Respiratory Physiotherapy Techniques and Oxygen Administration
Respiratory Physiotherapy
Respiratory physiotherapy encompasses a range of procedures designed to assist patients in clearing respiratory secretions, the blockage of which could lead to respiratory failure. This is particularly important for patients with:
- Chronic respiratory conditions: These patients often experience reduced spontaneous drainage of secretions.
- Postoperative conditions: Analgesics can decrease cough reflex and mobility, making coughing painful and less frequent.
- Neurological conditions: Certain conditions can lead to muscle weakness and diminished cough reflex.
Physiotherapy Procedures
Some common chest physiotherapy procedures include:
- Respiratory percussion exercises
- Vibration exercises
- Passive removal of secretions: This technique involves facilitating the movement of secretions from the lungs to the main bronchi through appropriate positioning, prescribed by a doctor and held for 10 minutes. These procedures are typically performed by physiotherapists and nurses, with assistance from nursing auxiliaries if needed.
Breathing Exercises
The goal of breathing exercises is to achieve deep breathing, mobilize secretions, and improve airway permeability. These exercises are frequently used in preoperative preparation and postoperatively.
Incentive Spirometer
An incentive spirometer is used when patients have difficulty or pain with deep breathing. It helps prevent pulmonary complications, increase lung capacity, and strengthen respiratory muscles.
Chest Vibration
Chest physiotherapy, including manual percussion or ultrasonic vibration, helps loosen and remove deeper secretions.
Oxygen Therapy
Oxygen therapy involves administering gaseous oxygen to restore normal blood oxygen levels. Atmospheric air contains 21% oxygen, 78% nitrogen, and a small percentage of carbon dioxide. This therapy delivers higher concentrations of oxygen.
Indications: Oxygen therapy is indicated for any condition causing breathing difficulties, such as dyspnea, orthopnea, cyanosis, and expectoration, which may signal respiratory failure. The aim is to increase oxygen concentration in blood and tissues without causing respiratory depression.
Blood Oxygen Determination
Arterial blood gas analysis determines the gases in arterial blood, including:
- Partial pressure of oxygen (PaO2): Indicates the amount of dissolved oxygen in arterial blood. A normal value is considered 80 mmHg. Values below this indicate hypoxemia.
- Partial pressure of carbon dioxide (PaCO2): Indicates the amount of dissolved carbon dioxide in arterial blood. Typical values are between 35 and 45 mmHg. Values above this indicate hypercapnia.
- Other parameters: pH, standard bicarbonate, and oxygen saturation.
Pulse Oximetry
Oxygen saturation (SaO2) and heart rate can be measured noninvasively using pulse oximetry. A finger clip is placed on a finger to monitor hemoglobin oxygen saturation. This method can be used for several days, but the skin condition should be monitored, and the clip’s position changed regularly to prevent skin issues (ischemia or allergic reactions). The advantage of pulse oximetry is continuous monitoring of the patient’s oxygenation.
Oxygen Administration Sources
Oxygen administration requires an oxygen source, gauge, humidifier, and flowmeter. Oxygen is stored centrally in hospitals or in portable tanks.
A central source typically involves pipelines to patient units and other hospital departments. Cylindrical tanks of varying capacities store oxygen at pressures higher than atmospheric pressure, monitored by a pressure gauge. Portable tanks or backpacks are also available for ambulation.
Equipment for Oxygen Administration
- Flowmeter/Pressure Gauge: A flowmeter regulates oxygen flow from a tank, measured in liters/minute. It contains a floating ball that indicates the flow rate. A pressure gauge is used when oxygen comes from a cylinder and measures pressure in kg/cm2. It is not used with central oxygen systems.
- Humidifier: A container attached to the flowmeter, filled with distilled water to a specified level, humidifies the oxygen to prevent drying and irritation of the respiratory tract.