Help me in Chest Physiotherapy

[saeidphysio]

Hi Mel
What kind of Chest physio you did for a patient with SPO2 50 ?

[Mel]

I increased her FiO2 so she had 100% O2 (only while stabilising and due to us needing to remove her mask frequently to suction) High levels of FiO2 cause toxicity, it was later decreased to 40%. We sat her bolt upright in bed, did expiratory vibes while trying to stimulate a cough. I used a yanker suction to the back of her throat, which cleared quite alot but also had to go deeper so inserted a nasopharyngeal airway. In this treatment session we mainly cleared the central airways as she could only tolerate limited amounts in that state.
Just abit of background on this patient, the main cause of her acute deterioration was sputum plugging due to aspiration pneumonia. She also had respiratory muscle weakness due to a recent intubation and neuromuscluar disease. She did pull through and returned home several weeks later.
I notice in some previous threads people are questioning the effectiveness of chest physiotherapy and also mentioning that we don't do anything nurses can't do. Its true that some of our treatment strategies are quite simple but it is critical how and when they are applied. Nurses do not have the training or assessment and rationalisation skills that we have in this area and I believe many people such as the above patient would not be with us today if it wasn't for many of the cardiorespiratory physiotherapist out there! Sorry if its abit off the topic but just wanted to get my point across :-)

[dr.pavansinghal]

positioning is important and breathing exercise will help to increase the spo2 level