Pulmonary hygiene

Methods used for pulmonary hygiene include suctioning of the airways, chest physiotherapy, blow bottles, and nasotracheal suction.{{cite journal |vauthors=Allen GS, Cox CS |title=Pulmonary contusion in children: Diagnosis and management| journal=Southern Medical Journal |volume=91 |issue=12 |pages=1099–1106 |date=December 1998 |pmid=9853720 |doi= 10.1097/00007611-199812000-00002|s2cid=28583201}} Bronchoscopy, in which a tube is inserted into the airways so that an examiner can view them, can be used therapeutically as part of pulmonary hygiene. Incentive spirometry and use of analgesics (pain medications) that do not inhibit breathing are also parts of pulmonary toilet. Coughing is also important for ridding the airways of secretions, so healthcare providers are careful not to oversedate patients, because that could inhibit coughing.{{cite book |author=Goodman G|chapter= Chronic pulmonary disease: Bronchopulmonary dysplasia |veditors=Perkin RM, Swift JD, Dale AN, Anas NG | title=Pediatric Hospital Medicine: Textbook of Inpatient Management |publisher=Lippincott Williams & Wilkins |location=Hagerstown, MD |year=2007 |pages=233 |isbn=978-0-7817-7032-3 |access-date=2008-06-30 |chapter-url = https://books.google.com/books?id=sV6-ifUGoMYC&q=%22pulmonary+toilet%22&pg=PA233}} Tracheotomy facilitates pulmonary toilet.{{cite book |vauthors=Reilley JM, Sicard GA |veditors=Rosenthal RA, Zenilman ME, Katlic MR |title=Principles and Practice of Geriatric Surgery |publisher=Springer |location=Berlin |year=2001 |pages=[https://archive.org/details/principlespracti0000unse_s7k0/page/492 492] |isbn=0-387-98393-7 |access-date=2008-07-01 |url = https://archive.org/details/principlespracti0000unse_s7k0|url-access=registration |quote=pulmonary toilet pulmonary physiotherapy. }} Percussion, another method, loosens secretions and allows the cilia of the airways to remove material. Positioning is another method for promoting drainage of secretions; sometimes patients are placed in a prone position to aid in this purpose.

The most common treatment of atelectasis in the hospital setting is manual chest physiotherapy{{cite journal|vauthors=Galvis AG, Reyes G, Nelson WB | title=Bedside management of lung collapse in children on mechanical ventilation: saline lavage--simulated cough technique proves simple, effective. | journal=Pediatr Pulmonol | year= 1994 | volume= 17 | issue= 5 | pages= 326–30 | pmid=8058427 | doi= 10.1002/ppul.1950170510| s2cid=28088458 }} though there is limited evidence of its efficacy.{{cite journal| author=Schindler MB| title=Treatment of atelectasis: where is the evidence? | journal=Crit Care | year= 2005 | volume= 9 | issue= 4 | pages= 341–2 | pmid=16137380 | doi=10.1186/cc3766 | pmc=1269473 | doi-access=free }}{{cite journal| author=Stiller K| title=Physiotherapy in intensive care: towards an evidence-based practice. | journal=Chest | year= 2000 | volume= 118 | issue= 6 | pages= 1801–13 | pmid=11115476 | doi= 10.1378/chest.118.6.1801}} Chest percussion and postural drainage are used in bronchiectasis and lung abscess. The patient's body is positioned so that the trachea is inclined downward and below the affected chest area.Dorland's Medical Dictionary. Postural drainage is essential in treating bronchiectasis. Patients must receive physiotherapy to learn to tip themselves into a position in which the lobe to be drained is uppermost at least three times daily for up to 30 minutes during each session.

The treatment is often used in conjunction with a technique for loosening secretions in the chest cavity called chest percussion. Chest percussion is performed by clapping the back or chest with a cupped hand. Alternatively, a mechanical vibrator may be used in some cases to facilitate loosening of secretions.{{Cite web|url=https://www.merck.com/mmhe/sec04/ch040/ch040i.html|title = Hypersensitivity Pneumonitis - Lung and Airway Disorders}} There are drainage positions for all segments of the lung. These positions are modified depending on the patient's condition and the location of the area in most need of therapy.

{{Main|Intermittent positive pressure breathing}}

Intermittent positive pressure breathing (IPPB) physiotherapy has long been used in the intensive care setting in non-intubated patients. Although widely accepted, few studies have validated its efficacy. In a Respiratory Care Clinical Practice Guideline,{{cite journal| vauthors=Sorenson HM, Shelledy DC | title=AARC clinical practice guideline. Intermittent positive pressure breathing--2003 revision & update. | journal=Respir Care | year= 2003 | volume= 48 | issue= 5 | pages= 540–6 | pmid=12778895 }} IPPB is suggested for patients who have impaired airway clearance, and for delivery of aerosolized medications to patients with neuromuscular weakness who are incapable of inhaling deeply. IPPB physiotherapy should be used with caution in patients with severe, uncontrolled bronchospasm or severe airway obstruction

People with neuromuscular weakness and atelectasis benefit from mechanical insufflation-exsufflation.{{cite journal|vauthors=Miske LJ, Hickey EM, Kolb SM, Weiner DJ, Panitch HB | title=Use of the mechanical in-exsufflator in pediatric patients with neuromuscular disease and impaired cough. | journal=Chest | year= 2004 | volume= 125 | issue= 4 | pages= 1406–12 | pmid=15078753 | doi= 10.1378/chest.125.4.1406}} Mechanically assisted coughing greatly improves secretion clearance in the setting of respiratory infection in the patient with neuromuscular disease and should be first-line therapy for this patient population.{{cite journal| author=Bach JR| title=Mechanical insufflation-exsufflation. Comparison of peak expiratory flows with manually assisted and unassisted coughing techniques. | journal=Chest | year= 1993 | volume= 104 | issue= 5 | pages= 1553–62 | pmid=8222823 | doi= 10.1378/chest.104.5.1553}} Mechanical insufflation-exsufflation physiotherapy is greatly aided by simultaneous manual augmentation of cough with either a thoracic squeeze or abdominal thrust during the expiratory phase (exhale). An American Thoracic Society consensus statement in 2004 supported the use of mechanical insufflation-exsufflation physiotherapy for patients with Duchenne muscular dystrophy.{{cite journal |vauthors=Finder JD, Birnkrant D, Carl J, Farber HJ, Gozal D, Iannaccone ST, etal | title=Respiratory care of the patient with Duchenne muscular dystrophy: ATS consensus statement. | journal=Am J Respir Crit Care Med | year= 2004 | volume= 170 | issue= 4 | pages= 456–65 | pmid=15302625 | doi=10.1164/rccm.200307-885ST | url=https://pubmed.ncbi.nlm.nih.gov/15302625 }} The use of this technique for children with neuromuscular disease has gained widespread acceptance in the United States and internationally.{{cite journal |vauthors=Fauroux B, Guillemot N, Aubertin G, Nathan N, Labit A, Clément A, etal | title=Physiologic benefits of mechanical insufflation-exsufflation in children with neuromuscular diseases. | journal=Chest | year= 2008 | volume= 133 | issue= 1 | pages= 161–8 | pmid=18071020 | doi=10.1378/chest.07-1615 | url=https://pubmed.ncbi.nlm.nih.gov/18071020 }}{{cite journal |vauthors=Birnkrant DJ, Bushby KM, Amin RS, Bach JR, Benditt JO, Eagle M, etal | title=The respiratory management of patients with duchenne muscular dystrophy: a DMD care considerations working group specialty article. | journal=Pediatr Pulmonol | year= 2010 | volume= 45 | issue= 8 | pages= 739–48 | pmid=20597083 | doi=10.1002/ppul.21254 | s2cid=26505785 | doi-access=free }}

Pulmonary bronchial hygiene is used for preventing infections such as pneumonia. It is also used in the management of conditions such as pneumonia and cystic fibrosis.

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cite book |chapter=Tracheobronchitis and lower respiratory tract infections |vauthors=Virk A, Wilson WR |veditors=Wilson WR, Sande MA, Drew L |title=Current Diagnosis & Treatment in Infectious Diseases |publisher=Lange Medical Books/McGraw-Hill |location=New York |year=2001 |pages=145 |isbn=0-8385-1494-4 |access-date=2008-06-30 |chapter-url= https://books.google.com/books?id=mv4AjrAATPIC&q=%22pulmonary+toilet%22&pg=PA145

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For people with chronic lung diseases, bronchial hygiene is used to prevent infections and lung abscesses.Virk and Wilson, p. 153 Bronchial hygiene is also used to prevent acute respiratory distress syndrome after chest trauma.

The need for bronchial hygiene is indicated in cases of COPD, pneumonia and cystic fibrosis as both interventional and prophylactic. Prophylactic indications also include pre and post thoracic surgery to prevent atelectasis and respiratory infections.

The decision to use postural drainage therapy requires assessment of potential benefits versus potential risks. Therapy should be provided for no longer than necessary to obtain the desired therapeutic results. Some of the contraindications include an increased intracranial pressure (>20 mmHg), any spinal injury acute or otherwise, active hemoptysis, pulmonary embolism, pulmonary edema with congestive heart failure and an open or healing wound in the area where chest physiotherapy is otherwise indicated.

Medication contraindications vary depending on the medication being delivered.

• Airway clearance therapy, Airway management
• Respiratory therapy
• Chest physiotherapy
• ThAIRapy Vest
• Intrapulmonary percussive ventilator

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{{Respiratory system procedures}}

Category:Respiratory system procedures

Category:Respiratory therapy