How does pep therapy work

Cycles of tidal volume breaths are followed by the forced expiration technique, then coughing if secretions are in the upper airways to further mobilise secretions. For an individual with unstable airways, FET may be performed into the mask, using the expiratory resistance to assist with stabilising the airways.

The patient should be given written instructions including the technique, prescription and cleaning of the device. When using a mouthpiece PEP device, a nose-clip may be used in the initial phases of teaching the technique to minimise the loss of airflow through the nasal passages. The mouthpiece should be positioned well into the mouth, with an effective seal created by the lips.

Common hole-sizes often selected during the initial teaching session are 2. Slightly active expiration is then performed through the mouthpiece, maintaining a steady PEP of cmH 2 0 during mid-expiration. This is repeated consecutively for a number of breaths, without losing the seal of the mouthpiece. Cycles of tidal volume breaths are followed by FET, then coughing if secretions are in the upper airways to further mobilise secretions.

The positive pressure is thought to assist in splinting the airways open to reduce airway collapsibility and promote more homogenous expiratory airflow. The adapted technique of huffing through the mask a form of high pressure PEP may further improve lung emptying and assist in moving the equal pressure point EPP to move more peripherally during expiration, avoiding airway collapse and further gas trapping.

To select the correct resistance, it is preferable to use a manometer in the circuit to enable an accurate assessment of expiratory pressures and provide feedback for the patient. For most adults, a setting of 2.

Once the patient has learnt the correct use of the device, the resistor size should be moved between 2. With each resistor size, note the achieved expiratory pressure and the length of flow. The ideal setting is the resistor size that provides expiratory pressures of cmH20 maintained through the middle of expiration with good expiratory flow and the least effort.

When the resistor size has been chosen, the patient should complete a full cycle of breaths to ascertain their ability to cope with this setting.

The expiratory pressure setting should be checked at every out-patient visit as their clinical status may have changed. Patients should be given written instructions as to the assembly and care of the device and instructed not to alter the resistor setting.

For a simple, portable device a mouthpiece PEP can be set up by selecting the correct resistor as described above and placing it into a mouthpiece Fig 7. PEP therapy may be performed in a seated or gravity assisted drainage position, depending on the optimal position for secretion clearance for each individual. PEP therapy may be applied daily or twice daily in a stable clinical state. During an acute infection, the frequency, the number of breaths per cycle and the number of cycles may alter.

PEP therapy is an independent technique, able to be combined with other airway clearance options, including positioning and inhalation therapy and is beneficial for those patients with unstable or compliant airways.

There are clinical precautions which may influence the choice of this technique. It is therefore important that the technique is taught to the patient by a physiotherapist trained in this technique. Post-lung lobectomy or lung transplantation, due to the risk of pneumothorax or compromise to the anastomosis. Haemodynamic instability or severe cardiovascular disease due to the application of positive pressure to the thorax, although with low pressure PEP, the risk is minimal compared to cough.

Undrained empyema or lung abscess due to the risk of sudden release of large volume of loculated fluid. A Huff Cough will help move the mucus out of the airways. Have your child take slightly deeper breaths than normal for 1 to 2 minutes. Have your child hold their breath for 2 to 3 seconds.

Repeat 15 times 1 cycle. Keep the mask sealed around your child's mouth and nose throughout the cycle. At end of a cycle, remove the mask and perform 2 to 3 Huff Coughs. Follow this with 1 or more regular cough to clear the mucus from the large airways. Have your child rest for 1 to 2 minutes while doing the controlled breathing technique. Every day: Clean with mild soap and rinse with sterile water Air dry on a clean paper towel Disinfect.