1. Presented by
Ahmed Al Gahtani, BSRC, RRT
Associate Director Clinical Education
Chairman, RTS Advisory Committee
Dept. of Respiratory Therapy Program
Inaya Medical College, Riyadh
Optimizing Bronchial Hygiene Therapy

2. • The current research and clinical trials are not conclusive, and have number
of limitations regarding study design, sample number, reported positive
outcomes. (LACK OF EVIDENCE VERSUS LACK OF BENEFIT)
• The physician needs the assistance and expertise of trained and motivated
respiratory therapists.
• Bronchial Hygiene Therapy is an interactive process.
• No single method of airway clearance is better than another.
• The therapist needs to work for and with the patient to find the methods
most suitable.
• Variety helps, it is useful to be proficient in several methods of airway
clearance.
The Conclusion

4. • Measure 1:
▫ Therapist-Driven Protocol Program
• Measure 2:
▫ Patient involvement and selection of BHT technique.
• Measure 3:
▫ Therapeutic & Clinical Objective
• Measure 4:
▫ Combination & Variety of techniques
Optimizing Bronchial Hygiene Therapy
Measures to wards the right direction

5. • Deliver individualized diagnostic and therapeutic respiratory care to
patients
• Assist the physician with evaluating patients’ respiratory care needs and
to optimize the allocation of respiratory care services
• Determine the indications for respiratory therapy and the appropriate
modalities for providing high- quality, cost-effective care that improves
patient outcomes and decreases length of stay
• Empower respiratory care practitioners to allocate care using sign- and
symptom-based algorithms for respiratory treatment
Measure 1: Therapist-Driven Protocol Program
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6. • Give practitioner authority to:
▫ Gather clinical information related to the patient’s respiratory status
▫ Make an assessment of the clinical data collected
▫ Start, increase, decrease, or discontinue certain respiratory therapies on a
moment-to-moment basis
• The Innate Beauty of Respiratory TDPs Is That:
▫ The physician is always in the “information loop” regarding patient care
▫ Therapy can be quickly modified in response to the specific and immediate
needs of the patient
Therapist-Driven Protocol Program
Copyright © 2016 CLINICAL MANIFESTATIONS AND ASSESSMENT OF RESPIRATORY DISEASE, SEVENTH EDITION

7. • Respiratory TDPs significantly improve respiratory therapy outcomes,
and They do so at appreciably lower therapy costs
Clinical Research Verifies
The implementation of this protocol appears to have improved utilization
and reduced airway clearance charges to patients.
One limitation of this study is the relatively short period of time the protocol
has been in place
Copyright © 2016 CLINICAL MANIFESTATIONS AND ASSESSMENT OF RESPIRATORY DISEASE, SEVENTH EDITION

8. • Results showed a statistically significant difference with decreased
duration of therapy
• The statistically significant decrease is due to the combined effect of
therapies discontinued immediately upon assessment as well as an
overall shorter therapy duration due to the application of the treatment
flowchart/risk tool
• Conclusions: Successful implementation was facilitated by achieving
buy-in from the medical director of Respiratory Care Services as well as
medical leadership in all areas
1. Importance of communicating with physicians in ICU prior to changing
therapy on patients with higher Respiratory Risk scores
2. Vigilant monitoring of staff adherence to protocol requirements
(implementation and documentation).

9. No assessment program in place
The promise of a good therapist-driven protocol
Therapist-Driven Protocol Program
Copyright © 2016 CLINICAL
MANIFESTATIONS AND ASSESSMENT
OF RESPIRATORY DISEASE, SEVENTH
EDITION

10. Foundations for a strong therapist-driven protocol program.
The Knowledge Base Required for a Successful TDP
Program
Copyright © 2016 CLINICAL MANIFESTATIONS AND ASSESSMENT OF RESPIRATORY DISEASE, SEVENTH EDITION

11. Protocol
Copyright © 2016 CLINICAL MANIFESTATIONS AND ASSESSMENT OF RESPIRATORY DISEASE, SEVENTH EDITION

12. • Availability
• Effectiveness
• Clinical Status
• Lifestyle
• Expense
Measure 2: Patient involvement and selection of BHT
technique.
Patient Preference is Important

13. • Why are we doing
• What were the indications
• Assessment of outcomes
Measure 3: Therapeutic & Clinical Objective

14. • Combination of techniques to provide Bronchial Hygiene Therapy
improves outcomes than single technique approach.
• Variety improves patient adherence
Measure 4: Combination & Variety of techniques

15. • The current respiratory devices have been designed to enhance patients’
compliance and independence.
• Also they decrease the respiratory complications. Furthermore these devices are
easy in use and they reduce cost of therapy
• The number of published reports is limited, though more research is needed to
define the effectiveness of the devices of respiratory physiotherapy and their place
among the current techniques available
Measure 4: Combination & Variety of techniques