Inpatients and People with a Tracheostomy

Being confined to bed creates ideal conditions for secretions to build up and lung capacity to fall. Treatment can still be delivered when a person is unconscious or has a tracheostomy.

Immobility leaves parts of the lung poorly ventilated. Secretions collect in those areas; retained secretions both reduce lung capacity and create favourable ground for infection. When a person cannot clear them with their own cough, the picture can deteriorate quickly.

No active participation is required in this group. Treatment is delivered through positioning, techniques applied to the chest wall and, where needed, device support — following the person's own breathing rhythm. All work is carried out within the framework set by the treating physician and clinical team.

When does it apply?

• People admitted to intensive care or a hospital ward
• People who are unconscious or unable to communicate
• People with a tracheostomy — secretion management and airway care
• People on mechanical ventilation or in the weaning process
• People whose lung ventilation has fallen after prolonged bed rest
• People whose cough strength is insufficient for neurological reasons
• Situations requiring a long admission after surgery

What treatment covers

• Positioning: raising the trunk and changing position regularly to support ventilation of different lung regions.
• Secretion management: techniques adapted to the individual to move secretions from the small airways to the large ones.
• Cough support: manual support techniques and, for selected people, mechanical cough assist devices.
• Coordination in tracheostomy care: planning treatment around suctioning, in step with the clinical team.
• Chest wall mobility: maintaining trunk and rib mobility, which becomes restricted during a long admission.
• Early mobilisation: in-bed movements, sitting and graded mobilisation as the clinical picture allows.
• Support during ventilator weaning: supporting the respiratory muscles, within the physician's plan.
• Carer training: teaching the family what will continue at home after discharge.

What is watched closely

Treatment is always adjusted to the person's clinical state at that moment. Pulse, oxygen saturation and respiratory rate are monitored, and duration and intensity are changed according to tolerance.

Treatment is postponed in the presence of fever, haemodynamic instability, newly developing respiratory distress, or any restriction set by the clinical team. Work in this group is carried out in coordination with the treating physician and nursing team.

Treatments used in this group

Frequently Asked Questions