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WELCOMEAll Modes of Airway Clearance

The Healthcare Environment Today

Current Situation• Respiratory complications are a

major concern• More focus on hospital acquired

infections• Changing Reimbursement

Strategies to Avoid Re-admission • Identifying patients at high risk• Early detection of respiratory

complications• Early intervention of airway clearance

Could result in:• Fewer pulmonary complication• Healthcare savings• Improved patient outcomes • Improved quality of life

Know which modality for which patient

• Chest Physical Therapy• Therapy Beds• Coughing Techniques• Mechanical Insufflation – Exsufflation• Breathing Techniques• Positive Expiratory Pressure / Oscillatory PEP• Intrapulmonary Percussive Devices• High Frequency Chest Wall Oscillation• Other adjuncts to Airway Clearance

Airway Clearance Techniques

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• Cognitive limitations– Age / mental status– Sedation

• Physical ability– Coordination / strength– Shortness of breath / fatigue– Mechanical Ventilation / Artificial Airways

• Promote improved compliance / adherence when: – Effective, without side effects– Comfortable– Time efficient– Adaptable with illness– Can be used in any setting– Easy to teach, learn and use

Considerations for Selecting an Airway Clearance Modality

Better understanding of airway clearance options:• Definition of each device / technique• Mechanisms of action• General technique for delivering therapy• Level of patient participation required• Advantages / limitations of each• Finding the best airway clearance option or combination of options for

each individual patient

Today’s Objectives…

Chest Physical Therapy

• Percussion / vibration

• Postural drainage

• Mechanical percussors

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Chest Physical Therapy

• 12 positions using: – Gravity– Percussion– Vibration

• Time consuming• Labor Intensive• May be harmful in some

patients1

1SELSBY DS, BMJ VOLUME 298 4 MARCH 1989

Hand-Held PercussorsManual, Electronic or Pneumatic

• Features to support ventilator-associated complication protocols‒ Digital HOB angle indicator and alarm‒ Continuous lateral rotation therapy (CLRT)

Pulmonary Surface (Powered Air)

• Pulmonary surface (powered air)‒ Percussion and Vibration

‒ Helps prevent ventilator-associated complications when used with CLRT

Continuous Lateral Rotation (CLRT)Percussion & Vibration Therapy Beds

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Advantages

• Effective proven therapy• Requires no equipment• May be used on very young

patients• Promotes time with caregiver

Limitations

• Technique dependent• Physically demanding on patient

and staff• Time consuming for patient and

staff• Infection control issues • Reflux related respiratory

complications• Age / weight restrictions on beds• Maintenance of beds

Chest Physical Therapy

Coughing Techniques and DevicesComing Up Next

• Red face• Distended neck veins• No airflow after first or second

cough• Decreased sats• Bronchospasms• Ineffective body position

Paroxysmal Cough

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Egans Fundamentals of Respiratory Care Ninth Edition. Wilkins R, Stoller J, Kacmarek R. Section V, Chapter 40, pages 921-9461

• Definition– One or two forced expirations without closure of the glottis1

– Followed by a period of diaphragmatic breathing and relaxation1

• Theory– The goal is to help clear secretions with less change in pleural

pressure and less likelihood of bronchiolar collapse1

– Periodic diaphragmatic breathing and relaxation following forced expiration restores lung volume and minimizes fatigue1

Huff Cough / Forced Expiratory Technique (FET)

Huff Forced Exhalation Technique1

1. 3–5 slow deep breaths through nose, exhaling through pursed lips,

using diaphragmatic breathing

2. Take a deep breath, hold for 1–3 seconds

3. Exhale contracting abdominal and chest wall muscles, with glottis

open during exhalation

4. Repeat several times

5. As secretions enter the larger airways, exhale from high-to-mid lung

volume

6. Repeat maneuver 2–3 times

Forced Expiratory Technique, Directed Cough, and Autogenic Drainage. James B Fink MSc RRT FAARC RESPIRATORY CARE • SEPTEMBER 2007 VOL 52 NO 9; page 12131

Egans Fundamentals of Respiratory Care Ninth Edition. Wilkins R, Stoller J, Kacmarek R. Section V, Chapter 40, pages 921-946

• External application of pressure to the thoracic cage or epigastric region, coordinated with forced exhalation

• Mimics the normal cough mechanism by generating an increase in the velocity of the expired air

Who could benefit?• Neuromuscular patients• Patients unable to generate the forceful expulsion of air

needed to move secretions toward the trachea

Manually Assisted Cough

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Homnick DN Mechanical insufflation-exsufflation for airway mucus clearance. Resp Care 2007; 52 (10): 1296-1305.

Mechanism of action:1. Inflation of the lungs with positive pressure 2. Followed by an active negative pressure exsufflation3. Creates peak and sustained flows

– High enough to provide adequate shear and velocity to loosen and move secretions towards the mouth for clearance by expectoration or suctioning

Mechanical Insufflation-Exsufflation (MI-E)

Mechanical Insufflator – Exsufflator Devices

• Non-invasive• Lung Expansion• Cough Clearance

Optional Foot Pedal for purchase

VitalCough™ System User Manual (178729 REV 1) p.21

Mechanical Insufflator – Exsufflator

Circuits will contain the following; adapter, breathing hose, bacterial/viral filter, and the patient interface.

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Mechanical Insufflator – Exsufflator

• Multiple patient interfaces– Mouthpiece– Face mask– Adaptor to a tracheostomy

The following will need to be programmed before you initiate treatment

Automatic SettingsInhale Pressure*

Exhale Pressure*

Resting Pressure/PAP*

Flow Rate*

Manual SettingsInhale Pressure*

Exhale Pressure*

Resting Pressure/PAP*

Flow Rate*

*Indicates the settings that are set for both automatic and manual modes

VitalCough™ System User Manual (178729 REV 1) p.40-55, 57

Number of cycles to be completed foreach treatment setInhale breath time

Exhale breath time

Pause Time

Lock Device-optional optional both modes

Manual or Automatic Mode Programming

Mechanical Insufflator – Exsufflator Technique

Start at 10-15 cmH2O recommended for those new to the device

– Pressures can be increased as necessary to achieve adequate secretion clearance

– Typical inhale pressures 15 cmH20 to 40 cmH20– May vary depending on lung and chest wall compliance– Optimal exhale pressure 35 cmH20 and 45 cmH20

Automatic: Inhale, exhale, pause times– Inhale 2-3 seconds / exhale 1-2 seconds– Neutral (Pause) few seconds

4 – 5 cough cycles / remove visible secretions

Rest 20 to 30 seconds

Repeat 4 – 6 times or until clear

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2

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Advantages

• Lung expansion• Cough augmentation• Alternative to suctioning• Non-invasive• Multiple patient interfaces• Alert or unconscious patient• May be used on very young

patients• Combine with other therapies

Limitations

• Incomplete AWC device• Mask / mouthpiece seal• Cleaning / changing circuit• Change filter when soiled or wet• Maintenance required

– Periodic operation verification– Change internal fuses if blown

• Assure air intake ports are not blocked

Mechanical Insufflation – Exsufflation

Breathing TechniquesActive Cycle Of BreathingAutogenic Drainage

Coming Up Next

Active Cycle of Breathing Technique (ACBT)

A cycle of breathing techniques; Breathing Control (BC), Thoracic Expansion Exercises (TEE) and Forced Expiratory Technique (FET)1

– BC to help prevent bronchospasm– TEE to loosen secretions, improve distribution of ventilation and provide

volume needed for a forced expiratory technique– FET to clear secretions with less change in pleural pressure and less

likelihood of bronchiolar collapse

TheoryEgans Fundamentals of Respiratory Care Ninth Edition. Wilkins R, Stoller J, KacmarekR. Section V, Chapter 40, pages 921-9461

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Breathing Control • Gentle diaphragmatic

breathing at tidal volume1

• Relaxation of the upper chest and shoulders1

Thoracic Expansion Exercises • Deep inhalation• Relaxed exhalation• 3-4 TEE’s1

Forced Expiratory Technique• 1-2 forced expirations

to middle to low lung volumes without closure of the glottis1

Egans Fundamentals of Respiratory Care Ninth Edition. Wilkins R, Stoller J, KacmarekR. Section V, Chapter 40, pages 921-9461

Pryor Jennifer A. Booklet: Physiotherapy for people with Cystic Fibrosis: from infant to adult. 4th edition 2009; page 6: available online on www.cfww.org/ipg-cf/22

Repeated until huff dry sounding and non-

productive or it is time for a rest2

Active Cycle of Breathing TechniqueComponents, Sequence & Duration Adapted to Need

Theory

Autogenic Drainage (AD)

• Three-phased breathing regime using high expiratory flow rates at varying lung volumes to facilitate mucus clearance– Attain highest possible expiratory flows without forced expirations and

associated airway closure– Move mucus with a relaxed sighing exhalation, regulating airflow and velocity

with use of expiratory muscles, avoiding unnecessary expiratory resistance

Forced Expiratory Technique, Directed Cough, and Autogenic Drainage. James B Fink MSc RRT FAARCRESPIRATORY CARE • SEPTEMBER 2007VOL 52 NO 9

UnstickLLV

CollectMLV

EvacuateHLV

TV

ERV

RV

HUFF

COPDVOL

PREDVOL

*May be difficult with advanced disease

Breathing Phases of Autogenic Drainage

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Advantages

• Effective techniques• No equipment• Preferred over CPT• Saves treatment time• Active Cycle of Breathing Technique

– Easy to teach– Easy to learn

Limitations

• Limited by age / cognition• Dependent on patient effort /

ability• Autogenic Drainage

– Time consuming to teach

– Difficult to learn– Maintenance technique

Active Cycle Breathing Technique and Autogenic Drainage

Lung Expansion Therapy

• Prevent / reverse atelectasis

• Simulate / re-establish normal breathing

• Mimic natural sigh / yawn

• Deep breathing exercises

• Incentive spirometry

• Handheld devices

• Mechanical devices

http://www.smiths-medical.com/catalog/lung-expansion/ezpap-positive-airway-pressure/ezpap.html

Positive Airway Pressure System

Indicated for:• Treatment/prevention of

atelectasis• Need for lung expansion

therapyMay be used with:

• Mask• Mouthpiece• Nebulizer

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Positive Expiratory Pressure (PEP) DevicesComing Up Next

Theory

Positive Expiratory Pressure (PEP)

• Alters airflow and pressure behind mucus via collateral ventilation• Stabilizes peripheral airways• Increases pressure gradient across mucus plug forcing secretions

central• Increased outward pull on alveoli

Positive Expiratory Pressure Devices

TheraPEP® PEP Therapy SystemSmiths Medical ASD, Inc.

PARI PEP™ S SystemPARI Respiratory Equipment, Inc.

Threshold® PEPPhilips Respironics

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Oscillatory PEP Devices

Flutter® Mucus Clearance DeviceAxcan Pharma™ US, Inc.

Quake®

Thayer Medical Corporation

acapella ® Vibratory PEP Therapy SystemsSmiths Medical ASD, Inc.

acapella® choice acapella® duet

Oscillatory PEP Devices

Aerobika®

Monaghan™

The VibraPEP®

Curaplex®

Lung Flute®

Medical Acoustics, LLC

• Creates low frequency acoustical sound waves¹• Secretion mobilization and induction device¹• Components include: plastic mouthpiece, reed, 14.5 inch hardened plastic horn²

¹http://www.lungflute.com/medical-professionals.php²http://www.lungflute.com/PDF/lungflute-physics-physiology.pdf

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PEP/Oscillatory PEP TechniqueInstruct individual to sit comfortably and upright while holding mouthpiece firmly in mouth or mask firmly to face

Adjust resistance to prescribed setting

Have patient breathe in a larger than normal breath, but not to total capacity

and exhale gently through device

– maintain a pressure of 5-20 cm H2O or no longer than a 1:3 inspiratory to expiratory ratio

Have patient perform 10-20 breaths, then 2-3 Huffs

– With oscillatory PEP devices, patient should first perform forced maneuvers through device to facilitate secretion removal, then follow up with huffs

Repeat steps until:

– Secretions are cleared– Or the predetermined period has elapsed

Respiratory Care, October 2007 Vol 52 No 10 pages 1308-1327

Advantages

• Prefer over CPT• Easy to learn• Saves treatment time• Provides independence• May be used with a mask

Limitations

• Age / cognition levels• Patient effort dependent• Requires tight seal with

mouthpiece / mask • Most are flow dependent• Require periodic replacement• Cleaning required – follow

individual device manufacturer instructions

PEP / Oscillatory PEP

Intrapulmonary Percussive DevicesComing Up Next

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A therapeutic device that uses a systematic approach to enhance normal mucus clearance and resolve or prevent atelectasis.For use in Acute Care and Long Term Care

The MetaNeb® System User Manual (174432 REV 1) page 1-4

Offers 3 therapies:1. Continuous Positive Expiratory Pressure (CPEP)

– Lung expansion therapy 2. Continuous High Frequency Oscillation (CHFO)

– Secretion mobilization therapy3. Aerosol Mode

– Aerosol therapy

• Provides supplemental oxygen when used with compressed oxygen

3 in 1 Therapy with Intrapulmonary Percussive Devices

Indicated for lung expansion and secretion mobilization therapies for the treatment and prevention of atelectasis and the complications of retained secretions

3 in 1 Therapy with Intrapulmonary Percussive Devices

1 molecule of therapy

Gas entrains 5 molecules

of air

Venturi Throat Jet

Venturi and Entrainment of Ambient Air

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Venturi and Entrainment of Ambient Air with Decreased Airway Compliance

• “1 dot” position – largest opening with least resistance

• “2 dot” position – creates more resistance

• “3 dot” position – smallest opening with most resistance

Exhalation Orifice

Blue Selector Ring

3 levels of Positive Expiratory Pressure (PEP) available

Additional Positive Expiratory Pressure

The MetaNeb® System

Mouthpiece Face Mask Tracheostomy In-line with Ventilator

Multiple Patient Interfaces

15. The MetaNeb® System User Manual (174432).

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The MetaNeb® System - Easy Treatment to Deliver

Delivering a Treatment

1. Begin with CPEP Mode.

2. Adjust flow and selector ring to patient comfort / needs

3. Continue CPEP Mode ~ 2 ½ minutes.4. Move the Higher/Lower dial to Higher.

• Higher/Lower dial may be moved if needed5. Change mode to CHFO Mode.

6. Continue CHFO Mode for ~ 2 ½ minutes.

7. Alternate between CPEP and CHFO ~ every 2 1/2 minutes. 8. Deliver treatment for 10 minutes or depending on patient need

or as otherwise provided in institutional protocol.

Follow instructions stated in the User Manual

15. The MetaNeb® 4.0 System User Manual (174432).

Higher

Lower

The MetaNeb® System - Easy to Deliver In-Line with a Ventilator

Delivering a Treatment1. Connect The MetaNeb® System to 50 psi oxygen source.

2. Set the mode to CHFO and select Higher.

3. Put the master switch in the ON position.4. Put a spring-valve "tee" adapter in inspiratory limb of ventilator

circuit.

5. Monitor and continue the treatment for 10 minutes or per facility protocol.

6. Adjust the alarm parameters as necessary during in-line therapy.7. Suction secretions as necessary during treatment.

8. Remove the handset and adapter from the spring-valve tee and cap before you put The MetaNeb® System master switch in the OFF position.

9. Return the ventilator alarms and mode to their previous settings if needed.

Follow instructions stated in the User Manual15. The MetaNeb® 4.0 System User Manual (174432).

• Delivers aerosolized medication and oscillates during inhalation and exhalation to help remove endobronchial secretions¹

• Single patient, multiple use device

• Hospital or home use

• May purchase compressor for home

PercussiveNEB® User Guide, rev. 3.5.2008, pages 2-11

High Frequency Intrapulmonary Percussive Nebulizer

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• During inhalation ‒ The patient entrains high density aerosol from the nebulizer with high

frequency intrapulmonary percussion for enhanced aerosol deposition

• During exhalation‒ High frequency (11-30 Hz) pressure bursts create a gas bolus velocity

profile that travels down the center of the bronchial airways

‒ Exhaled gas to travel at high speeds along the wall of the bronchial airways

‒ Imparts a sizeable force on bronchial secretions moving them up and out of the airways¹

PercussiveNEB® User Guide, rev. 3.5.2008, pages 2-11

Theory of Operation

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2

3

4

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TechniquePlace prescribed medication into nebulizer reservoir and add saline

-Reservoir holds 20 ml and typically uses 1 ml/min (residual)

Attach high flow source to 60 l/min (±25%)

– May be used with compressed air or oxygen

Intended to be used only on those patients who are able to breathe

spontaneously and to be used with the attached mouthpiece

Adjust flow rate until modulator piston begins to oscillate and adjust

as needed for patient comfort

Adjust oscillating amplitude as needed for patient’s comfort, starting

with soft and increase to hard setting once patient appears

comfortable with good breathing pattern

Treatment times are typically 15 – 20 minutes

Advantages

• Customize treatments• Internal vs. external application• Aerosol delivery• Ability to deliver oxygen with

therapy• Delivers PEP• Shorter treatment times• Single patient multi-use circuits• May be used on very young

patients

Limitations

• Cleaning after every use recommended

• High pressure / flow gas source required

• Patient technique with mouthpiece

• Requires proper training– Staff – Patient

Intrapulmonary Percussive Devices

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High Frequency Chest Wall Oscillation (HFCWO)Coming Up Next

HFCWO for Airway Clearance System

The Vest® Airway Clearance System, Model 105User Manual (145330 REV 7) page 10

An Air Pulse Generator, connected by hoses to an inflatable garment that is rapidly inflated and deflated, creating High Frequency Chest Wall Oscillation (HFCWO)

HFCWO generates increased airflow velocities:

• Creates repetitive cough-like shear forces & an expiratory airflow bias

– Decreases viscosity of secretions

– Dislodges and moves secretions toward central

airways

HFCWO for Acute Care/Long-Term Care

The Vest® System Generator• Rolling stand• Adjustable height• Disposable Air Hoses

The Vest® System Disposable Garments• Single patient use (SPU)• Color coded to size

Wrap SPU Vest• Extra small (19”) to XXL (75”)

Full SPU Vest• Child medium (23”) to Adult Large

(52”)

33. The Vest® Airway Clearance System, Model 105 User Manual (145330 REV 13)

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HFCWO for Home Care

• Color options• Inflatable bladder• Outer shell • Soft fabric with Dupont™ Teflon® stain protection• 3D Mesh lining for breathability• Machine washable and machine dryable

C3® Garment Line

Classic Garment Line

Chest Vest Sizes Small, Medium, Large, X Large 28” to 67”

Wrap Vest Sizes X Small to XX Large 19” to 75”

• Easy to use with multiple program options• Eases into therapy to maximize comfort• Hour meter reading from main menu• Small one bag system on wheels

33. The Vest® Airway Clearance System, Model 105 User Manual (145330 REV 13)

HFCWO for Airway Clearance System

• Normal Mode- Set frequency, pressure and time.

• Program Modes- Program A & B: Use the preset

program or customize up to 8 different frequencies, pressures and times within one session with a Cough Pause™ option.

• Ramp Mode- Gradual increase of frequency and

pressure over a period of time.

• Set default settings for above modes.• Ability to change language to Spanish.

Most Commonly used treatment settings in home care:• Twice a day treatment

• Time: 20 minute treatment

• Frequency: 10-14 HZ• Pressure per garment style

– C3 (full) garment – pressures of 4-6

– Wrap garment and Chest Vest

garment – pressure of 1-4

Programmability 33Most Commonly Used Settings 52

Eases into Therapy - Gradual increase in frequency & pressure to pre-set level.

33. The Vest® Airway Clearance System, Model 105 User Manual (145330 REV 13)52. Data report (2017). Most Commonly Used Settings on file at Hill-Rom, Inc.

• Has been shown to help remove mucus from people’s lungs• Just some of the conditions/diseases that may benefit:

– Cystic Fibrosis– Bronchiectasis– Neuromuscular / Neuromotor Disease– Cerebral Palsy– Chronic Bronchitis– Asthma– Emphysema– Quadriplegia– Obesity– Many other conditions

High Frequency Chest Wall Oscillation

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New Mobile Technology in High Frequency Chest Wall Oscillation(HFCWO)

Battery powered HFCWO combining Mobility with Targeted Kinetic Energy and Airflow to mobilize secretions.

The Monarch™ Airway Clearance System is a HFCWO therapeutic device that is used to aid mobilization of secretions from the airways and help improve airway health.1

1. Monarch™ Airway Clearance System User Manual (195292) page 91.

Intentional Design – Design Matters

1. Creates impulse force (Kinetic Energy ) to:1,2,3,4

• Help break up secretions3

• Help loosen secretions3,4

2. Creates airflow within the lungs to:2,3,4,5

• Help mobilize secretions from the small airways to the large airways where they can be coughed out or suctioned.

Powered by POD Technology1

• 8 pulmonary oscillation discs (PODs) anatomically positioned on the chest wall to treat all lobes of the lungs. The PODs oscillate and provide a targeted kinetic energy to the lungs.

1. Monarch™ Airway Clearance System User Manual (195292) page 91, 95.2. Airflow data: Independent lab testing analyzed and compared average airflows at the mouth generated by high frequency chest wall oscillation (HFCWO) therapy in 10 human subjects using home care garments. Airflows

measured at maximum intensity at multiple therapy frequencies (5, 10, 15, and 20 Hz). Impulse force data: Bench testing conducted at maximum intensity at multiple therapy frequencies (5, 14, and 20 Hz). Test data and reports on file at Hill-Rom, Inc.

3. Kendrick A. (2012) Airway Clearance Techniques in Cystic Fibrosis: Physiologu, Devices and the Future, Cystic Fibrosis – Renewed Hopes Through Research, Dr. Dinesh Srifamulu (Ed), ISBN: 978-953-51-0287-8, InTech, Available from http://www.intechopen.com/books/cystic-fibrosis-renewed-hopes-through-research/airway-clearance-tecniques-in-cystic-fibrosis-physiology-device-and-the0-future

4. www.rcjournal.com/cpgs/pdtcpg.html. AARC Clinical Practice Guidelines. (December 1991) Respir Care 1991; 36 (12):1418-1426 accessed 4-5-2017.5. King M, et al. (1984). Tracheal mucus clearance in high-frequency oscillation. II: Chest wall versus mouth oscillation. Am Rev Respir Dis, 1984. 130(5): p. 703-6 King M, et al. Tracheal mucus clearance in high-frequency

oscillation. II: Chest wall versus mouth oscillation. Am Rev Respir Dis, 1984. 130(5): p. 703-6.

4 PODs on the front 4 PODs on the back

Indications for Use• The Monarch™ product is intended to provide Airway Clearance Therapy and

promote bronchial drainage where external manipulation of the thorax is the physician’s choice of treatment. It is indicated for patients having difficulty with secretion clearance, or the presence of atelectasis caused by mucus plugging.

• The Monarch™ Airway Clearance System is intended to be used in the Home Care environment by patients, 15 years and older. 38

38. Monarch™ Airway Clearance System, Model 1000 User Manual (195292).

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Treatment Adherence Can Be Low • Low adherence can affect important health outcomes including pulmonary exacerbations. 34

• Assessment and monitoring considered an integral part of management to ensure treatment interventions are optimized. 34

VisiViewTM Health Portal - Remote Therapy Monitoring With The Vest® System or the Monarch® System

• Patient’s opt in for the connectivity.• Connects patients wirelessly to their care team via the VisiView™

Health Portal.

• The dashboards and prompt feedback helps to motivate patients.

• Clinic and patient-specific dashboards to utilize adherence information to tailor care decisions

• Encourages adherence through collaboration.

34. McCullough, A. et al. (2014) Treatment adherence and health outcomes in patients with bronchiectasis. BMC Pulmonary Medicine 2014, 14:107. http//www.biomedcenter.com/1471-2466/14/107.

Advantages

• Less physically demanding on patient and staff

• Consistent quality therapy• Disposable garments / air hoses• Doesn’t require patient

cooperation / effort• Aerosol treatments

Limitations

• Requires manipulation of thorax

• Patient must be able to wear vest garment

• Follow Manufacturer’s cleaning guidelines

HFCWO

Mobility Exercise Activities

Adjuncts To Airway Clearance

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Chair Egress Lift SystemSide Egress

Flexible frame configurations, egress positions & integrated lift systemsHelp move patients easily & safely through all stages of early mobilization

Surface & Frame - Advancing Mobility

Benefits of Exercise• Improves general fitness

• Stimulates deep breathing• Uses oxygen more efficiently

• Loosens mucus by moving large volumes of air

• Creates environment less conducive to organism growth

• Preserves the elasticity of the lung

• Provides increased stamina• Builds muscle mass and weight gain

• Provides sense of independence and well being

w w w .heathersanim ations.com

The Challenge…

Identifying patient’s acute & chronic airway clearance needsand finding the best modalities for each individual patient’s may

• Decrease incidence or severity of PPC• Decrease morbidity / mortality• Reduce ICU time• Reduce length of stay• Help address readmissions / hospitalizations for the complication of retained

secretions• Decreased healthcare costs related to the complication of retained secretions• Improve QOL for patients and their families

Work with HCT, insurers, manufacturers, patients and familiesto find best modality or combination of modalities for

each individual patient

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What to Use When?Finding the Best Modality or Combination of Modalities

THANK YOU

You Are In The Best PositionTo Make The Difference!