Inhalation therapies

Inhalation therapies are a group of respiratory, or breathing, treatments designed to help restore or improve breathing function in patients with a variety of diseases, conditions, or injuries. The treatments range from at-home oxygen therapy for patients with chronic obstructive pulmonary disease to mechanical ventilation for patients with acute respiratory failure. Inhalation therapies usually include the following categories:

  • Oxygen therapy
  • Incentive spirometry
  • Continuous positive airway pressure (CPAP)
  • Oxygen chamber therapy
  • Mechanical ventilation
  • Newborn life support.

Inhalation therapies are ordered for various stages of diseases that are causing progressive or sudden respiratory failure.

Oxygen therapy is most commonly ordered to support patients with emphysema and other chronic obstructive pulmonary disease (COPD). The oxygen therapy is usually ordered once decreased oxygen saturation in the blood or tissues is shown. Oxygen therapy may also be used in the hospital setting to help return apatient's breathing and oxygen levels to normal.

Once a patient shows hypoxemia, or decreased oxygen in arterial blood, supplemental oxygen may be ordered. The main purpose of the oxygen is to prevent damage to vital organs resulting from inadequate oxygen supply. The lowest possible saturation will be given to keep the patient's measurements at a minimumacceptable level. The oxygen is administered through a mask or nasal tube, or sometimes directly into the trachea. The amount of oxygen prescribed is measured in liters of flow per minute.

In the case of respiratory distress in newborns or adults, oxygen therapy maybe attempted before mechanical ventilation since it is a noninvasive and less expensive choice.

Incentive spirometry may be ordered to help patients practice and improve controlled breathing. It may be ordered after surgery to the abdomen, lungs, neck, or head. It is designed to mimic natural sighs and yawns. A device provides positive feedback when a patient inhales at a predetermined rate and sustains the breath for a specific period of time. This helps teach the patient totake long, slow, and deep breaths. A spirometer, or equipment that measures pulmonary function, is provided to the patient and a respiratory therapist will work with the patient to demonstrate and explain the technique. Once patients show mastery of the technique, they are instructed to practice the exercises frequently on their own.

Common uses of continuous positive airway pressure include the treatment of sleep apnea and respiratory distress syndrome in both adults andinfants. Patients with sleep apnea will receive continuous positive airway pressure to prevent upper airway collapse. It is usually administered througha tight-fitting mask as humidified oxygen. The pressure of flow is constant during both exhaling and inhaling and the level of pressure is determined based on each individual. Most patients undergoing CPAP in a hospital setting will receive continuous monitoring of some vital signs and periodic sampling ofblood gas values.

Oxygen chamber therapy is ordered for various causes that indicate immediateneed for oxygen saturation in the blood. Divers with decompression illness, climbers in high altitude, patients suffering from severe carbon dioxide poisoning, and children or adults in acute respiratory distress may requireoxygen chamber therapy. In recent years, physicians have also used the forced pressure of oxygen chambers to help heal burns and other wounds because thepressure under which the oxygen is delivered can reach areas that are blocked off or suffering from poor circulation.

Also known as hyperbaric oxygen chamber or hyperbaric oxygen therapy (HBO), this treatment delivers pure oxygen under pressure equal to that of 2-3 timesnormal atmospheric pressure.

Mechanical ventilation is ordered for patients in acute respiratory distress,and is often used in intensive care situations. In some cases, mechanical ventilation is a final attempt to continue the breathing function in a patientand may be considered "life-sustaining."

In general, mechanical ventilation replaces or supports the normal lung function of a patient. Although normally delivered in a hospital, often to treat serious illness, mechanical ventilation may be performed at home under the order and supervision of a physician and home health agency. The patient will usually be intubated and the ventilator machine "takes over" the breathing function.

Newborn babies, particularly those who were premature, may require inhalationtherapies immediately upon birth because the lungs are among the last organsto fully develop. Some newborns suffer from serious respiratory problems orbirth complications, such as respiratory distress syndrome, neonatal wet lungsyndrome, apnea of prematurity or persistent fetal circulation, which may require inhalation therapies.

Premature infants, especially those born before the 28th week of gestation, have underdeveloped breathing muscles and immature structures within the lungs. These infants will require breathing support, often in the form of mechanical ventilation. The support delivers warm, humidified, oxygen-enriched gaseseither by oxygen hood or through mechanical ventilation. In serious cases, the infant may require mechanical ventilation with CPAP or positive-end expiratory pressure (PEEP) through a tightly fitting face mask or even by endotracheal intubation.

Need for continued resuscitation for newborns depends not only on gestationalage, but on signs indicating ineffective breathing, including color, heart rate, and respiratory effort. CPAP will be delivered through nasal or endotracheal tubes with a continuous-flow ventilator specifically designed for infants. An alarm system alerts the neonatal staff to problems and monitoring of breathing and other vital functions will accompany the therapy. As respiratorydistress syndrome begins to resolve, usually in four or five days, the type of support will be reduced accordingly and the infant may be weaned from the ventilator and moved to only CPAP or an oxygen hood.

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