Airway Clearance/Hyperinflation Therapy, Non-Pharmacological — Calculating the Clinical Assessment Score — Clinical Pathway: ICU

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

Calculating the Clinical Assessment Score

For Respiratory and Secretions assessment, use the highest score out of two subcategories for calculation
Assign an additional point for each of the following:

  1. Patient has Chronic Pulmonary Illness defined as presence of:
    • Asthma
    • Chronic Lung Disease
    • Dysphagia/aspiration/gastroesophageal reflex disease
    • Neuromuscular disease, swallowing impairment
    • Primary ciliary dyskinesia
    • Sleep disordered breathing
    • Chest wall/spine physical deformities
    • Chronic/recurrent respiratory infections
    • Use of ventilators/tracheostomies at home
    • Interstitial lung disease as these can lead to chronic respiratory debilitation
  2. Lack of plateau on capnographic tracing
  3. Neuromuscular blockade
  4. Oscillations on ventilator flow tracing

Scoring Tool for Severity of Disease for Airway Clearance/Hyperinflation Therapy Pathway

Clinical Assessment Score Frequency of Therapy
Weaning therapy should not occur more frequently than
every 12 hours and should occur one step at a time
0 - 4 Discontinue, PRN, or baseline home regimen
5 - 8 8 - 12 hr
9 - 12 6 hr
13 - 16 4 hr
> 16 2 hr
  Q2 prn therapy as an exception in severe pulmonary disease process unresponsive to other therapies

Oscillations on Ventilator Flow Tracking

Lack of Plateau