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Improving ventilation & reducing the work of breathing in infants and children

Improving ventilation & reducing the work of breathing in infants and children. Robyn Smith Department of Physiotherapy University of Free State 2011. Other aims of chest physiotherapy apart from mobilising and clearing secretions are: improve ventilation and

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Improving ventilation & reducing the work of breathing in infants and children

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  1. Improving ventilation & reducing the work of breathing in infants and children Robyn Smith Department of Physiotherapy University of Free State 2011

  2. Other aims of chest physiotherapy apart from mobilising and clearing secretions are: • improve ventilation and • decrease the work of breathing (WOB) Aims of Chest Physiotherapy

  3. Ventilation

  4. Maintaining adequate lung volumes and ensuring adequate ventilation remains a challenge in children whose immature airways have a tendency to closure/collapse • Physiotherapy aims to: • Re-expand atelectatic segments • prevent secondary lung complications due to atelectasis Challenges in children

  5. Positioning • Play and exercise • Breathing exercises • ACBT • Incentive spirometry • Postural drainage and manual techniques In this section only positioning and breathing exercises will be discussed. Please refer to the presentation regarding mobilisation of secretions for information regarding the other techniques Physiotherapy techniques to improve ventilation and lung volume

  6. Differentiating between shortness of breath and dyspnoea

  7. Shortness of breath Dyspnoea • Associated rapid RR or tachypnoea largely • Common in children with acute respiratory disease • Sense of breathlessness cannot get enough breath

  8. Teach relaxation positions and breathing control in older children • Position in relaxation position • Relax shoulder girdle • Encourage diaphragmatic breathing Shortness of breath and dyspnoea

  9. Positioning

  10. Positioning is one of the most important ways one can optimise respiratory functioning • Small children breathe more comfortably in a slightly head up position Positioning

  11. Position in semi-fowlers or head up position: • Not slumped as this compresses the diaphragm • Knees in slight flexion to decrease the load on the diaphragm • Can even use sitting up on parents lap • Can use cuddly toys to aid positioning Positioning

  12. Breathing exercises

  13. It is possible to encourage children to breathe deeply from about 2 years • Can make use of games and activities in younger children e.g. Blowing bubbles, pinwheels or even incentive spirometry (flutter) or bubble PEP Breathing exercises

  14. Blowing activities children

  15. Makes use of tactile and proprioceptive stimulation • A stimulus (intercostal stretch) is given at the end of expiration • This facilitates improved chest expansion and therefore ventilation Neurophysiological stimulation of respiration

  16. Used to improve thoracic expansion in older children • Physiotherapists hands at the level of the 8th rib • Child is instructed to expand the lower ribs against her hands Localised breathing exercises

  17. Physiological characteristics of the immature respiratory system influence the inability of ventilated areas of the lung to match the perfused areas in a child. • In young children ventilation is preferably distributed to the uppermost lung areas and the dependant areas are poorly ventilated. • This happens due to the airway closing pressure in young child being before the FRC is reached and the highly compliant chest wall. • The dependant lung areas have better perfusion. Improving the ventilation/ perfusion ration

  18. Principles to improve gaseous exchange in a child are the opposite to those in an adult (up until 10 years of age) • e.g. Child with right sided pathology should be placed on the right side to optimise ventilation and reduce mismatching • Children may desaturate and their respiratory function deteriorate significantly when placing child with the affected lung uppermost Improving the ventilation/ perfusion ration

  19. Hardy, L. 2007. Cardiorespiratory physiotherapy for the acutely ill, non-ventilated child. In Physiotherapy for Children. Poutney, T (Ed). Butterworth Heinemann Elsevier pp 285-290 • Anderson, JM & Innocenti, DM. 1992. Techniques used in physiotherapy. In Cash’s Textbook of chest, vascular disorders for Physiotherapists. Downie PA (ed). 4th ed. Pp 325-354 • Ammani Prasad, S & Main, E. 2008. Respiratory disease in childhood. In Physiotherapy for respiratory and cardiac problems .Adults and children. Pryor, JA & Ammani Prasad, S (eds).4 ed. Churchill Livingstone Elsevier pp 337-343 References

  20. Pryor, JA & Ammani Prasad, S. 2008. Physiotherapy techniques. In Physiotherapy for respiratory and cardiac problems .Adults and children. Pryor, JA & Ammani Prasad, S (eds).4 ed. Churchill Livingstone Elsevier pp136-176 • Hough , A. 2001. 2001. Physiotherapy to clear secretions. In Physiotherapy in Respiratory care. An evidence based approach to respiratory and cardiac management. 3rd edition. Nelson Thornes. London pp184- 210 References

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