Indications for airway clearance include impaired mucocillary escalator function or impaired cough. According to the American Association for Respiratory Care’s Clinical Practice Guidelines for Airway Clearance, it is important to look at the rationale behind your decision to order airway clearance. Is gas exchange being affected by retained secretions? A patient with an increase in secretions may not necessarily need airway clearance when suctioning is all that is needed. With this in mind, the indications for airway clearance are:
Evidence of difficulty with secretion clearance
Evidence of retained secretions
Presence of atelectasis caused by mucus plugging
Diagnosis of cystic fibrosis, bronchiectasis, or neuromuscular disease
How it works
Percussion to the chest improves air movement and loosens secretions
Positioning allows gravity to assist in draining secretions
Contraindications:
Hemoptysis
Untreated tension pneumothorax
Increased intracranial pressure (ICP)
Pleural effusions
Brittle bone disease
PEP
How it works:
Patient exhales against a fixed orifice, which creates a resistance to flow
Airway stability is maintained due to prolonged expiratory time
Collateral ventilation allows air to move beyond the obstruction to improve aeration
Airflow through device helps move mucus into larger airways
Airway clearance is more effective as a result of improved air distribution in the lungs
Contraindications
Increased work of breathing
Increased ICP
Hemodynamic compromise
Active hemoptysis
Untreated tension pneumothorax
Recent esophageal surgery
Middle ear pathology
Flutter
How it works:
The patient exhales into the device, which contains a steel ball sitting in a cone
The patient’s expiratory flow causes the steel ball to lift and roll in the cone until the weight of the ball causes it to drop down
Movement of the steel ball causes air to oscillate
Oscillations of air in the lungs loosens and moves mucus
Contraindications:
Increased work of breathing
Increased ICP
Hemodynamic instability
Active hemoptysis
Untreated tension pneumothorax
Esophageal surgery
Acapella
How it works:
This therapy combines the effects of PEP and flutter
Patient exhales against a fixed orifice, which creates resistance to flow
Exhaled air is interrupted by a valve that opens and closes, creating vibrations
Adjusting a dial changes the frequency of vibration and resistance to exhalation
Contraindications:
Increased work of breathing
Increased ICP
Hemodynamic instability
Acute sinusitis
Active hemoptysis
Untreated tension pneumothorax
Esophageal surgery