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Percussive VentilationTerry L. Forrette, M.H.S, RRT
TL Forrette & Associateswww.tlforrette.com [email protected]
985-624-9640Wisdom is knowledge applied1
Percussive Ventilation:Percussive Ventilation:Theory and Application for Theory and Application for
Critically Ill PatientsCritically Ill Patients
Terry L. Forrette, M.H.S., RRTTerry L. Forrette, M.H.S., RRT
What would you do?What would you do?
• Blow bottles
• Cough & deep breath
• Hypertonic saline
• Tilt beds
Chest Physical TherapyChest Physical Therapy
BenefitsBenefits–– Requires minimal Requires minimal
equipmentequipment–– Tolerated by most Tolerated by most
patientspatients–– Effective when Effective when
applied correctlyapplied correctlyComplicationsComplications–– Practitioner fatiguePractitioner fatigue–– Improper Improper
applicationsapplications
Incentive SpirometryIncentive Spirometry
• Indications – Atelectasis
• Contraindications –Unconscious patient, failure to generate sufficient inspiration
•Complications –Hyperventilation, pulmonary barotrauma, bronchospasms
Coughing Exercises & Other Coughing Exercises & Other TechniquesTechniques
Huff CoughingHuff CoughingAutogenic DrainageAutogenic DrainageCough assist Cough assist devicesdevices
Percussive VentilationTerry L. Forrette, M.H.S, RRT
TL Forrette & Associateswww.tlforrette.com [email protected]
985-624-9640Wisdom is knowledge applied2
Oscillatory DevicesOscillatory Devices PercussionPercussion
Key Features of Airway Key Features of Airway Clearance Therapies (ACT)Clearance Therapies (ACT)
Airflow behind the Airflow behind the secretions with secretions with pressure or vibrationspressure or vibrationsHumidityHumidityPositive Expiratory Positive Expiratory Pressure (PEP)Pressure (PEP)
What would you do?What would you do?
48 hour post IPV48 hour post IPV Intrapulmonary Percussive Intrapulmonary Percussive Ventilation (IPV)Ventilation (IPV)
Mobilization of Mobilization of Pulmonary Pulmonary Secretions Secretions Creation of Bilateral Creation of Bilateral Uniform Alveolar Uniform Alveolar VentilationVentilationEnhancement of Enhancement of Endobronchial Endobronchial Diffusion Diffusion Providing Providing Convective Tidal Convective Tidal Flow Flow
Percussive VentilationTerry L. Forrette, M.H.S, RRT
TL Forrette & Associateswww.tlforrette.com [email protected]
985-624-9640Wisdom is knowledge applied3
““Percussive Air Hammer”Percussive Air Hammer”
Airways are Airways are “percussed”“percussed”Airway “dilation”Airway “dilation”Gas mixing and Gas mixing and hydrationhydrationIncreased expiratory Increased expiratory flowflow
Lung Inflation and Secretion Lung Inflation and Secretion Removal Removal –– All in One TreatmentAll in One Treatment
FORREST M BIRD, M.D., PhD. ScD.
IPVIPV--1C (Institutional Use)1C (Institutional Use)
IPV Treatment Circuit:IPV Treatment Circuit:Phasitron, Nebulizer, HarnessPhasitron, Nebulizer, Harness
Slide courtesy of:Slide courtesy of:Brent D. Kenney BSRT, RRTBrent D. Kenney BSRT, RRT
Educational CoordinatorEducational CoordinatorRespiratory Care ServicesRespiratory Care Services
PHASITRONPHASITRON
Percussive VentilationTerry L. Forrette, M.H.S, RRT
TL Forrette & Associateswww.tlforrette.com [email protected]
985-624-9640Wisdom is knowledge applied4
VENTURI PRINCIPLEVENTURI PRINCIPLE IPV in line Treatment Set UpIPV in line Treatment Set Up
IPV Pig Lung Bronch ViewIPV Pig Lung Bronch View InIn--LineLine
IPV in Line Pressure ControlIPV in Line Pressure Control
IPV Pig Lungs.wmv
Tyco Puritan Bennett 840: Tyco Puritan Bennett 840: A/C Pressure Control IPV inA/C Pressure Control IPV in--lineline
Percussive VentilationTerry L. Forrette, M.H.S, RRT
TL Forrette & Associateswww.tlforrette.com [email protected]
985-624-9640Wisdom is knowledge applied5
Prior to IPV
IPV 24 hr
2 days IPV – Q4
The ProblemThe Problem
Percussive HFV (HFOV)Percussive HFV (HFOV)
Percussive VentilationTerry L. Forrette, M.H.S, RRT
TL Forrette & Associateswww.tlforrette.com [email protected]
985-624-9640Wisdom is knowledge applied6
Higher Frequency VentilationHigher Frequency VentilationRapid rates and tidal volumes less than Rapid rates and tidal volumes less than anatomical and physiologic dead spaceanatomical and physiologic dead spaceLower lung inflation pressuresLower lung inflation pressuresReduced need for sedation/paralysisReduced need for sedation/paralysisImproved oxygenation (P/F ratio)Improved oxygenation (P/F ratio)Enhanced COEnhanced CO22 removalremovalImproved mucoImproved muco--ciliary actionciliary action
HFJV – HF Jet Ventilation HFOV – HF Oscillatory Ventilation
Convective vs. Diffusive Convective vs. Diffusive VentilationVentilation
VDR beforeVDR before VDR afterVDR after
Percussive VentilationTerry L. Forrette, M.H.S, RRT
TL Forrette & Associateswww.tlforrette.com [email protected]
985-624-9640Wisdom is knowledge applied7
Benefits of Percussive Benefits of Percussive VentilationVentilation
CombinesCombines–– Medicated aerosol deliverMedicated aerosol deliver–– Volume oriented Volume oriented
breathingbreathingMobilizes secretionsMobilizes secretionsResolves atelectasisResolves atelectasisImproves gas exchangeImproves gas exchange
Questions and Demonstration
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