RE: Airway Clearance Strategies for the Pediatric Pat ient/question?

[Guest guest]

Hi! I have a question. Am I missing something or where is the rest of the

article that talks about the different types and when and why to introduce

them? It sounds very interesting so I was hoping to get ahold of the rest of

it.

Thanks,

Amy (mom to Tristan 2 1/2w/cf, Skye 5w/ocf, 14w/ocf, and Cary 15w/ocf)

Airway Clearance Strategies for the Pediatric Patient

Airway Clearance Strategies for the Pediatric Patient

L son RRT

Introduction

Adherence

Chest Physiotherapy

Breathing Games

Diaphragmatic Breathing and Huffing

Active Cycle of Breathing Technique

Positive Expiratory Pressure Therapy

High-Frequency Chest Wall Oscillation

Oscillating Positive Expiratory Pressure

Autogenic Drainage

Summary

Clinicians who care for cystic fibrosis (CF) patients have many

techniques to choose from to facilitate mucus clearance. Little has

been

published about when to introduce the various techniques and in what

order to teach them. Debates have occurred over these issues in the CF

community, and there is now consensus on some topics. It is very

important to teach adherence to therapy at an early age. Adherence to

an

airway clearing regimen assists in maintaining good pulmonary

function in

CF patients. Knowing when and how to introduce airway clearance

techniques beyond chest physiotherapy (CPT) is clinically relevant and

useful. A 5-position modified CPT routine can be used with infants and

children, and it takes less time and may improve adherence. Infants

and

toddlers can be taught breathing games that eventually lead them to

perform diaphragmatic breathing and huffing. Once they have mastered

diaphragmatic breathing and huffing, children can be taught the active

cycle of breathing technique. Modified CPT can be phased out at that

point. Positive expiratory pressure therapy can usually be introduced

around 6-7 years of age. High-frequency chest wall oscillation,

oscillating positive expiratory pressure, and autogenic drainage all

follow. CF patients should be given every opportunity to learn and

master

various techniques to promote mucus clearance. Key words: cystic

fibrosis, CF, airway clearance, adherence, chest physiotherapy,

breathing

games, diaphragmatic breathing, huffing, active cycle of breathing

technique, positive expiratory pressure therapy, autogenic drainage,

pediatric. [Respir Care 2001:47(7):808-817]

Introduction

Airway clearance techniques for pediatric and adult patients have

improved and changed dramatically over the last 10 years in the United

States. There is an abundance of literature about the various

techniques:

some is good science; some not so good. But all of it boils down to

enhancing the ability to clear secretions from the airways of sick

lungs.

The respiratory therapist is responsible for introducing patients to

the

various techniques at the appropriate ages. Not much has been

published

with regard to when to start the various techniques, which techniques

are

clinically useful at what age, and in what order we should teach them.

This review addresses those questions with regard to pediatric cystic

fibrosis (CF) patients. My purpose here is not to discuss the pros and

cons of the science behind the techniques or how to do the techniques,

but, rather, when, how, and why to incorporate them into the life of a

young CF patient. Many of the airway clearance techniques can be used

with other patient populations as well, but the focus here is to

provide

information clinically relevant and useful to CF patients.

PLEASE do not post religious emails to the list.

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