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Airway Clearance/Hyperinflation Therapy, Non-Pharmacological — For Patients > 30 Days, in PICU and 8 South/8 Central Location — Clinical Pathway: ICU

Airway Clearance/Hyperinflation Therapy, Non-Pharmacological Clinical Pathway — ICU and Inpatient

Non-Pharmacologic Airway Clearance and Hyperinflation Therapy for Patients > 30 days, in PICU and 8 South/8 Central Location

This pathway applies to patients with a disease process leading to the need for increased respiratory support:

  • Pneumonia
  • Acute respiratory infection
  • V/Q mismatch

Exclusion Criteria

Diagnoses Present
Contraindications to Therapies Present
IPV

Intrapulmonary
Percussive
Ventilation
Absolute
Relative
Untreated pneumothorax
Active, untreated TB
TEF/recent esophageal surgery
Pulmonary hemorrhage
Radiologic evidence of bleb/bullae
Increased ICP
Hemodynamic instability
Recent orofacial surgery
Nausea/vomiting, gastric distention
HFCWO (Vest)

High Frequency
Chest Wall
Oscillation
Absolute
Relative
Unstable cervical spine
Recent skin grafts or flaps on the thorax
Burns, open wounds, and/or skin infections of the thorax
Endotracheal tube
Pulmonary hemorrhage
Fresh tracheostomy, within 7 days
Other surgical considerations
MI-E (Cough Assist)

Mechanical
Insufflation-
Exsufflation
Absolute
Relative
Untreated pneumothorax
Active, untreated TB
Increased ICP or intracranial aneurysm
Acute unstable head, neck, or spine surgery
Pulmonary hemorrhage
Hemodynamic instability
ICU Only
  • Consider team discussion when patient is receiving:
    • PEEP > 12 cm H2O
    • Inhaled Nitric Oxide
    • High Frequency Ventilation (HFV)

 

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