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Bronchial Hygiene What is bronchial hygiene? • Any device/procedure utilized to maintain lung sterility by loosening/removing retained secretions, Bronchodilating, and hyper inflating the lung • Techniques include: • Suctioning patients • Giving bronchodilating and mucus thinning medications • Giving chest physiotherapy • Giving devices to increase lung volume • Maintaining airways • Warm Humidity Why is Bronchial Hygiene important? • The lungs are a sterile environment • Anything unnatural can lead to inflammatory cell release/congestion • We must clear the lung of this congestion to allow for proper gas exchange/breathing • Atelectasis and/or Pneumonia can occur Mucus Plugging can lead to… Atelectasis/Collapsed Lung Suctioning • RT’s often suction patients airways either through their nose to their lungs, mouth or through a artificial airway Suctioning • Suctioning is the application of negative pressure (below atmopheric) to the airways through a collecting tube • Performed on patients without the ability to cough or who have weak coughs Effective Cough • Components • Abdominal contraction • Glottic closure/ability to take a deep breath • Coughing is a reflex, however it can also be voluntarily controlled • Increased urge to cough: viral vs bacterial (acute bronchitis); chronic cough (chronic bronchitis from smoking or lung ailment) Phases of a Cough • Irritation of airway (particulate/dust…) • Inspiration of adequate volume • Compression • Glottic closure • Contraction of abdominal muscles • Increase in intrathoracic pressure Phases of a Cough • Expulsion • Opening of glottis • Explosive expulsion of air and matter (flow up to 500 mph) Ineffective Cough • You must have every patient demonstrate the effectiveness of a cough before/after every treatment. • If a patient is unable to cough: • Give expectorants/ensure patient is hydrated • Give mucoactives/bronchial hygiene • Suction patient? • May lead to mucus accumulation • Leads to mucus plugs and atelectasis • Leads to lung infection and pneumonia Ineffective Cough Causes • The very old and young • Patients who are physically weak • Patients with neuromuscular diseases • Patients who are medicated/sedated • Patients with strokes Bronchodilators • • • • • • Used to relax constricted bronchial smooth muscle Allows better gas flow out of the lung thus helps with cough Common medications include: Albuterol Xopenex Given as a MDI or a Nebulizer Mucus thinning medications Chest Physiotherapy Chest Physiotherapy Vest Therapy Lung Inflation • Increasing lung inflation allows for a bigger and better cough • Devices include: • Incentive Spirometer • Intermittent Positive Pressure Breathing • Positive Expiratory Pressure Airway Management • Some patient’s require artificial airways, in part to help facilitate suctioning. Artificial airways include: • Endotracheal intubation • Trachestomy Warm Humidity • Adding humidity to inspired air helps to add moisture to the mucosal lining of the airway, allowing mucus to become more fluidic and mobile Others • Ensuring the patient is properly hydrated • Ensuring the patient is taking deep breaths, coach patient to perform pursed lip breathing and diaphragmatic breathing • Nasal breathing, nasal sprays
