percussive ventilation - tl forrette & associates

Percussive VentilationTerry L. Forrette, M.H.S, RRT

TL Forrette & Associateswww.tlforrette.com [email protected]

985-624-9640Wisdom is knowledge applied1

Percussive Ventilation:Percussive Ventilation:Theory and Application for Theory and Application for

Critically Ill PatientsCritically Ill Patients

Terry L. Forrette, M.H.S., RRTTerry L. Forrette, M.H.S., RRT

What would you do?What would you do?

• Blow bottles

• Cough & deep breath

• Hypertonic saline

• Tilt beds

Chest Physical TherapyChest Physical Therapy

BenefitsBenefits–– Requires minimal Requires minimal

equipmentequipment–– Tolerated by most Tolerated by most

patientspatients–– Effective when Effective when

applied correctlyapplied correctlyComplicationsComplications–– Practitioner fatiguePractitioner fatigue–– Improper Improper

applicationsapplications

Incentive SpirometryIncentive Spirometry

• Indications – Atelectasis

• Contraindications –Unconscious patient, failure to generate sufficient inspiration

•Complications –Hyperventilation, pulmonary barotrauma, bronchospasms

Coughing Exercises & Other Coughing Exercises & Other TechniquesTechniques

Huff CoughingHuff CoughingAutogenic DrainageAutogenic DrainageCough assist Cough assist devicesdevices




Oscillatory DevicesOscillatory Devices PercussionPercussion

Key Features of Airway Key Features of Airway Clearance Therapies (ACT)Clearance Therapies (ACT)

Airflow behind the Airflow behind the secretions with secretions with pressure or vibrationspressure or vibrationsHumidityHumidityPositive Expiratory Positive Expiratory Pressure (PEP)Pressure (PEP)

What would you do?What would you do?

48 hour post IPV48 hour post IPV Intrapulmonary Percussive Intrapulmonary Percussive Ventilation (IPV)Ventilation (IPV)

Mobilization of Mobilization of Pulmonary Pulmonary Secretions Secretions Creation of Bilateral Creation of Bilateral Uniform Alveolar Uniform Alveolar VentilationVentilationEnhancement of Enhancement of Endobronchial Endobronchial Diffusion Diffusion Providing Providing Convective Tidal Convective Tidal Flow Flow




““Percussive Air Hammer”Percussive Air Hammer”

Airways are Airways are “percussed”“percussed”Airway “dilation”Airway “dilation”Gas mixing and Gas mixing and hydrationhydrationIncreased expiratory Increased expiratory flowflow

Lung Inflation and Secretion Lung Inflation and Secretion Removal Removal –– All in One TreatmentAll in One Treatment

FORREST M BIRD, M.D., PhD. ScD.

IPVIPV--1C (Institutional Use)1C (Institutional Use)

IPV Treatment Circuit:IPV Treatment Circuit:Phasitron, Nebulizer, HarnessPhasitron, Nebulizer, Harness

Slide courtesy of:Slide courtesy of:Brent D. Kenney BSRT, RRTBrent D. Kenney BSRT, RRT

Educational CoordinatorEducational CoordinatorRespiratory Care ServicesRespiratory Care Services

PHASITRONPHASITRON




VENTURI PRINCIPLEVENTURI PRINCIPLE IPV in line Treatment Set UpIPV in line Treatment Set Up

IPV Pig Lung Bronch ViewIPV Pig Lung Bronch View InIn--LineLine

IPV in Line Pressure ControlIPV in Line Pressure Control

IPV Pig Lungs.wmv

Tyco Puritan Bennett 840: Tyco Puritan Bennett 840: A/C Pressure Control IPV inA/C Pressure Control IPV in--lineline




Prior to IPV

IPV 24 hr

2 days IPV – Q4

The ProblemThe Problem

Percussive HFV (HFOV)Percussive HFV (HFOV)




Higher Frequency VentilationHigher Frequency VentilationRapid rates and tidal volumes less than Rapid rates and tidal volumes less than anatomical and physiologic dead spaceanatomical and physiologic dead spaceLower lung inflation pressuresLower lung inflation pressuresReduced need for sedation/paralysisReduced need for sedation/paralysisImproved oxygenation (P/F ratio)Improved oxygenation (P/F ratio)Enhanced COEnhanced CO22 removalremovalImproved mucoImproved muco--ciliary actionciliary action

HFJV – HF Jet Ventilation HFOV – HF Oscillatory Ventilation

Convective vs. Diffusive Convective vs. Diffusive VentilationVentilation

VDR beforeVDR before VDR afterVDR after




Benefits of Percussive Benefits of Percussive VentilationVentilation

CombinesCombines–– Medicated aerosol deliverMedicated aerosol deliver–– Volume oriented Volume oriented

breathingbreathingMobilizes secretionsMobilizes secretionsResolves atelectasisResolves atelectasisImproves gas exchangeImproves gas exchange

Questions and Demonstration

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percussive ventilation - tl forrette & associates

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