Question re: pleural effusion and atelectasis?

hi

am little bit confused and i need your help . If you have a postoperative patient(70 years old) with pleural effusion and atelectasis ( surgery complications) and this lead to decrease lung .As a physiotherapist what can you do for this patient?

I found in some books that deep breathing is used to increase lung volume but others books mentioned that in pleural effusion cases using deep breathing exercise(TEE) wont help????

And what about using IPPB and incentive spirometry??

could you share with me your opinions and experiences

Hi ,
its normally to have atelectasis when you have pleural effusion ,
the underlying cause of pleural effusion must be identified.
Ippb is contraindications unless chest tube is not placing.

incentive spirometry is good to exercicing with
Breathing exercices with pursed-lip(it help reducing respiratory rat and increasing tidal volume.

in atelectasis you do thoracic extension exercises.The deep brething is always helpful!Be careful with the expiration , myst not be very extended.

The aims of physiotherapy in pleural effusion are;

To prevent disabling adhesions between two layers of pleura.

To obtain full expansion of the affected lung.

To increase ventilation of lungs

To increase exercise tolerance following immobility

Treatment must be modified to take into account any underlying condition. Following aspiration of effusion, breathing exercises should be given to encourage localised expansion of the affected side. The patient is encouraged to practice these exercises with the aid of a belt. Incentive spirometry is a very good mean to regain the reexpansion of the lung. Furthermore, the positioning for ventilation and positioning for postural drainage for the affected lung also help in reexpansion of the lung. Continuous positive airy way pressure is also used in atelectasis to help in reexpansion of the lung.

If the patient has difficulty in localizing the expansion, it may be helpful to lie on the unaffected side over a firm pillow to help stretch affected side. Breathing exercises may be practised in this position several times a day. When the patient has regained full lung expansion, the treatment programme should be expanded to include mobilisation of the patient and to increase exercise tolerance.

Some malignants effusions may require a pleuridesis- insertion of a powder such as tetracycline into the pleural cavity.

Incentive spirometry can be used but with the help of good guidance. Along with that PNF techniques for the chest muscles should be used. Thorasic expansion exercises, proper positioning. Correction of posture is important and shoulder exercises should be also added to improve lung expansion.

hello,
pleural effusion will inevitably will have an associated atelectasis as it will compress the underlying lung tissue,so few things for the managment will be,
1 Identify the underlying cause and manage that.
2 As atelectasis involves loss of lung volume so any form of technique that will increase the lung volume eg. deep breathing exercises,positioning,mobilization,sniff,incentive spirometry,IPPB....etc will be helpful but sine every patient is different so the need for appropiate selection for a particular patient exists.
3 If the patient is quite able to do any form of active exercises then no better technique to improve lung volumes that mobilizations like lying to sitting, moving from bed to chair,sit to stand ,walking .......
4 If the pateint is bed ridden ie on ventilators/or associated problems the second best thing to improve lung volumes is body positioning with the sound lung the underlying but if the pleural effusion large then affected lung will be the underlying one.
5.If the chest drains are connected which is important to drain the larger effusions coughing should be encouraged it will aid in draining IF NOT connected to the drain this should not be attempted .
6 IPPB is usually only prescribed for those individuals who cannot manage their tidal volume so the lung volumes are aided through IPPB eg. Myesthenia gravis resp involvment etc...
hope this will be helpful
Regards

thank you for your reply,
but I know that Any positive pressure is contra indication with non drainaged pleural effusion