Pep
Pep
Pep
airway clearance. PEP creates a back pressure to stent the airways open during exhalation and promotes collateral ventilation, allowing pressure to buildup distal to obstruction. PEP eases the mobilization of secretion from the periphery toward the central airways
INTRODUCTION
The main components of the PEP device consist of a one way valve connected to either a small-exit orifice or an adjustable expiratory resistor. Sometimes a disposable manometer is incorporated to measure the expiratory pressure. Low pressure PEP devices typically generate a pressure range of 1020 cm H2O at mid-expiration. IT AIMS To reduce air trapping and optimize delivery of bronchodilators (e.g. in asthma and COPD), Enhance secretion mobilization (e.g. in cystic fibrosis, chronic bronchitis and bronchiectasis) Treat atelectasis, thus preventing recurring infection and disease progression. It promotes mucus clearance by either preventing airway collapse through stenting the airways 3 or by increasing intra thoracic pressure distal to retained secretions through collateral ventilation or by increasing functional residual capacity.
OPEP THERAPY
Oscillatory PEP Therapy OPEP therapy was first developed and described in Switzerland, as an adjunct or supplement to traditional airway clearance methods. OPEP combines the purported benefits previously described for PEP with airway vibrations or oscillations. The theoretical benefits of oscillations have been described as a 2-fold effect in airway clearance. Oscillations reportedly decrease the viscoelastic properties of mucus, which makes it easier to mobilize mucus up the airways, and create short bursts of increased expiratory airflow that assist in mobilizing secretions up the airways. Secretion removal is then facilitated by the patient forcing deep exhalations through the device or with subsequent coughing and/or huffing techniques.
OPEP DEVICES
Three OPEP devices are currently available in the United States: 1. Acapella 2.Quake 3.Flutter
FLUTTER
The basic operation of the Flutter occurs when
expiratory flow through the mouthpiece causes the ball to rise and fall within the cone, which creates a PEP between 5 cm H2O and 35 cm H2O. The vibrations, which are typically in the range 826 Hz, create airflow pulsations throughout the airways. The Flutter can be tilted (frequently referred to as tuning) slightly upward or downward to change the vibration frequency.
PEP THERAPY
ADVANTAGES
Easy method Easy to learn Less expensive Portable device
DISADVANTAGES
Risk of pneumothorax with
high pressure pep Special care in case of acute sinusitis, oral or facial surgery Fullest cooperation o the pt. Precaution for airway hyperreactivity.