Airway Clearance Therapy

Definition: Noninvasive techniques designed to mobilize and remove secretions to improve gas exchange and work of breathing
Make cough more productive -> expel mucous and secretions -> decrease airway inflammation, prevent obstruction/ atelectasis and infection -> improve gas exchange and respiratory symptoms
Indications:
- Pathologies that cause retained secretions/mucous plugging due to overproduction or impaired mucociliary clearance
Contraindications:
- Hemodynamically unstable, hemoptysis, PTX, recent lung surgery or trauma

Therapy	Description	Order Set	Comments
Chest Physiotherapy (CPT)	Patient assumes sequence of positions aimed at “draining” each of the lobes of the lung by gravity. Usually combined with percussion or vibration	CPPD Panel (RT Bronchial Hygiene Protocol) – usually TID	Done with RT Better tolerated than vest physiotherapy Can be combined with a percussive/vibratory device such as a wand
High Frequency Chest Wall Compression (HFCWC) – Vest Physiotherapy	An inflatable vest rapidly inflates and deflates to break up thickened mucus from airway wall. Can target specific areas depending on the vest	Vest Physiotherapy	Usually done with RT Vest can be uncomfortable and difficult to tolerate particularly for elderly/frail patients
Positive Expiratory Pressure (PEP)	Patient exhales against fixed or fluttering resistors Allows air to get behind mucus and move away from airway walls. Holds airways open longer for improved ventilation	PEP Therapy or Oscillatory PEP Therapy	Also commonly called flutter valve, Acapella, AerobIKA Can find these in any RT station
Cough Assist	Via mask or trach/vent connection – applies positive pressure to fill the lungs then quickly switches to negative pressure to produce a high expiratory flow rate. Stimulates a cough to produce expectorant	Cough Assist Treatment Panel	Most effective in patients with neuromuscular weakness affecting diaphragmatic strength - ALS, muscular dystrophy, myasthenia gravis, spinal cord lesions, SMA