Week 3 #3 - The Bird Machine

Today, we were referred to see at 91 yr old lady for chest physio. We read the file and it stated that she was a paraplegic from T7 down. So this was going to be interesting!
We found her sitting in the chair and coughing a very moist and effective cough.
We auscultated her and found that she had decreased breathe sounds in the lower zones of her lungs.
We tried to do some deep breathing to help get the sputum up, but found that her diaphragm excertion wasn't great, and she was using her accessory muscle and hitching her shoulders when trying to take a deep breath.
My supervisor concluded the lack of diaphragmatic excertion due to her paraplegia with secondary weakness to the muscles of respiration, so she thought she might use the bird machine.
I found this a really interesting machine. It forces the air down to the lower airways when you breathe in causing a postive pressure and allows for the sputum to be moved easily. It stops blowing air into your lungs when you take a breath out. Coupling this with vibes on exhalation, the IPPB was a very effective treatment for this lady as after a cycle, we got her to cough and she was productive of a light yellow runny sputum, which she was previously having trouble getting up.
After been shown how to use the machine it is very easy, because the patient controls it with their breathing.
If i was to do this treatment again, i think i would get the lady to huff instead of cough, as it did make her very SOB and she was having to use a lot of force behind that cough to get up the sputum, and the huff might have been a bit less exerting for her.