Inhoud
1. Mechanismes v/h respiratoire systeem .................................................................................................................. 1
1.1 Respiratoire systeem........................................................................................................................................... 1
1.1.1 De longen ...................................................................................................................................................... 1
1.1.2Respiratoire spieren ....................................................................................................................................... 1
1.1.3Bronchiale boom ............................................................................................................................................ 1
1.1.4Alveoli & terminale bronchiolen .................................................................................................................... 3
1.2 Drainage .............................................................................................................................................................. 5
1.2.1Obstructie vs compressie ............................................................................................................................... 5
1.2.2Equal pressure point ...................................................................................................................................... 5
1.2.3O2-verbruik bij respiratie ............................................................................................................................... 6
1.2.4Longfunctie..................................................................................................................................................... 6
1.2.5Maximale flow-volume curve ......................................................................................................................... 7
2. Obstructieve longziektes ......................................................................................................................................... 7
2.1 Verwachtte problemen bij obstructieve longziektes ........................................................................................... 7
2.2 Hoofddoelen bronchiale drainage ....................................................................................................................... 8
2.3 Effecten lineaire luchtsnelheid ............................................................................................................................. 8
2.4 Diagnose ............................................................................................................................................................... 8
2.5 Functioneel onderzoek ......................................................................................................................................... 8
2.6 Extra diagnostische info ....................................................................................................................................... 9
2.7 Chest X-ray adult .................................................................................................................................................. 9
3. Autogene drainage technieken ............................................................................................................................. 11
3.1 Basic mechanisme .............................................................................................................................................. 11
3.1.1 Inademen .................................................................................................................................................... 11
3.1.2 Uitademing .................................................................................................................................................. 12
3.2 Veranderingen v/d bronchiale “trechter” .......................................................................................................... 12
3.3 Modulatie v AH-niveau ....................................................................................................................................... 12
3.3.1 Grafiek ......................................................................................................................................................... 12
3.3.2 ADHV flow-volume curve ............................................................................................................................ 13
3.3.3 Positie v autogene drainage ........................................................................................................................ 13
3.4 Noodzakelijk bij AD ............................................................................................................................................ 13
3.5 Andere hulpmiddelen......................................................................................................................................... 14
3.5.1 HFCWO = high frequency chest wall oscilation ........................................................................................... 15
3.5.2 ELTGOL = expiration lente total avec la glotte ouverte en lateral .............................................................. 15
3.5.3 ACBT = active cycle of breathing techniques .............................................................................................. 15
3.5.4 PEP = positive expiratory pressure .............................................................................................................. 15
3.5.5 Flutter .......................................................................................................................................................... 16
3.5.6 RC Cornet .................................................................................................................................................... 16
3.5.7 Acapella ....................................................................................................................................................... 17
3.5.8 Aerobika ...................................................................................................................................................... 17
, 3.5.9 Keuze van hulpmiddelen ............................................................................................................................. 17
4. Drainage bij kinderen ............................................................................................................................................ 17
4.1 De longen & thorax bij baby’s ............................................................................................................................ 17
4.2 Assisted autogene drainage (AAD) ..................................................................................................................... 17
4.2.1 Modulatie v ademniveau v periferie naar grote luchtwegen ...................................................................... 18
4.2.2 Verschil AD – AAD ....................................................................................................................................... 18
4.2.3 L’expiration lente prolongée – ELPr ............................................................................................................ 19
5. Inhalatie therapie .................................................................................................................................................. 19
5.1 Hoe inhalatie optimaliseren? ............................................................................................................................. 20
5.2 Baby’s ................................................................................................................................................................. 21
5.3 Aandoeningen .................................................................................................................................................... 21
5.4 Toestellen ........................................................................................................................................................... 21
5.4.1 E-flow membraanvernevelaar ..................................................................................................................... 22
5.4.2 Pressurised metered dose inhalor (pMDI) .................................................................................................. 22
5.4.3 Dry powder inhalor (DPI) ............................................................................................................................. 22
5.4.4 Dose indicator ............................................................................................................................................. 23
5.5 Longdepositie ..................................................................................................................................................... 23
5.6 Combineren inhalatie met AD ............................................................................................................................ 23
5.7 Geïnhaleerde medicatie ..................................................................................................................................... 23
5.7.1 Timing v medicatie tijdens AD met aerosol ................................................................................................. 24
5.7.2 Medicatie mixen .......................................................................................................................................... 24
6. Inspiratoire oef’en & non-invasieve ventilatie ...................................................................................................... 24
6.1 Respiratoire kinesitherapie na operatie ............................................................................................................. 24
6.1.1 Triflow ......................................................................................................................................................... 24
6.1.2 Coach ........................................................................................................................................................... 25
6.1.3 Intermittent possitive pressure breathing (IPPB) ........................................................................................ 25
6.1.4 Continuous positive airway pressure (CPAP) .............................................................................................. 25
6.1.5 EzPAP ........................................................................................................................................................... 26
6.1.6 Bilevel positive airway pressure (BIPAP) ..................................................................................................... 26
6.2 Niet-meewerkende P → IPV .............................................................................................................................. 26
7. Mobilisatie & oefentherapie ................................................................................................................................. 28
7.1 Mobilisatie oefeningen ...................................................................................................................................... 28
7.2 Oefentherapie .................................................................................................................................................... 31
7.3 Evaluatie P .......................................................................................................................................................... 31
7.3.1 respiratoire spierfunctietest ....................................................................................................................... 31
7.3.2Perifere spierfunctietest .............................................................................................................................. 31
7.3.2 Inspanningstesten ....................................................................................................................................... 32
7.4 Oefentherapie .................................................................................................................................................... 32
7.4.1 Respiratoire spierkracht .............................................................................................................................. 33
7.4.2 Perifere spierkracht ..................................................................................................................................... 33
,7.4.3 Sporten ........................................................................................................................................................ 33
, 1. Mechanismes v/h respiratoire systeem
1.1 Respiratoire systeem
• Respiratoire pomp = sternum, ribben, wervelkolom & respiratoire spieren
• Longen met bronchiale boom (luchtwegen) & alveoli (gasuitwisseling)
1.1.1 De longen
• Structuur
o Re long: 3 kwabben, Li long: 2 kwabben met ertussen
een zone = lingula
o Pleura mediastinalis & pleura costalis → rond longen
en binnenkant borstwand
▪ Staan 2mm uit elkaar met ertussen vloeistof
die zorgt voor goede mob
▪ Zorgen dat longen vastkleven aan respiratoire
pomp
o Longen kunnen niet respireren → resp pomp
• Perforatie v/d longen door messteek/trauma = klaplong =
pneumothorax
o Lucht tss de 2 vliezen
o Thorax staat in inspiratoire stand
• Structuur longen lijkt op bloemkool
o Grote stam = grote luchtwegen
o Kleine luchtwegen situeren zich a/d buitenkant v/d longen & overal i/d longen (niet alleen
onderkant zoals veel mensen denken)
1.1.2 Respiratoire spieren
• Primaire spieren
o Functioneren altijd, ook in rust + in inspanning
o Belangrijkste = diafragma & intercostales externa (= inademing)
• Secundaire spieren
o Spreek je aan als je inspanning doet
o Als je gezond bent tenminste → respiratoire aandoening: P gebruikt in rust de secundaire spieren
ook
o Sternocleidomastoideus, pectoralis
• Uitademingsspieren → rectus abdominis, obliquus abdominis & intercostales internus
• Volume verandert in 3D → antero-posterieur, lateraal & cranio-caudaal
o Pump handle → bovenste ribben bewegen ant & craniaal
o Bucket handle → onderste ribben bewegen lateraal & craniaal
o P met contradictorische/paradoxale AH → borst naar binnen & buik naar buiten bij inademing
1.1.3 Bronchiale boom
• Trachea = luchtpijp → grootste oppervlakte
• Hoofdbronchi → diameter kleiner maar je hebt er 2 dus uiteindelijk
heb je meer opp
o Diameter elk onderdeel w kleiner → de gezamenlijke opp w
groter
o Longen lijken op omgekeerde trechter → belangrijk ivm
snelheid
o Opp terminale luchtwegen 180x groter dan opp trachea
• Secreties doen bewegen in luchtwegen door ciliar transport & luchtsnelheid (hoe meer luchtsnelheid bij
uitademing, hoe beter secreties bewegen)
1
1. Mechanismes v/h respiratoire systeem .................................................................................................................. 1
1.1 Respiratoire systeem........................................................................................................................................... 1
1.1.1 De longen ...................................................................................................................................................... 1
1.1.2Respiratoire spieren ....................................................................................................................................... 1
1.1.3Bronchiale boom ............................................................................................................................................ 1
1.1.4Alveoli & terminale bronchiolen .................................................................................................................... 3
1.2 Drainage .............................................................................................................................................................. 5
1.2.1Obstructie vs compressie ............................................................................................................................... 5
1.2.2Equal pressure point ...................................................................................................................................... 5
1.2.3O2-verbruik bij respiratie ............................................................................................................................... 6
1.2.4Longfunctie..................................................................................................................................................... 6
1.2.5Maximale flow-volume curve ......................................................................................................................... 7
2. Obstructieve longziektes ......................................................................................................................................... 7
2.1 Verwachtte problemen bij obstructieve longziektes ........................................................................................... 7
2.2 Hoofddoelen bronchiale drainage ....................................................................................................................... 8
2.3 Effecten lineaire luchtsnelheid ............................................................................................................................. 8
2.4 Diagnose ............................................................................................................................................................... 8
2.5 Functioneel onderzoek ......................................................................................................................................... 8
2.6 Extra diagnostische info ....................................................................................................................................... 9
2.7 Chest X-ray adult .................................................................................................................................................. 9
3. Autogene drainage technieken ............................................................................................................................. 11
3.1 Basic mechanisme .............................................................................................................................................. 11
3.1.1 Inademen .................................................................................................................................................... 11
3.1.2 Uitademing .................................................................................................................................................. 12
3.2 Veranderingen v/d bronchiale “trechter” .......................................................................................................... 12
3.3 Modulatie v AH-niveau ....................................................................................................................................... 12
3.3.1 Grafiek ......................................................................................................................................................... 12
3.3.2 ADHV flow-volume curve ............................................................................................................................ 13
3.3.3 Positie v autogene drainage ........................................................................................................................ 13
3.4 Noodzakelijk bij AD ............................................................................................................................................ 13
3.5 Andere hulpmiddelen......................................................................................................................................... 14
3.5.1 HFCWO = high frequency chest wall oscilation ........................................................................................... 15
3.5.2 ELTGOL = expiration lente total avec la glotte ouverte en lateral .............................................................. 15
3.5.3 ACBT = active cycle of breathing techniques .............................................................................................. 15
3.5.4 PEP = positive expiratory pressure .............................................................................................................. 15
3.5.5 Flutter .......................................................................................................................................................... 16
3.5.6 RC Cornet .................................................................................................................................................... 16
3.5.7 Acapella ....................................................................................................................................................... 17
3.5.8 Aerobika ...................................................................................................................................................... 17
, 3.5.9 Keuze van hulpmiddelen ............................................................................................................................. 17
4. Drainage bij kinderen ............................................................................................................................................ 17
4.1 De longen & thorax bij baby’s ............................................................................................................................ 17
4.2 Assisted autogene drainage (AAD) ..................................................................................................................... 17
4.2.1 Modulatie v ademniveau v periferie naar grote luchtwegen ...................................................................... 18
4.2.2 Verschil AD – AAD ....................................................................................................................................... 18
4.2.3 L’expiration lente prolongée – ELPr ............................................................................................................ 19
5. Inhalatie therapie .................................................................................................................................................. 19
5.1 Hoe inhalatie optimaliseren? ............................................................................................................................. 20
5.2 Baby’s ................................................................................................................................................................. 21
5.3 Aandoeningen .................................................................................................................................................... 21
5.4 Toestellen ........................................................................................................................................................... 21
5.4.1 E-flow membraanvernevelaar ..................................................................................................................... 22
5.4.2 Pressurised metered dose inhalor (pMDI) .................................................................................................. 22
5.4.3 Dry powder inhalor (DPI) ............................................................................................................................. 22
5.4.4 Dose indicator ............................................................................................................................................. 23
5.5 Longdepositie ..................................................................................................................................................... 23
5.6 Combineren inhalatie met AD ............................................................................................................................ 23
5.7 Geïnhaleerde medicatie ..................................................................................................................................... 23
5.7.1 Timing v medicatie tijdens AD met aerosol ................................................................................................. 24
5.7.2 Medicatie mixen .......................................................................................................................................... 24
6. Inspiratoire oef’en & non-invasieve ventilatie ...................................................................................................... 24
6.1 Respiratoire kinesitherapie na operatie ............................................................................................................. 24
6.1.1 Triflow ......................................................................................................................................................... 24
6.1.2 Coach ........................................................................................................................................................... 25
6.1.3 Intermittent possitive pressure breathing (IPPB) ........................................................................................ 25
6.1.4 Continuous positive airway pressure (CPAP) .............................................................................................. 25
6.1.5 EzPAP ........................................................................................................................................................... 26
6.1.6 Bilevel positive airway pressure (BIPAP) ..................................................................................................... 26
6.2 Niet-meewerkende P → IPV .............................................................................................................................. 26
7. Mobilisatie & oefentherapie ................................................................................................................................. 28
7.1 Mobilisatie oefeningen ...................................................................................................................................... 28
7.2 Oefentherapie .................................................................................................................................................... 31
7.3 Evaluatie P .......................................................................................................................................................... 31
7.3.1 respiratoire spierfunctietest ....................................................................................................................... 31
7.3.2Perifere spierfunctietest .............................................................................................................................. 31
7.3.2 Inspanningstesten ....................................................................................................................................... 32
7.4 Oefentherapie .................................................................................................................................................... 32
7.4.1 Respiratoire spierkracht .............................................................................................................................. 33
7.4.2 Perifere spierkracht ..................................................................................................................................... 33
,7.4.3 Sporten ........................................................................................................................................................ 33
, 1. Mechanismes v/h respiratoire systeem
1.1 Respiratoire systeem
• Respiratoire pomp = sternum, ribben, wervelkolom & respiratoire spieren
• Longen met bronchiale boom (luchtwegen) & alveoli (gasuitwisseling)
1.1.1 De longen
• Structuur
o Re long: 3 kwabben, Li long: 2 kwabben met ertussen
een zone = lingula
o Pleura mediastinalis & pleura costalis → rond longen
en binnenkant borstwand
▪ Staan 2mm uit elkaar met ertussen vloeistof
die zorgt voor goede mob
▪ Zorgen dat longen vastkleven aan respiratoire
pomp
o Longen kunnen niet respireren → resp pomp
• Perforatie v/d longen door messteek/trauma = klaplong =
pneumothorax
o Lucht tss de 2 vliezen
o Thorax staat in inspiratoire stand
• Structuur longen lijkt op bloemkool
o Grote stam = grote luchtwegen
o Kleine luchtwegen situeren zich a/d buitenkant v/d longen & overal i/d longen (niet alleen
onderkant zoals veel mensen denken)
1.1.2 Respiratoire spieren
• Primaire spieren
o Functioneren altijd, ook in rust + in inspanning
o Belangrijkste = diafragma & intercostales externa (= inademing)
• Secundaire spieren
o Spreek je aan als je inspanning doet
o Als je gezond bent tenminste → respiratoire aandoening: P gebruikt in rust de secundaire spieren
ook
o Sternocleidomastoideus, pectoralis
• Uitademingsspieren → rectus abdominis, obliquus abdominis & intercostales internus
• Volume verandert in 3D → antero-posterieur, lateraal & cranio-caudaal
o Pump handle → bovenste ribben bewegen ant & craniaal
o Bucket handle → onderste ribben bewegen lateraal & craniaal
o P met contradictorische/paradoxale AH → borst naar binnen & buik naar buiten bij inademing
1.1.3 Bronchiale boom
• Trachea = luchtpijp → grootste oppervlakte
• Hoofdbronchi → diameter kleiner maar je hebt er 2 dus uiteindelijk
heb je meer opp
o Diameter elk onderdeel w kleiner → de gezamenlijke opp w
groter
o Longen lijken op omgekeerde trechter → belangrijk ivm
snelheid
o Opp terminale luchtwegen 180x groter dan opp trachea
• Secreties doen bewegen in luchtwegen door ciliar transport & luchtsnelheid (hoe meer luchtsnelheid bij
uitademing, hoe beter secreties bewegen)
1
