Positive Expiratory Pressure Therapy PEP Overview呼气末正压治疗PEP概述.ppt

Positive Expiratory Pressure Therapy PEP Overview What is PEP? History of PEP Current PEP Devices Clinical Evaluation Conclusion What is PEP? PEP is a form of bronchial hygiene, and is one of the 3 adjuncts of positive airway pressure (PEP, CPAP, and EPAP). PEP involves active expiration through a one-way valve against a variable flow resistor. In modern PEP devices, flow resistance can be manipulated to adjust for a desired pressure. What does PEP do? Enhances secretion mobilization and removal Helps prevent infections Helps mitigate atelectasis Improved pulmonary mechanics and gas exchange How does PEP accomplish this? 2 ways: Filling under-inflated or collapsed alveoli via collateral ventilation (pores of Kohn, Canals of Lambert).* Helping to stint the airways open during expiration. History of PEP Origin of PEP -Traditional CPT with manual percussion, postural drainage, and vibration was first introduced in 1901 to assist airway clearance in children with bronchiectasis. -In the 1970’s PEP devices were developed in Denmark, as a means to aid the patient’s airway clearance with an effective, self-administered low-pressure device (mouth piece @ 5-20 cm H20). -High-pressure PEP therapy was developed in Austria (face mask @ 26-102 cm H20). -In 1991, PEP was introduced in the U.S. by Louise Lanafours from Sweden. -Since 1991, PEP devices have been modified and improved upon, which have produced devices such as the TheraPEP and Acapella. Current PEP Devices Airway Oscillation Devices (AOD) Provide standard PEP with the added benefit of oscillating pressure within the airway Oscillations reduce the viscoelasticity of mucus Oscillations provide short bursts of increased expiratory airflow to help with secretion mobilization Flutter Valve TheraPEP Acapella Current PEP Devices Flutter Valve Developed in Switzerland Pipe-shaped AOD with a steel ball resting in an angled bowl. On exhalation, the ball oscillates at approximately 15 Hz, and provides 10-25