Adjunctive Respiratory Therapies
OVERVIEW
- Goal = to help clear secretions
SUMMARY
Mucociliary Clearance Optimization
- physiotherapy: percussion, postural drainage, chest vibration
- suctioning: PO, NP, ETT
- continuous rotational therapy: special beds that change patient position (lower rates of pneumonia and atelectasis but doesn’t translate into other outcome data)
- positive expiratory pressure devices: facemask/mouth piece that provides resistance to airflow on expiration -> helps mobilize secretions.
- assisted coughing: huffing or abdominal/thoracic compression on expiration
- forced expiration
- closed chest oscillation
- bronchoscopy
- manual hyperinflation: a form of recruitment
- bronchodilators: nebulization, MDI’s
- mucoactive agents: induce bronchospasm -> no role in ICU
Lung Expansion Optimization
- deep breathing
- incentive spirometry
- intermittent positive ventilation
- head up 30 degrees
Ventilation and Oxygenation Optimization
- diseased lung up in lateral position (increased V/Q matching and helps with postural drainage)
- prone positioning
Advanced Therapies
- iNO -> suldenafil
- prostaglandins (inhaled)
- steroids (early ARDS)
- heliox (airflow obstruction)
- minimal fluid strategy
- paralysis
- recruitment manoeuvres
- selective lung ventilation
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.
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