation or Hard Pushes with Rapid Exhalation
• Coughing
  • Patient Forcefully Coughs to Expectorate Sputum
• Huffing (Huff Coughing)
  • Definition: Taking a Long Inhalation and Holding it, Then Actively Exhaling
  • Less Forceful than a Cough but Less Exhausting and May Work Better
• Frequent Orotracheal Suctioning

Incentive Spirometry (IS)

• A Hollow Cylinder with a Flexible Mouthpiece Used to Incentivize Deep Inhalation
• Technique:
  • Breathe In Slow and Deep (Keeping Indicator Between the Marked Lines to Indicate Appropriate Speed)
  • Hold Inspiration for as Long as Able (Watching Piston Rise as High as Able)
  • Then Exhale Slowly
• Generally Recommended to Use About 10 Times per Session and 10 Sessions per Hour
• Should Attempt Coughing or Huffing After Each Session to Additionally Clear Mucous

Chest Physiotherapy (CPT)

• Definition: Physical Therapies to Release and Help Clear Mucous
• Postural Drainage
  • Patient is Placed into Various Positions (Trendelenburg) to Promote Mucous Clearance by Gravity
• Chest Percussion (Clapping)
  • Therapist Lightly Claps a Patient’s Chest and Back
• Vest Physiotherapy (High-Frequency Chest Wall Oscillation)
  • A Vest is Worn by the Patient that Induces Frequent Vibrations
  • Helps to Release and Thin Mucous as Well as Helping to Clear

Advanced Methods

• Positive Expiratory Pressure (PEP)
  • Devices Include: TheraPEP and Resistex PEP Mask
  • A Mask/Mouthpiece Provides Resistance (Positive Pressure) During Expiration but Does Not Affect Inhalation
  • Effects:
    • Increases Gas Pressure Behind Mucous by Collateral Ventilation and Temporarily Increases Functional Residual Capacity
    • Forced Release of Mucous Off Airway Walls
    • Hold Airways Open and Prevents Collapse
  • Technique:
    • Patient Exhales Forcefully Through the Device
    • After Multiple Uses/Breaths the Patient Stops to Cough and Clear the Released Mucous
    • Sessions Last Around 20 Minutes
• Oscillating Positive Expiratory Pressure (OPEP)
  • Devices Include: Flutter, Acapella, AerobikA, and RC-Cornet
  • Provides Resistance During Expiration (Similar to PEP) and Creates Vibrations During Expiration
  • Similar Effects and Technique as PEP
  • More Commonly Used than PEP Alone
• Intrapulmonary Percussive Ventilators (IPV)
  • A Device Delivers Short Bursts of Air (150-300/Minute) Through a Mouthpiece to Clear Mucous
• Mechanical Insufflation-Exsufflation (CoughAssist)
  • Delivers a Gradual Positive Pressure for Large Volume Insufflation
  • Then Rapidly Reverses to a Negative Pressure Inducing Exsufflation and Cough
• Bronchoscopy
  • Endoscopically Suctioning All Visible Mucous