Pulmonary toilet
Encyclopedia
Pulmonary hygiene, formerly referred to as pulmonary toilet, is a set of methods used to clear mucus
and secretion
s from the airway
s. The word pulmonary refers to the lung
s. The word toilet is related to the French toilette, refers to body care and hygiene
; this root is used in words such as toiletry that also relate to cleansing.
Pulmonary hygiene prevents atelectasis
(the collapse of the alveoli of the lungs) and rids the respiratory system of secretions, which could cause respiratory infections. It can also decrease pulmonary shunt
ing, increase the functional reserve capacity of the lungs, and prevent respiratory infection after chest trauma
. Methods include using suction to remove fluids and placing the patient in a position that allows secretions to drain by gravity.
of the airways, chest physiotherapy
, blow bottles, and nasotracheal suction. 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 analgesic
s (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. Tracheotomy
facilitates pulmonary toilet. 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.
and lung abscess
. The patient's body is positioned so that the trachea
is inclined downward and below the affected chest area. Postural drainage is essential in treating bronchiectasis and 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. 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.
. It is also used in the management of conditions such as pneumonia and cystic fibrosis
. For people with chronic lung diseases, bronchial hygiene is used to prevent infections and lung abscess
es. Bronchial hygiene is also used to prevent acute respiratory distress syndrome
after chest trauma.
and cystic fibrosis
as both interventional and prophylactic. Prophylactic indications also include pre and post thoracic surgery to prevent atelectasis and respiratory infections.
, 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.
Mucus
In vertebrates, mucus is a slippery secretion produced by, and covering, mucous membranes. Mucous fluid is typically produced from mucous cells found in mucous glands. Mucous cells secrete products that are rich in glycoproteins and water. Mucous fluid may also originate from mixed glands, which...
and secretion
Secretion
Secretion is the process of elaborating, releasing, and oozing chemicals, or a secreted chemical substance from a cell or gland. In contrast to excretion, the substance may have a certain function, rather than being a waste product...
s from the airway
Airway
The pulmonary airway comprises those parts of the respiratory system through which air flows, conceptually beginning at the nose and mouth, and terminating in the alveoli...
s. The word pulmonary refers to the lung
Lung
The lung is the essential respiration organ in many air-breathing animals, including most tetrapods, a few fish and a few snails. In mammals and the more complex life forms, the two lungs are located near the backbone on either side of the heart...
s. The word toilet is related to the French toilette, refers to body care and hygiene
Hygiene
Hygiene refers to the set of practices perceived by a community to be associated with the preservation of health and healthy living. While in modern medical sciences there is a set of standards of hygiene recommended for different situations, what is considered hygienic or not can vary between...
; this root is used in words such as toiletry that also relate to cleansing.
Pulmonary hygiene prevents atelectasis
Atelectasis
Atelectasis is defined as the collapse or closure of alveoli resulting in reduced or absent gas exchange. It may affect part or all of one lung. It is a condition where the alveoli are deflated, as distinct from pulmonary consolidation.It is a very common finding in chest x-rays and other...
(the collapse of the alveoli of the lungs) and rids the respiratory system of secretions, which could cause respiratory infections. It can also decrease pulmonary shunt
Pulmonary shunt
A pulmonary shunt is a physiological condition which results when the alveoli of the lung are perfused with blood as normal, but ventilation fails to supply the perfused region. In other words, the ventilation/perfusion ratio is zero...
ing, increase the functional reserve capacity of the lungs, and prevent respiratory infection after chest trauma
Chest trauma
Chest trauma is a serious injury of the chest. Thoracic trauma is a common cause of significant disability and mortality, the leading cause of death from physical trauma after head and spinal cord injury. Blunt thoracic injuries are the primary or a contributing cause of about a quarter of all...
. Methods include using suction to remove fluids and placing the patient in a position that allows secretions to drain by gravity.
Techniques
Methods used for pulmonary hygiene include suctioningSuction (medicine)
In medicine, devices are sometimes necessary to create suction. Suction may be used to clear the airway of blood, saliva, vomit, or other secretions so that a patient may breathe. Suctioning can prevent pulmonary aspiration, which can lead to lung infections...
of the airways, chest physiotherapy
Chest physiotherapy
Chest physiotherapy is a broad, non-specific term used to describe treatments generally performed by physiotherapists and respiratory therapists whereby breathing is improved by the indirect removal of mucus from the breathing passages of a patient...
, blow bottles, and nasotracheal suction. Bronchoscopy
Bronchoscopy
Bronchoscopy is a technique of visualizing the inside of the airways for diagnostic and therapeutic purposes. An instrument is inserted into the airways, usually through the nose or mouth, or occasionally through a tracheostomy. This allows the practitioner to examine the patient's airways for...
, 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
Spirometry
Spirometry is the most common of the pulmonary function tests , measuring lung function, specifically the measurement of the amount and/or speed of air that can be inhaled and exhaled...
and use of analgesic
Analgesic
An analgesic is any member of the group of drugs used to relieve pain . The word analgesic derives from Greek an- and algos ....
s (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
Sedation
Sedation is the reduction of irritability or agitation by administration of sedative drugs, generally to facilitate a medical procedure or diagnostic procedure...
patients, because that could inhibit coughing. Tracheotomy
Tracheotomy
Among the oldest described surgical procedures, tracheotomy consists of making an incision on the anterior aspect of the neck and opening a direct airway through an incision in the trachea...
facilitates pulmonary toilet. 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
Prone position
The term means to lie on bed or ground in a position with chest downwards and back upwards.-Etymology :The word "prone," meaning "naturally inclined to something, apt, liable," has been recorded in English since 1382; the meaning "lying face-down" was first recorded in 1578, but is also referred to...
to aid in this purpose.
Chest percussion & postural drainage
Drainage used in bronchiectasisBronchiectasis
Bronchiectasis is a disease state defined by localized, irreversible dilation of part of the bronchial tree caused by destruction of the muscle and elastic tissue. It is classified as an obstructive lung disease, along with emphysema, bronchitis, asthma, and cystic fibrosis...
and lung abscess
Abscess
An abscess is a collection of pus that has accumulated in a cavity formed by the tissue in which the pus resides due to an infectious process or other foreign materials...
. The patient's body is positioned so that the trachea
Vertebrate trachea
In tetrapod anatomy the trachea, or windpipe, is a tube that connects the pharynx or larynx to the lungs, allowing the passage of air. It is lined with pseudostratified ciliated columnar epithelium cells with goblet cells that produce mucus...
is inclined downward and below the affected chest area. Postural drainage is essential in treating bronchiectasis and 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. 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.
Applications
Pulmonary bronchial hygiene is used for preventing infections such as pneumoniaPneumonia
Pneumonia is an inflammatory condition of the lung—especially affecting the microscopic air sacs —associated with fever, chest symptoms, and a lack of air space on a chest X-ray. Pneumonia is typically caused by an infection but there are a number of other causes...
. It is also used in the management of conditions such as pneumonia and cystic fibrosis
Cystic fibrosis
Cystic fibrosis is a recessive genetic disease affecting most critically the lungs, and also the pancreas, liver, and intestine...
. For people with chronic lung diseases, bronchial hygiene is used to prevent infections and lung abscess
Lung abscess
Lung abscess is necrosis of the pulmonary tissue and formation of cavities containing necrotic debris or fluid caused by microbial infection....
es. Bronchial hygiene is also used to prevent acute respiratory distress syndrome
Acute respiratory distress syndrome
Acute respiratory distress syndrome , also known as respiratory distress syndrome or adult respiratory distress syndrome is a serious reaction to various forms of injuries to the lung....
after chest trauma.
Indications
The need for bronchial hygiene is indicated in cases of COPD, pneumoniaPneumonia
Pneumonia is an inflammatory condition of the lung—especially affecting the microscopic air sacs —associated with fever, chest symptoms, and a lack of air space on a chest X-ray. Pneumonia is typically caused by an infection but there are a number of other causes...
and cystic fibrosis
Cystic fibrosis
Cystic fibrosis is a recessive genetic disease affecting most critically the lungs, and also the pancreas, liver, and intestine...
as both interventional and prophylactic. Prophylactic indications also include pre and post thoracic surgery to prevent atelectasis and respiratory infections.
Contraindications
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 (>20mmHg), any spinal injury acute or otherwise, active hemoptysisHemoptysis
Hemoptysis or haemoptysis is the expectoration of blood or of blood-stained sputum from the bronchi, larynx, trachea, or lungs Hemoptysis or haemoptysis is the expectoration (coughing up) of blood or of blood-stained sputum from the bronchi, larynx, trachea, or lungs Hemoptysis or haemoptysis ...
, pulmonary embolism
Pulmonary embolism
Pulmonary embolism is a blockage of the main artery of the lung or one of its branches by a substance that has travelled from elsewhere in the body through the bloodstream . Usually this is due to embolism of a thrombus from the deep veins in the legs, a process termed venous thromboembolism...
, pulmonary edema with congestive heart failure
Congestive heart failure
Heart failure often called congestive heart failure is generally defined as the inability of the heart to supply sufficient blood flow to meet the needs of the body. Heart failure can cause a number of symptoms including shortness of breath, leg swelling, and exercise intolerance. The condition...
and an open or healing wound in the area where chest physiotherapy is otherwise indicated.
Medication contraindications vary depending on the medication being delivered.
See also
- Respiratory therapyRespiratory therapyRespiratory therapy is a healthcare profession in which specialists work with patients suffering from either acute or chronic respiratory problems. These specialists are termed Respiratory Therapists in most places internationally but may also be referred to as Respiratory Scientists or...
- Chest physiotherapyChest physiotherapyChest physiotherapy is a broad, non-specific term used to describe treatments generally performed by physiotherapists and respiratory therapists whereby breathing is improved by the indirect removal of mucus from the breathing passages of a patient...
- ThAIRapy VestThAIRapy VestThe "Vest Airway Clearance System", a form of chest wall oscillation, is a device and system for clearing excess mucus from lung airways...
- Intrapulmonary percussive ventilatorIntrapulmonary percussive ventilatorIntrapulmonary percussive ventilators are machines which deliver short bursts of air through a mouthpiece to help individuals with lung disease clear sputum. The air is delivered at a rate of 150 times a minute and may be used with nebulized medication...