Care of Chronic Bronchitis in ICU

[august1302]

Hi,
Would really appreciate some help with this topic. What are the various treatment we as physios should provide for chronic bronchits patients in ICU?
Thanks!

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[sdkashif]

It depends what is problems your patient facing in the ICU and reasons for him to be admitted to ICU. Tracheal intubation and mechanical ventilation providing intermittent positive pressure ventilation is used in intensive care units or high dependency units to manage patients with detriorating respiratory failure. However, tracheal intubation result in complications, which include tracheal injury and infection. Furthermore, some patients find it difficult to stop using IPPV, resulting in prolonged stay in the hospital.

Non invasive positive pressure ventilation is therefore indicated for the delivery of intermittent pressure and may be applied via the nose ormouth using silicone mask attached to bed side ventilator. Unlike IPPV, NIPPV can be administered on the general ward for patients in respiratory failure. The ventilator is programmed to supplement patient's own respiratory effort and if required oxygen therapy may be given in conjunction with NIPPV. NIPPV can be used during an acute exacerbation and has been shown to improve the quality of life and arterial blood gase pressures and to reduce mortality in patients with COPD.

Physiotherapy will be required for short spells but frequently throughout the day and sometimes at night. Intermittent positive pressure ventilation may be given using mask if patient is too drowsy to use a mouth piece. Postural drainage me be necessary, if tolerated, together with rigourous shaking applied during expiratory phase of ventilator. Patients should be positioned appropraitely in order to facilitate the gaseous exchange.

Suction via an air way or nasal suction may have to be used as a last resort to remove secretions if patient is unable to cough spontaneously. If PaCO2 is high and PO2 is low the patient should not be given a high concentration of oxygen. Two litres of oxygen through a nebulizer with IPPV respirator driven off air gives 25% oxygen-to-air mix which is generally suitable. Drugs such as mucolytic agents or bronchodilators may be provided through the nebulizer attached to ventilator. The patient should be encouraged to sip drinks because dehydration makes the secretions viscid.

As the patient recovers, treatment should directed towards that given in the early stages, with special emphasis on daily maintenance programme of regular exercise, sputum clearance and breathing exercises.

In terminal stages, the main emphasis is to keep patient as comfortable as possible. Treatment needs to be short and frequent. Non invasive nasal ventilation may be provided for home use. Inhalations may be used to loosen and liquify the secretions. Suction may be necessary.

[august1302]

Thank you so much for your invaluable help. There is so much I have to learn!