Impaired Airway Clearance
It again has been a pretty uneventful week in the cardio placement and I will dig deep for this blog so do bear with me guys on this one. I would like to discuss when Impaired Airway clearance is actually a problem with the surgical patient. I have seen a few patients with either a sternotomy for CABG or valve replacement or a thoracotomy for a lung resection or a laparotomy for numerous reasons. Now the criteria on Ax for impaired airway clearance is :
1. The presence of sputm either found out subjectively or on auscultation or a moist cough
2. The inability of the patient to clear the sputum independently which could be due to pain, weak cough, thick secretions, conscious state.
The ones that I question is even if a patient has thick sputum but they can cough it up they then do not have impaired airway clearance and also if a patient has sputum and a weak cough that is limited by pain the problem is not impaired airway clearance but pain. Control, the pain and they can clear it themselves. I would like to hear some thoughts from those cardio purists out there (Tam) and so do we really need to see these patients if they can clear secretions and impaired airway clearance is their main problem?
posted by Col @ 8:00 AM
2 Comments:
Ok Colin you asked for my opnion so here it goes: yes i see where you are coming from in saying that if a patient is able to clear there own secretions then it is not really a problem that we have to deal with. But when the secretions get to the point where the patient is unable to clear them, either due to pian or what not then that is when we have to step in. I don't agree with the whole if you control the pain then they can clear it themselves. Is it really that simple? I don't know about you, but any patient that I have seen who complains of pian and they are given pain cover, thier pain is never totally eliminated. Besides, they tend to be very apprehensive about doing a proper cough because they are afraid of distrubing the wound, so if we were to leave them to their own defices I feel that would still not be able to produce a cough effective enough to clear those secretions. That is why we were taught all those techniques, such as supportive cough, huff and SMI's to help to bring up the secreations with less effort then a normal cough. The whole point of clearing the secretions to to prevent lung infections from occuring. Therefore, I feel that if the patients main problem is Impaired airway clearance then I still think they need to be seen.
Hi Col, think pain is definitely an issue with most surgical patients as forced expiratory techniques are really taxing on them. Tam has pointed out really good points on why we have to see them and just adding in my two cents worth here. Guess we also need to consider the history of the patient ie smoker cos we know they'll probably be more productive and may need help with clearance. Also, we need to know that most surgical patients have been on general anaesthesia and one of the effects if we can remember is decreased mobility of the cilia and will impair airway clearance. GA will also affect diaphragm function, decreasing the tidal volume and hence affect the effectiveness of shifting secretions/expectorating of the whole lung. Its always good to check on them just to make sure. Even if they seem to be able to clear their airways independently, are they doing it correctly/are there more effective methods to help them? Or on auscultation they are still having problems with their lower lobes? You never know until to assess and see for yourself.
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