咳嗽能力之評估及促進技術.pdf

Cough Assessment and Augmentation 咳嗽能力之評 估及促進技術 赴碧燕 The 2nd Critical Rehabilitation and 香港物理治療師 Cardiopulmonary Rehabilitation Seminar 23 SEPTEMBER 2017 Cough Augmentation 4 Phases of cough Diaphragm Glottic Closure Anterior/lateral Muscles Intercostals Lateral crioarytenoids abdominals Accessories transverse arytenoid Accessories Cough efficacy in healthy individual 7th to 12th generation Cough reflex Normal cough Inspiratory volume of around 2.3L but 50% of vital capacity Normal cough Glottic closure for 0.2 second Normal cough Contraction of the expiratory muscles intact expiratory muscle MEP 60cmH2O producing a audible noise Normal cough Inspiration ▪ 60-90% Total Lung Capacity Contraction phase ▪ patients glottis closes and the expiratory muscles begin to contract. This phase lasts only 0.2 seconds; however, during this time, elevated intrathoracic pressures are reached Expulsion Phase ▪ Glottis opens, shearing force created. During this expiratory phase flow rates of 360 to 1000 L/minute are generated in a normal cough Cough assessment ▪Airflow Waveforms ▪Flow Volume Loops (Cough spikes) ▪Spirometry ▪Maximal Insufflation Capacity ▪Peak Cough Flow ▪Respiratory Muscle Testing Measurement of PCF ▪The peak flow meter is connected to the face mask ▪The patient is asked to take a deep