Lung Expansion Therapy: Overview and Practice Questions

Lung expansion therapy is a crucial component of respiratory care aimed at preventing and treating complications such as atelectasis, hypoxemia, and impaired gas exchange.

Whether a patient is recovering from surgery, dealing with a chronic lung condition, or experiencing reduced mobility, this therapy plays a vital role in maintaining healthy lung function.

By using targeted techniques like deep breathing exercises, incentive spirometry, CPAP, and early mobilization, lung expansion therapy helps reopen collapsed alveoli, improve oxygenation, and enhance overall pulmonary performance.

In this article, we’ll explore the different types of lung expansion therapy, how they work, and when they are most effective.

What is Atelectasis?

Atelectasis occurs when part or all of a lung collapses or fails to inflate fully. This can lead to reduced oxygen exchange, making breathing less effective and increasing the risk of further complications.

Causes

Atelectasis results from a blockage of the airways or pressure from outside the lung. Common causes include mucus plugs, foreign objects, or tumors that obstruct airflow. Surgery, particularly chest or abdominal surgery, raises the risk because pain or medications may suppress deep breaths and coughs that help keep the lungs expanded.

Other contributors are chest injuries, lung diseases, or conditions causing shallow breathing. Prolonged bed rest or immobility often lowers a person’s ability to clear secretions and fully expand the lungs. In some cases, inhalation of certain anesthetics can decrease the drive to breathe deeply, increasing the risk of lung segments collapsing.

In children, inhaling small objects often leads to atelectasis. In adults, chronic lung diseases and smoking may make it harder for the lungs to clear mucus, raising the risk.

Symptoms

Symptoms of atelectasis depend on the extent and speed of lung collapse. Minor cases may cause few or no symptoms. More extensive collapse often causes shortness of breath, rapid shallow breathing, or chest discomfort.

Coughing or wheezing can occur, especially if the cause is airway obstruction. Low blood oxygen levels may result in bluish skin or lips (cyanosis) and increased heart rate. Some individuals experience increased fatigue and difficulty exercising.

In cases related to infection, fever or increased sputum production may develop. Physical examination may reveal reduced chest motion on the affected side and decreased breath sounds upon listening with a stethoscope. Prompt recognition of symptoms helps guide effective treatment.

What Is Lung Expansion Therapy?

Lung expansion therapy is a set of techniques and treatments designed to help improve lung inflation, prevent alveolar collapse (atelectasis), and enhance overall respiratory function. It is commonly used in patients recovering from surgery, those with limited mobility, or individuals with conditions that impair normal breathing, such as COPD or pneumonia.

The primary goal of lung expansion therapy is to increase the volume of air entering the lungs, thereby promoting better oxygen and carbon dioxide exchange. This is achieved through methods like deep breathing exercises, incentive spirometry, CPAP, positive airway pressure devices, and early mobilization.

By encouraging fuller breaths and maintaining open airways, lung expansion therapy reduces the risk of complications such as infection, hypoxemia, or respiratory failure. It is often administered under the guidance of respiratory therapists and tailored to each patient’s clinical needs and capabilities, making it a key component of respiratory care and recovery.

Types of Lung Expansion Therapy

Lung expansion therapy consists of targeted techniques used to optimize lung inflation, improve gas exchange, and prevent or treat atelectasis. These methods are essential for patients at risk of respiratory complications, particularly those recovering from surgery, suffering from prolonged immobility, or managing chronic pulmonary conditions.

Here are the main types of lung expansion therapy, each with distinct mechanisms and clinical applications:

Early Patient Mobilization

Early patient mobilization refers to initiating physical activity—such as sitting up in bed, dangling the legs, standing, or walking—as early as safely possible during a patient’s recovery.

How it works:

• Encourages deeper breathing through natural movement
• Promotes improved circulation and oxygen delivery
• Facilitates airway clearance by stimulating spontaneous coughing and respiratory muscle activity

Clinical Relevance: This therapy is especially important for post-surgical patients, individuals on prolonged bed rest, and those in the intensive care unit (ICU). Early mobilization helps prevent atelectasis, pneumonia, and other complications associated with immobility.

Deep Breathing Exercises and Directed Cough

These are fundamental techniques used to expand the lungs and promote secretion clearance.

Deep Breathing:

• Involves slow, maximal inspirations to enhance alveolar ventilation
• Helps maintain or increase lung compliance
• Encourages full lung inflation, especially in lower lobes

Directed Coughing:

• Utilizes a deliberate technique to mobilize and expel secretions
• Often combined with splinting (using a pillow or towel against the chest) for postoperative patients

Clinical Relevance: This approach helps prevent pulmonary complications in both ambulatory and non-ambulatory patients and is often taught and reinforced by respiratory therapists during recovery.

Incentive Spirometry (IS)

Incentive spirometry encourages sustained maximal inspiration through visual feedback using a hand-held device.

How it works:

• Patient inhales slowly and deeply to reach a set inspiratory volume goal
• Promotes alveolar recruitment and improves inspiratory muscle performance

Benefits:

• Reduces the risk of postoperative atelectasis
• Improves oxygenation and breath sounds
• Increases vital capacity and SpO₂
• Encourages patient engagement in their own recovery

Clinical Relevance: Incentive spirometry is widely used after abdominal or thoracic surgery and is most effective when performed regularly with proper technique and coaching.

Continuous Positive Airway Pressure (CPAP)

CPAP provides a constant flow of air at a fixed pressure to keep the airways open throughout the respiratory cycle.

How it works:

• Maintains positive end-expiratory pressure (PEEP)
• Prevents airway collapse during exhalation
• Promotes alveolar stability and gas exchange

Benefits:

• Enhances oxygenation
• Increases lung volumes
• Improves respiratory mechanics

Clinical Relevance: While commonly associated with sleep apnea, CPAP is also useful for treating atelectasis, especially in patients with hypoxemia who can breathe spontaneously but need alveolar support.

Positive Airway Pressure (PAP) Therapy

PAP therapy includes several modalities that apply positive pressure to the lungs during exhalation or the entire breathing cycle, depending on the device.

Common types:

• Positive Expiratory Pressure (PEP): Patient exhales against resistance, improving airway clearance and lung expansion.
• Flutter valve: Combines PEP with oscillations to mobilize secretions.
• CPAP: Maintains continuous airway pressure.

Benefits:

• Improves functional residual capacity (FRC)
• Reopens collapsed alveoli
• Enhances secretion mobilization
• Decreases work of breathing

Clinical Relevance: PAP devices are valuable for both lung expansion and secretion clearance, making them ideal for patients with COPD, cystic fibrosis, or post-surgical atelectasis.

Intermittent Positive Pressure Breathing (IPPB)

IPPB is a short-term, noninvasive ventilatory support therapy that delivers positive pressure during inhalation to augment spontaneous breathing.

How it works:

• Provides controlled, machine-assisted deep breaths
• Allows passive exhalation back to atmospheric pressure
• Often used with aerosolized medications

Benefits:

• Improves tidal volume and alveolar ventilation
• Reduces atelectasis and work of breathing
• Enhances inspiratory muscle performance

Clinical Relevance: IPPB is used selectively for patients with weak inspiratory effort, neuromuscular disorders, or in those who cannot perform deep breathing exercises effectively on their own.

High-Flow Nasal Cannula (HFNC)

HFNC delivers heated and humidified oxygen at high flow rates through a nasal interface, allowing for comfortable and effective respiratory support.

How it works:

• Provides a stable FiO₂ at high flow rates (up to 60 L/min)
• Generates low-level positive airway pressure
• Washes out CO₂ from anatomical dead space

Benefits:

• Improves oxygenation without the need for a mask
• Increases patient comfort and compliance
• Promotes alveolar recruitment through flow-generated pressure

Clinical Relevance: HFNC is particularly useful in patients with hypoxemic respiratory failure or those at risk of atelectasis, especially when traditional oxygen therapy is insufficient.

 

Selecting the appropriate lung expansion therapy depends on a variety of factors, including the patient’s condition, level of consciousness, ability to cooperate, and the severity of lung involvement. Clinicians must use sound clinical judgment to determine the most effective approach or combination of techniques.

When used correctly, these therapeutic methods play a crucial role in reducing pulmonary complications, improving respiratory mechanics, and promoting faster recovery.

Clinical Indications for Lung Expansion Therapy

Lung expansion therapy is prescribed in clinical settings to address specific respiratory conditions and to reduce the risk of certain pulmonary complications. The primary indications involve patients who are at increased risk for lung volume loss or who already exhibit compromised lung function.

Postoperative Patients

Lung expansion therapy is commonly indicated for patients following surgery, especially thoracic or upper abdominal procedures. These patients often experience reduced lung volumes due to pain, anesthesia, or immobility. The risk of postoperative pulmonary complications, such as pneumonia or atelectasis, increases if lung volumes are not restored.

Preventive strategies may include incentive spirometry, deep breathing exercises, or positive expiratory pressure therapy. Early intervention aims to minimize hospital stay, improve oxygenation, and decrease the likelihood of infection. Monitoring vital signs and respiratory status helps adjust therapy for optimal recovery.

Atelectasis

Atelectasis, or the collapse of lung tissue affecting gas exchange, represents a direct and urgent indication for lung expansion therapy. Common causes include airway obstruction, mucus plugging, and post-surgical changes. Untreated atelectasis can lead to hypoxemia and increased work of breathing.

Treatment options focus on reinflating the affected lung segments. Techniques might include chest physiotherapy, positive airway pressure modalities, or recruitment maneuvers based on patient tolerance and severity. Consistent assessment guides therapy effectiveness and the need for escalation or modification.

Restrictive Lung Diseases

For patients with restrictive lung diseases, such as interstitial lung disease or neuromuscular disorders, lung expansion therapy serves to maintain or improve ventilatory function. These conditions often lead to decreased lung compliance and diminished inspiratory capacity. Therapy may help prevent further reduction in lung volumes.

Specific techniques, including breath-stacking or mechanical insufflation-exsufflation, can be tailored to the individual’s pathology and severity. Regular assessment is needed to prevent secondary complications such as atelectasis or respiratory failure. Education on breathing techniques also plays a protective role.

Prevention of Pulmonary Complications

Lung expansion therapy is essential for high-risk populations to prevent complications such as pneumonia, mucus plugging, and general deconditioning. Risk groups include immobile patients, those with chronic cardiopulmonary disease, and the elderly.

Therapy strategies may combine physical mobilization with respiratory techniques to optimize airway clearance and maintain lung inflation. Emphasis is placed on patient participation and routine monitoring. The approach and frequency are individualized based on risk assessment and ongoing evaluation.

Contraindications and Precautions

Lung expansion therapy is widely used for various pulmonary conditions but poses specific risks in certain patient populations. Strict criteria and careful assessment are essential to avoid adverse effects or complications.

Absolute Contraindications

Absolute contraindications refer to conditions where lung expansion therapy should not be performed under any circumstances. The presence of an untreated pneumothorax is the most critical, as the increased airway pressure can worsen the air leak or cause tension pneumothorax.

Another absolute contraindication is active, significant hemoptysis, because increasing lung volumes may worsen bleeding. Recent thoracic or esophageal surgery patients are also at high risk due to the potential for air leaks, wound dehiscence, or disruption of surgical repairs.

Severe hemodynamic instability, such as uncontrolled shock or severe arrhythmias, precludes safe therapy. In these cases, airway pressure changes could destabilize cardiovascular status.

Relative Contraindications

Relative contraindications are situations where therapy risks may outweigh benefits, so clinical judgment is necessary. Examples include patients with facial trauma, recent eye surgery, or increased intracranial pressure, as positive pressure can worsen injury or complications.

Those with untreated nausea, vomiting, or significant cognitive impairment may not cooperate or could aspirate during therapy. Bullous lung disease is another concern, as lung expansion can rupture bullae and cause pneumothorax.

Caution is also advised in populations with severe chronic obstructive pulmonary disease (COPD) or rib fractures, since overdistension or pain may compromise compliance or effectiveness. Providers must weigh patient history, present symptoms, and therapy goals when deciding to proceed.

Assessing Patient Suitability

Careful pre-therapy evaluation is essential. The clinician should review recent imaging, current clinical status, and patient ability to follow instructions. Objective measures, such as oxygen saturation and hemodynamic trends, should be evaluated before each session.

Patient communication is critical. Those unable to understand or follow commands are at increased risk of misuse or adverse outcomes, so assessment tools and standardized protocols help identify who is suitable.

Ongoing reassessment is necessary to detect new contraindications or complications early. Therapy parameters may need adjustment based on tolerance, changing clinical condition, or response. Individualized plans improve both safety and effectiveness for each patient.

Breathing Devices and Equipment

Lung expansion therapy often relies on specific devices to help patients increase air flow and lung volume. Proper use and understanding of these tools are central to treatment effectiveness.

Types of Devices

Several main devices are used in lung expansion therapy:

• Incentive Spirometers encourage deep, slow breaths by providing visual feedback on effort. Patients inhale through a mouthpiece, aiming to raise a piston or ball to a set target.
• Positive Expiratory Pressure (PEP) Devices create resistance when exhaling, helping open collapsed airways and move mucus.
• CPAP (Continuous Positive Airway Pressure) devices deliver a constant air stream to keep airways open and support breathing, especially for those with sleep apnea or severe lung conditions.

Note: Each device is chosen based on patient condition, ability to cooperate, and therapeutic goals. Hospitals and clinics may have staff demonstrate options before sending them home with patients.

How to Use Devices Correctly

Effective lung expansion depends on proper device technique. Patients should always start by sitting upright and fully exhaling before beginning a device session.

For an incentive spirometer, users form a tight seal around the mouthpiece, inhale slowly to raise the indicator, and hold their breath for a few seconds before exhaling. Performing 10 breaths per hour while awake is common practice.

With PEP devices, patients exhale against the device’s set resistance while keeping breaths steady—not forced. Regular cleaning after each use prevents infection and malfunction.

Consistent use based on prescribed schedules maximizes the benefits. Staff often review technique regularly to ensure effective therapy and minimize complications.

Clinical Protocols and Implementation

Effective lung expansion therapy depends on precise assessment, targeted education, and careful attention to safety. Each of these factors is addressed individually to promote optimal results in various patient populations.

Assessment and Monitoring

Assessment begins with a thorough respiratory evaluation. Clinicians review factors such as breath sounds, oxygenation (using pulse oximetry and arterial blood gas analysis), respiratory rate, and pattern. Particular emphasis is placed on identifying atelectasis or secretion retention through physical examination and imaging.

Monitoring is ongoing throughout therapy. Healthcare providers track parameters like lung compliance, tidal volume, and patient comfort. Any changes in respiratory status are documented and communicated promptly to the care team.

Key lung expansion techniques include incentive spirometry, intermittent positive pressure breathing (IPPB), and positive expiratory pressure (PEP) therapy. The chosen method depends on the patient’s condition, ability to cooperate, and clinical goals.

Patient Education

Effective patient education is essential for lung expansion therapy success. Patients must understand the purpose, technique, and expected outcomes of the prescribed therapy. Clear demonstrations improve technique adherence.

Individualized instruction focuses on proper device use, such as correct breathing maneuvers during incentive spirometry or maintaining seal and pressure with PEP devices. Providers offer written, visual, or verbal guidance based on patient preference and cognitive ability.

Encouraging questions and providing feedback during training improves confidence and performance. For patients with language or cognitive barriers, using interpreters or family support can further enhance understanding and compliance.

Safety Considerations

Patient safety is a core aspect of all lung expansion therapy protocols. Contraindications and risk factors—such as untreated pneumothorax, hemodynamic instability, or severe nausea—must be carefully screened before initiating treatment.

During therapy, clinicians watch for adverse responses like hypoxemia, increased respiratory distress, barotrauma, or dizziness. Immediate cessation and re-evaluation are necessary if complications arise.

Equipment is checked for cleanliness and appropriate function before each use. Hands are washed before patient contact, and infection control measures are followed to prevent transmission of pathogens during device-assisted breathing.

Lung Expansion Therapy Practice Questions

1. What is lung expansion therapy used for?
It is used to prevent or correct atelectasis and respiratory complications, often in postoperative patients.

2. What is gas absorption atelectasis?
Gas absorption atelectasis occurs when a mucus plug blocks ventilation to selected regions of the lung.

3. What is compression atelectasis?
A type of atelectasis caused by persistent breathing with small tidal volumes is common in certain types of restrictive chest wall disorders.

4. What factors can cause atelectasis?
Obesity, neuromuscular disorders, heavy sedation, surgery near the diaphragm, bed rest, poor cough, history of lung disease, and restrictive chest wall abnormalities.

5. What does atelectasis cause?
Decreased FRC, V/Q mismatch, arterial hypoxemia, decreased surfactant production, and an ineffective cough, which leads to retained secretions and possible pneumonia.

6. What are the clinical signs of atelectasis?
History of recent major surgery, tachypnea, fine late inspiratory crackles, bronchial or diminished breath sounds, tachycardia, and signs of volume loss on a chest radiograph

7. How does lung expansion therapy work?
It works by increasing the transpulmonary pressure gradient, which is the difference between alveolar and pleural pressure. The greater the transpulmonary pressure gradient, the more alveolar expansion will occur.

8. How can you increase the transpulmonary pressure gradient?
It can be increased by decreasing the surrounding pleural pressure or by increasing the alveolar pressure.

9. What therapy decreases pleural pressure?
Incentive spirometry

10. What therapy increases alveolar pressure?
IPPB and positive pressure therapies

11. What is another name for incentive spirometry?
Sustained maximal inspiration (SMI)

12. How does incentive spirometry work?
It mimics natural sighing by encouraging patients to take slow, deep breaths.

13. What are the indications for incentive spirometry?
The presence of pulmonary atelectasis; the presence of conditions that could cause atelectasis, like upper abdominal surgery, thoracic surgery, and surgery in patients with COPD; the presence of a restrictive lung defect associated with quadriplegia or a dysfunctional diaphragm.

14. What are the contraindications for incentive spirometry?
Unconscious patients or those unable to cooperate, inability to comprehend instructions, and patients unable to generate adequate inspiratory flow.

15. What are the hazards and complications of incentive spirometry?
Hyperventilation, discomfort, fatigue or overexertion, pulmonary barotrauma, and hypoxemia

16. How do you teach incentive spirometry?
Demonstrate, then observe the patient

17. When is the best time to teach incentive spirometry?
Prior to surgery

18. What must be performed before and after incentive spirometry?
Auscultation

19. What are the outcomes of incentive spirometry therapy?
Improvement of atelectasis, decreased respiratory rate, normal pulse rate, resolution of abnormal breath sounds, improved chest radiograph, improved PaO2, decreased PaCO2, increased SpO2, increased VC and peak expiratory flow, restoration of preoperative FRC or VC, improved inspiratory muscle performance and cough, attainment of preoperative flow and volume levels, and increased FVC.

20. What instructions are given for incentive spirometry?
Exhale normally, take slow deep inspirations, perform an inspiratory pause/breath-hold, take slow and passive exhalations, rest between breaths, and perform ten breaths every hour while awake.

21. What has to be documented during incentive spirometry?
Date and time given, type of treatment, goals reached and number of times, breath sounds before and after, cough and nature of secretions, and any adverse reactions.

22. What is intermittent positive pressure breathing?
A noninvasive technique that uses positive airway pressure to provide machine-assisted deep breaths and stimulates coughing.

23. How does IPPB work?
Positive pressure is applied to the airway and is transmitted to the alveoli and pleural space during inspiration. Gas flows into the lungs due to the pressure differences, and exhalation is passive.

24. What are the indications for IPPB therapy?
It is indicated in patients with atelectasis who aren’t responsive to other therapies and in patients who are at a high risk for atelectasis but can’t perform incentive spirometry.

25. What are the contraindications for IPPB?
Tension pneumothorax, ICP greater than 15 mmHg, hemodynamic instability, active hemoptysis, tracheoesophageal fistula, recent esophageal surgery, active untreated tuberculosis, radiographic evidence of blebs, recent facial oral or skull surgery, hiccups, air swallowing, and nausea.

26. What are the hazards and complications of IPPB?
Increased airway resistance, pulmonary barotrauma, nosocomial infections, respiratory alkalosis, hyperoxia, impaired venous return, gastric distension, air trapping, auto-PEEP, overdistention, and psychological dependence.

27. What baseline assessment should be performed before IPPB?
Medical history, vital signs, sensorium and appearance, breathing pattern, and auscultation.

28. What are the outcomes of IPPB?
Improved VC, increased FEV, enhanced cough and secretion clearance, improved chest radiograph, improved breath sounds, and improved oxygenation.

29. What are the alternative therapeutic methods to IPPB?
EzPAP, incentive spirometry, or pursed-lip breathing

30. What has to be documented when administering IPPB?
Pre-assessment, post-assessment, adverse effects, medications used, settings used, volume achieved, and length of the treatment.

31. What is the “triple S” rule for IPPB?
If a patient has a severe adverse reaction, you should stop the treatment, stay with the patient, and stabilize the patient.

32. What do PEP, EPAP, and CPAP stand for?
Positive expiratory pressure, expiratory positive airway pressure, and continuous positive airway pressure.

33. What is CPAP therapy?
A type of therapy where patients breathe through a pressurized circuit against a threshold resistor at pressures between 5 and 20 cmH2o. The CPAP machine maintains positive pressure during inspiration and expiration.

34. What are the indications for CPAP?
To recruit collapsed alveoli, decrease work of breathing, improve the distribution of ventilation, enhance secretion removal, treat cardiogenic pulmonary edema, and improve oxygenation.

35. What are the contraindications for CPAP?
Hemodynamic instability and hypoventilation

36. What are the hazards and complications of CPAP?
Barotrauma, hypoventilation, gastric distention, vomiting, and aspiration

37. What is the most common problem with CPAP?
System leaks

38. What should be monitored during CPAP?
Monitor for hypoventilation and an elevated PaCO2

39. How do you choose an approach for CPAP?
Choose the one that is safest, simplest, and most effective, and evaluate the patient’s level of cooperation, amount of pulmonary secretions, and spontaneous vital capacity.

40. What type of patients are at risk for postoperative atelectasis?
Patients with a history of lung disease that causes increased mucus production, patients with chronic bronchitis, patients who smoke cigarettes, and patients with a history of inadequate nutritional intake.

41. What is the cause of postoperative atelectasis?
An ineffective cough

42. What type of lung expansion therapy is physiologically most common?
Incentive spirometry

43. What is monitored during incentive spirometry?
Patient performance, frequency of sessions, number of breaths per session, inspiratory volume or flow goals, effort and motivation, compliance with technique, a device within reach and encouragement for the patient to do it independently, new and increasing inspiratory volumes each day, and vital signs.

44. What are the symptoms of hyperventilation during incentive spirometry?
Lightheadedness and dizziness

45. What are the two types of incentive spirometry?
Volumetric and flow-oriented

46. How does volumetric incentive spirometry work?
Volumetric incentive spirometry devices measure and visually indicate the volume achieved during a maneuver. They employ a bellow that rises according to the inhaled volume. When the patient reaches the target inspiratory volume, a controlled leak in the device allows the patient to sustain inspiratory effort for a short period of time.

47. How does flow-oriented incentive spirometry work?
Flow-oriented devices measure and visually indicate the degree of inspiratory flow. This flow can be equated with volume by assessing the duration of inspiration.

48. What do both types of incentive spirometers do?
They attempt to encourage the same goal for a patient, which is to achieve a sustained maximum inspiratory effort in order to prevent or correct atelectasis.

49. What patients benefit from IPPB?
Patients who are at high risk for atelectasis but are unable to participate in patient-directed techniques, such as incentive spirometry or deep breathing.

50. What are the goals of IPPB?
To help the patient take deeper breaths, promote a cough, improve the distribution of ventilation, and achieve improved ABG results.

51. What is the purpose of a cough?
To clear secretions from the airways

52. Which of the following is not a potential hazard of IPPB?
Increased cardiac output

53. Which of the following statements is not true about IPPB?
IPPB should be the single treatment modality for resorption atelectasis.

54. All of the following parameters should be evaluated after intermittent positive-pressure breathing therapy except:
Temperature

55. All of the following machine performance characteristics should be monitored during IPPB except:
Humidity output

56. Which of the following initial flow settings would you select when setting up a continuous positive airway pressure flow-mask system for a patient with atelectasis?
2 to 3 times the patient’s minute ventilation

57. In order to eliminate leaks in an alert patient receiving intermittent positive-pressure breathing therapy, which of the following adjuncts would you try first?
Nose clips

58. Which of the following patient groups should be considered for lung expansion therapy using IPPB?
Patients with clinically diagnosed atelectasis who are not responsive to other therapies and patients who are at a high risk for atelectasis who cannot cooperate with other methods.

59. Which of the following positions is ideal for intermittent positive-pressure breathing therapy?
Semi-fowler’s

60. What are the appropriate initial settings for intermittent positive-pressure breathing?
Sensitivity: -1 to -2 cmHO; Pressure 10 to 15 cmH2O; Flow: moderate

61. While administering IPPB, you notice that the device will not cycle off, even when you occlude the mouthpiece. What would be the most appropriate action to take?
Check the circuit for leaks

62. What is the minimum airway pressure at which the esophagus opens, allowing gas to pass directly into the stomach?
20 cmH2O

63. Which of the following will make an IPPB device cycle off prematurely?
Airflow obstruction, kinked tubing, occluded mouthpiece, and active resistance to inhalation

64. What is an absolute contraindication for using intermittent positive-pressure breathing?
Tension pneumothorax

65. During the administration of continuous positive airway pressure through a mask to a patient with atelectasis, you find it difficult to maintain the prescribed airway pressure. Which of the following is the most common explanation?
System or mask leaks

66. Which of the following is NOT a potential contraindication for intermittent positive-pressure breathing?
Neuromuscular disorders

67. Which of the following are potential desirable outcomes of IPPB?
Improved oxygenation, increased cough and secretion clearance, improved breath sounds, and reduced dyspnea

68. The general assessment for IPPB should include which of the following?
Measurement of vital signs, appearance and sensorium, and chest auscultation

69. What is the most common complication associated with IPPB?
Respiratory alkalosis

70. Which of the following should be charted in the patient’s medical record after completion of an intermittent positive-pressure breathing treatment?
Results of pre-and post-treatment assessment, any side effects, and succinct but complete account of the treatment session.

71. Which of the following are contraindications for continuous positive airway pressure (CPAP) therapy?
Hemodynamic instability, hypoventilation, and facial trauma

72. Which of the following are appropriate volume goals for IPPB?
10 to 15 mL/kg and at least 30% of the inspiratory capacity (IC)

73. Prior to starting IPPB on a new patient, what should the practitioner explain?
Why the physician ordered the treatment, what the treatment will do, how the treatment will feel, and what the expected results are.

74. Which of the following are potential complications of CPAP therapy?
Barotrauma, gastric distention, and hypercapnia

75. Which of the following is FALSE about gastric distention with IPPB?
Gastric distention is a relatively harmless effect of IPPB.

76. Which of the following mechanisms probably contribute to the beneficial effects of CPAP in treating atelectasis?
Recruitment of collapsed alveoli, decreased work of breathing, improved distribution of ventilation, and increased efficiency of secretion removal.

77. What is the optimal breathing pattern when using IPPB for the treatment of atelectasis?
Slow, deep breaths held at end-inspiration

78. Which of the following modes of lung expansion therapy is physiologically most normal?
Incentive spirometry

79. Which of the following are essential components of a CPAP system?
Blended source of pressurized gas, breathing circuit with reservoir bag, low-pressure or disconnect alarm, and expiratory threshold resistor.

80. Intermittent positive-pressure breathing is associated with what?
Passive exhalation

81. While administering intermittent positive-pressure breathing therapy, which of the following breathing patterns would be most desirable?
6 to 8 breaths/min with an I:E ratio of 1:3

82. The administration of IPPB should include which of the following?
The evaluation of alternative approaches to the patient’s problem, setting specific and individual clinical goals or objectives, and conducting a baseline assessment of the patient.

83. What do large negative pressure swings during inspiration indicate when IPPB is being administered?
Incorrect sensitivity

84. When adjusting the sensitivity control on an intermittent positive-pressure breathing device, which of the following parameters are you changing?
The effort required to cycle the device on

85. When you decrease the flow during IPPB, what happens to the inspiratory time?
It increases

86. What are the two types of atelectasis?
Passive and resorption

87. What is passive atelectasis?
It is the result of shallow breathing and is caused by the persistent use of small tidal volumes.

88. Passive atelectasis can occur with what?
Surgery medications, neurological disorders, neuromuscular weakness, bed rest, and immobility

89. Resorption atelectasis is the result of what?
It results from an airway obstruction (e.g., mucus plugs).

90. What is lobar atelectasis?
When an entire lobe of the lung has atelectasis

91. What factors cause atelectasis?
Obesity, neuromuscular disease, sedation, surgery, spinal injury, bedridden immobility, and a decreased cough.

92. What are the clinical signs of atelectasis?
Decreased breath sound with crackles, tachycardia, tachypnea, cyanosis, hypoxemia, and increased opacity on a chest x-ray.

93. Lung expansion therapy increases lung volumes by increasing what?
The transpulmonary pressure gradient

94. What happens if the transpulmonary pressure gradient is increased?
The lungs expand more

95. How does incentive spirometry work?
It increases the transpulmonary pressure gradient by lowering the pleural pressure. It is the most effective type of lung expansion therapy because it mimics the normal physiology of breathing.

96. How does IPPB work?
It increases the transpulmonary pressure gradient by increasing the alveolar pressure.

97. How do you know which lung expansion therapy method to choose?
It depends on the needed equipment, personnel, risk, and cost.

98. How does incentive spirometry mimic natural sighing?
By encouraging slow, deep breathing

99. Is IPPB used for short-term or long-term therapy?
Short-term

100. How frequently can IPPB be administered?
It can be administered several times a day or as frequently as once per hour.

101. What does IPPB require?
It requires a spontaneously breathing patient.

102. What are the four IPPB interfaces?
Mask, flange, trach adapter, and mouthpiece

103. What is the Bird Mark 7?
It is the most common type of IPPB that is pneumatically powered.

104. What are the IPPB controls?
Pressure, flow, sensitivity, air mix control, and apnea timer

105. Which of the following situations is a contraindication for incentive spirometry?
A patient with a vital capacity that is less than 10 ml/kg and a patient who cannot cooperate or follow instructions (e.g., unconscious patient).

106. Which of the following conditions is most likely to predispose a patient to atelectasis?
Surgery

107. When should high-risk surgical patients be oriented to incentive spirometry?
Before the surgical procedure

108. A patient complains of numbness around his lips during IS. What should the therapist recommend?
Tell the patient to slow their breathing rate

109. Physical signs of atelectasis that involve a significant portion of the lungs include:
Decreased or bronchial/tubular breath sounds, tachypnea, and tachycardia when hypoxemia is present.

110. In teaching a patient to perform the sustained maximal inspiration maneuver during incentive spirometry, what would you say?
“Exhale normally, then inhale as deeply as you can, then hold your breath for 5 to 10 seconds.”

111. A postoperative patient using incentive spirometry complains of dizziness and numbness. What is the most likely cause of these symptoms?
Hyperventilation

112. Which of the following is FALSE about flow-oriented incentive spirometry devices?
They have proved less effective than volumetric systems.

113. Which of the outcomes would indicate improvement in a patient previously diagnosed with atelectasis who has been receiving incentive spirometry?
Improved PaO2, decreased respiratory rate, and improved chest radiograph findings

114. Persistent breathing at small tidal volumes can result in which of the following?
Passive atelectasis

115. Correct instruction in the technique of incentive spirometry should include which of the following?
Diaphragmatic breathing at slow to moderate flows

116. Lung expansion therapy works because of an increase in what pressure gradient?
Transpulmonary

117. How often should a patient perform incentive spirometry?
Hourly

118. Lung expansion methods that increase the transpulmonary pressure gradients by increasing alveolar pressure include which of the following?
Positive end-expiratory pressure therapy, intermittent positive-pressure breathing (IPPB), and expiratory positive airway pressure (EPAP).

119. In observing a postoperative woman conduct incentive spirometry, you note the repetitive performance of the sustained maximal inspiration maneuver at a rate of about 10 to 12/min. Which of the following would you recommend?
Take a 30-second rest between breaths

120. Which of the following patient categories are at a high risk for developing atelectasis?
Those who are heavily sedated, those with upper abdominal or thoracic pain following surgery, and those with neuromuscular disorders.

121. Which of the following is not a potential hazard or complication of incentive spirometry?
Decreased cardiac output

122. How do all modes of lung expansion therapy aid in lung expansion?
By increasing the transpulmonary pressure gradient

123. When does acute respiratory alkalosis occur during incentive spirometry?
When the patient is breathing too quickly

124. An alert, cooperative 28-year-old female with no prior history of lung disease, underwent a cesarean section, and her x-ray film is clear. Which of the following approaches to preventing atelectasis would you recommend?
Incentive spirometry

125. The successful application of incentive spirometry depends on what?
The effectiveness of patient teaching

126. How can the transpulmonary pressure gradient be increased?
By increasing the alveolar pressure or decreasing the pleural pressure

127. Incentive spirometry devices can generally be categorized as which of the following?
Flow-oriented or volume-oriented

128. Which of the following is not at high risk for developing postoperative atelectasis?
Those with a non-smoking history

129. What is the pressure setting for IPPB?
10-20 cmH2O

130. What would you increase during IPPB to increase the patient’s tidal volume?
The pressure setting

131. If the patient can’t trigger an IPPB breath and the manometer needle is not moving off of the zero mark, what would you expect?
The patient is breathing through their nose

132. What is a device for lung expansion that requires negative transpulmonary pressure?
Incentive spirometer

133. What is an ideal I:E ratio when delivering IPPB?
An I:E ratio with a higher expiratory time

134. What is the purpose of EzPAP?
It helps with the prevention and treatment of atelectasis for lung expansion therapy, and it is recommended for patients with a decreased FRC.

135. What are some adverse reactions that occur with EzPAP?
Increased work of breathing that may lead to hypoventilation, increased intracranial pressure, cardiovascular compromise, decreased venous return, air swallowing, and pulmonary barotrauma.

136. What is the EzPAP system powered by?
It is powered by a flowmeter connected to a gas source such as oxygen or compressed air.

137. What patient population can benefit from EzPAP therapy?
Patients with poor inspiratory effort or difficulty using incentive spirometry.

138. How does EzPAP promote alveolar recruitment?
By providing continuous positive airway pressure during both inspiration and expiration.

139. What is the recommended flow setting for EzPAP?
Flow rates of 5–15 L/min are typically used, depending on the desired pressure.

140. What accessory can be used with EzPAP to aid in secretion clearance?
A nebulizer can be attached to deliver aerosolized medication simultaneously.

141. How is EzPAP different from IPPB?
EzPAP delivers continuous pressure, whereas IPPB delivers pressure only during inspiration.

142. What is one major advantage of EzPAP therapy?
It does not require a mechanical ventilator or electrical power source.

143. When should EzPAP therapy be avoided?
In patients with untreated pneumothorax, facial trauma, or those who cannot tolerate increased pressure.

144. What is an important assessment prior to initiating EzPAP?
Evaluate respiratory rate, oxygen saturation, and breath sounds.

145. What should be monitored during EzPAP treatment?
Pressure generated, patient comfort, SpO2 levels, and signs of barotrauma.

146. What distinguishes PEP therapy from CPAP?
PEP is only applied during exhalation, while CPAP is continuous through both inspiration and expiration.

147. What lung expansion technique uses a resistor during exhalation?
Positive expiratory pressure (PEP) therapy.

148. How often is PEP therapy typically administered?
2 to 4 times a day, depending on clinical need and patient tolerance.

149. What is the mechanism behind secretion mobilization in PEP therapy?
It promotes collateral ventilation and prevents airway collapse during exhalation.

150. What device uses a combination of PEP and oscillations for secretion clearance?
The Acapella or Flutter valve device.

Final Thoughts

Lung expansion therapy offers a wide range of benefits for patients with compromised respiratory function. From simple breathing exercises to advanced noninvasive support, each technique serves to improve lung inflation, promote secretion clearance, and reduce the risk of complications.

By understanding and applying the appropriate method based on individual patient needs, healthcare providers can significantly enhance recovery, comfort, and clinical outcomes.