Ineffective Airway Clearance. Relaxing airway smooth muscle with bronchodilation may reduce the effectiveness of airway peristalsis for mucus propulsion. High-frequency chest-wall compression has not been well studied in the treatment of neuromuscular patients. Coming from an HFOV background, I used to advocate closed suctioning to prevent losing lung volume. Our wish, however, should be that these therapies wane if they do not provide clear-cut benefit. Ineffective airway clearance is characterized by the following signs and symptoms: Abnormal breath sounds (crackles, rhonchi, wheezes) Abnormal respiratory rate, rhythm, and depth Dyspnea Excessive secretions Hypoxemia/cyanosis Inability to remove airway secretions Ineffective or absent cough Orthopnea Goals and Outcomes Chest radiograph may assist the clinical assessment by quantifying the severity of airway-clearance dysfunction. This airway collapse can be further exaggerated when CPT is performed or bronchodilators administered. Increased resistance through an HME can also create or enhance patient/ventilator asynchrony. The search of the literature by the group located a total of 443 citations; all but 13 were excluded, for the following reasons: did not report a review question, did not report a clinical trial, or did not contain original data. The characteristics of adult mucus in health and disease are well understood. A4. Neonatal chest manipulation is not without risk and requires a high level of expertise.34, When missing the key component of cooperation, airway clearance becomes much more difficult. Thank you for including the study on suctioning and VAP prevention,1 which was interesting to me because I see the wholesale banning of suctioning in the neonatal ICU because of concern about VAP prevention. 3. The mucus is then propelled out of the airway. The effectiveness of airway maintenance and clearance depends a great deal on the biochemical and biophysical characteristics of mucus. Studies have shown the cilia from CF patients to be normal, although chronic inflammation may result in a loss of ciliated cells.85. We used to use acetylcysteine a lot. I think it's important to recognize that we don't have a lot of good evidence on many elements of the suctioning guidelines.1 Can you comment on hyperventilation, hyperoxygenation, and the use of higher VT during suctioning? Because all of these therapies share the same goal, the term bronchial drainage or hygiene is often employed to describe them collectively. Administering dry gas through an artificial airway causes damage to tracheal epithelium within minutes.45,46 Care should be taken to quickly provide humidification to patients with artificial airways. In time-cycled pressure-limited ventilation, VT variation occurs during the suctioning procedure.51 In contrast, a bench study of adaptive pressure ventilation found a VT increase from 6 mL to 2026 mL after suctioning.55 The ventilator then took 812 seconds to titrate the inspiratory pressure level back to the pre-suctioning VT.55 That post-suctioning pressure increase might cause pulmonary overdistention and volutrauma lung injury. Treatment of viral upper respiratory infection largely consists of supportive measures such as applying dry medical gases. Risk for Ineffective Airway Clearance related to suppression of respiratory system Impaired Skin Integrity related to constant activity, diarrhea Altered Nutrition: Less than Body Requirements related to vomiting and diarrhea, uncoordinated suck and swallow reflex, hypertonia secondary to withdrawal Maternal Newborn Ch. 29 NCLEX Q's Flashcards | Quizlet I have yet to see any kind of randomized controlled trial on their routine use in the ICU. Research supports the use of closed-system suctioning. If you spend more time at the bedside before and after suctioning, you could alleviate a lot of that and manipulate the ventilator to keep the VT consistent. The group chose to look at the actual amount of sputum produced. The common thought process with most pediatric clinicians is that it cannot hurt, maybe it can help, but is this actually true? Increased acids in exhaled-breath condensate are present because of acidification of the source fluid from which the acids are derived. If you use a large volume of saline, you can inhibit oxygenation. The clinical picture of airway collapse often prompts CPT or bronchodilator orders. However, David Tingay's team at Murdoch Children's Research Institute in Australia published a series of articles on closed versus open suctioning.13 They found significantly better secretion clearance with open suctioning, because the airway collapse squeezes the secretions out to the larger airways where the suction catheter can pull them out. They also discovered that longer exsufflation time does not significantly alter maximum expiratory flow.103 Vienello et al102 found that mechanical insufflation-exsufflation in conjunction with traditional CPT may improve the management of airway secretions. Pain and sedation following surgery can decrease sigh and cough efforts. It helps with debris removal, which we found out when we were doing liquid lung ventilation. Nasal secretions and swollen turbinates increase the nose's contribution to airway resistance. PDF Domain 1. Health Promotion NANDA-I diagnosis: Ineffective Protection [12] There is little evidence that airway-clearance therapies in previously healthy children with acute respiratory failure improves their morbidity. Appropriate care must be taken to perform the therapy, allowing for the most comfort for the patient and the least amount of risk. 8.3 Applying the Nursing Process - Nursing Fundamentals Saline instillation prior to suctioning remains a controversial topic in pediatrics, particularly with neonates. Airway inflammation has a central role in the development and progression of acute lung injury. Risk for Altered Body Temperature. What you're talking about is percussion and postural drainage, right?