Airway Clearance/Hyperinflation Therapy, Non-Pharmacological Clinical Pathway — ICU and Inpatient
Airway Clearance/Hyperinflation Therapy, Non-Pharmacological Clinical Pathway — ICU and Inpatient
Clinical Assessment and Scoring Tool
Respiratory Therapist
Performs a Bedside Assessment using the Scoring Tool below
Then uses the Calculating the Clinical Assessment Score to determine score
Reviews assessment score, therapies, and frequency of therapies with clinical team
Secretion Management
Patient unable to clear secretions with cough or suction
Atelectasis on CXR with suspected retained secretions
Evidence of history of mucus plugging
Volume Expansion
Patient at risk for or with existing atelectasis unrelated to secretions
Scoring Tool for Severity of Disease for Airway Clearance/Hyperinflation Therapy Pathway
| Pulmonary Component |
Not Present Score = 0 |
Mild Score = 1 |
Moderate Score = 2 |
Severe Score = 3 |
|---|---|---|---|---|
| Acute Pulmonary Illness | No presence of or resolved acute pulmonary disease | Presence of acute pulmonary disease not requiring escalated respiratory support | Acute respiratory infection (viral or bacterial) and/or moderate V/Q mismatch receiving escalated respiratory support via CPAP/NIV | Acute respiratory infection (viral or bacterial) and/or severe V/Q mismatch receiving escalated respiratory support via artificial airway |
| Respiratory Assessment Use the highest score of the two subcategories for calculations.
|
Regular RR and pattern — |
Mild dyspnea, RR slightly increased from baseline > 10 bpm over baseline |
Moderate dyspnea, RR moderately increased from baseline > 15 bpm over baseline |
Severe dyspnea, RR severely increased from baseline > 20 bpm over baseline |
|
No retractions or increased work of breathing | Labored breathing, retractions and use of accessory muscles | Labored breathing, retractions and use of accessory muscles, nasal flaring | Labored breathing, retractions and use of accessory muscles, nasal flaring, grunting, head bobbing |
| Breath Sounds | Clear and equal aeration or baseline | Occasional adventitious breath sounds in one segment | Adventitious breath sounds or slightly decreased aeration in more than one segment | Adventitious or diminished breath sounds throughout |
| Cough | May not be present, but able to cough | Present and effectively clearing secretions | Present but weak | Non-existent or ineffective in clearing secretions |
| Secretions Use the highest score of the two subcategories for calculations.Amount |
Scant | Small amounts | Moderate amounts | Large, copious |
| Viscosity | Thin secretions | Mildly thick secretions | Moderately thick secretions | Mucus plugs |
| Oxygen Requirement | No supplemental oxygen required to maintain SpO2 > 95% |
SpO2 92 – 94% on room air | Supplemental FiO2 < 0.40 to maintain SpO2 > 92% with or without PPV | Supplemental FiO2 > 0.40 to maintain SpO2 > 92% with or without PPV |
| CXR within 48 Hours | No evidence of hyperinflation, infiltrate, or atelectasis | Mild atelectasis (restricted to one lobe) |
Moderate atelectasis or opacities (restricted to one side) | Severe atelectasis, bilateral opacities/infiltrates |
| Surgery | None in the past 7 days, ambulation and activity level appropriate for age | Minor surgery with minimal restrictions to ambulation and activity level | Major spinal, lower extremity, or neurosurgery with moderate restrictions to ambulation and activity level | Major thoracic or abdominal surgery |