Overview

Respiratory physiotherapists have a key role for helping to keep tracheostomy patients safe. Although the role can vary with institution or country, respiratory physiotherapists are independent practitioners with skills in assessment and treatment of respiratory problems, including the management of those dependent on mechanical ventilatory support.

Chest sputum clearance is a key part of the management of tracheostomy patients whose ability to humidify, cough and swallow chest secretions may be significantly impaired or absent.

Question: Other than suctioning, how many methods do you know to help chest clearance?

Answer

Respiratory physiotherapists have a key role for helping to keep tracheostomy patients safe. Although the role can vary with institution or country, respiratory physiotherapists are independent practitioners with skills in assessment and treatment of respiratory problems, including the management of those dependent on mechanical ventilatory support.

Chest sputum clearance is a key part of the management of tracheostomy patients whose ability to humidify, cough and swallow chest secretions may be significantly impaired or absent.

Question: Other than suctioning, how many methods do you know to help chest clearance?

Answer: Methods include:

Respiratory physiotherapists have a key role for helping to keep tracheostomy patients safe. Although the role can vary with institution or country, respiratory physiotherapists are independent practitioners with skills in assessment and treatment of respiratory problems, including the management of those dependent on mechanical ventilatory support.

Chest sputum clearance is a key part of the management of tracheostomy patients whose ability to humidify, cough and swallow chest secretions may be significantly impaired or absent.

Question: Other than suctioning, how many methods do you know to help chest clearance?

Answer: Methods include:

Active cycle of breathing techniques

Active cycle of breathing techniques (ACBTs) is a relatively basic form of chest clearance employed to aid sputum expectoration. It is accessible to most physiotherapists and applicable to a wide variety of patient groups.

This technique combines a cycle of relaxed breaths with thoracic expansions and breath hold, followed by forced expiration.

This technique is effective and safe in spontaneously breathing patients and also easily applied to those with a tracheostomy

Respiratory physiotherapists have a key role for helping to keep tracheostomy patients safe. Although the role can vary with institution or country, respiratory physiotherapists are independent practitioners with skills in assessment and treatment of respiratory problems, including the management of those dependent on mechanical ventilatory support.

Chest sputum clearance is a key part of the management of tracheostomy patients whose ability to humidify, cough and swallow chest secretions may be significantly impaired or absent.

Question: Other than suctioning, how many methods do you know to help chest clearance?

Answer: Methods include:

Manual hyperinflation

Manual hyperinflation administers passive positive pressure breaths by inflating the lungs, holding and then releasing the applied pressure. In addition to clearance of sputum, dependent areas of pulmonary collapse can be re-recruited with consequent improved lung compliance and gas exchange.

Respiratory physiotherapists have a key role for helping to keep tracheostomy patients safe. Although the role can vary with institution or country, respiratory physiotherapists are independent practitioners with skills in assessment and treatment of respiratory problems, including the management of those dependent on mechanical ventilatory support.

Chest sputum clearance is a key part of the management of tracheostomy patients whose ability to humidify, cough and swallow chest secretions may be significantly impaired or absent.

Question: Other than suctioning, how many methods do you know to help chest clearance?

Answer: Methods include:

Cough assist

An extension of manual hyperinflation with positive pressure is to apply a negative pressure in expiration, thus mimicking a cough effort. This change in pressure helps to replicate a cough effort, aiding sputum clearance. This insufflation/exsufflation device, commonly referred to as a 'cough assist', can be used with a facemask but also on tracheotomized patients, using an adaptor attached to the tracheostomy tube

Respiratory physiotherapists have a key role for helping to keep tracheostomy patients safe. Although the role can vary with institution or country, respiratory physiotherapists are independent practitioners with skills in assessment and treatment of respiratory problems, including the management of those dependent on mechanical ventilatory support.

Chest sputum clearance is a key part of the management of tracheostomy patients whose ability to humidify, cough and swallow chest secretions may be significantly impaired or absent.

Question: Other than suctioning, how many methods do you know to help chest clearance?

Answer: Methods include:

Pharmacological therapies

Physiotherapists may consider the use of pharmacological therapies in mobilizing secretions to aid expectoration.

Therapies include simple nebulized drugs such as isotonic 0.9% saline solution through to higher concentration hypertonic 9% saline, or mucolytics.

A simple spirometer can be used to monitor the effects on the airways.