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Resistant breathing is used for example:

after abdominal and / or thoracic surgery
in mucus problems
in the case of carbon dioxide retention or when there is a risk of carbon dioxide retention
in case of poor oxygenation
in prolonged bed rest [11,12,17-19]


Resistant breathing is contraindicated in:

Undrained pneumothorax (accumulation of air in the lung sac that has not been emptied)
Severe emphysema [17-19]

General guidelines for resistance breathing

The amount, frequency and body position of the treatment depends on the purpose of the treatment. After, for example, a tummy tuck procedure, 3×10 breaths interspersed with huffing / shock every hour can be a suitable treatment. Resistant breathing can be given by means of closed lip breathing, by means of various PEP tools or non-invasively with a ventilator [17-19]. Read more about this below.
Resistant breathing with closed lip breathing

Instruct the patient to “smell the flower and blow out the candle”:

Inhale deeper than normal through the nose. (If the patient has a stuffy nose, it is a good idea to inhale through the mouth instead.) Squeeze out through the mouth, with half-closed lips. The exhalation should be slightly active [11,12,17].

The use of a breathing bottle, PEP set and PEP mask must be adapted to the individual person. The treatment is usually started by a physiotherapist [11,12,17-19]. If the patient is short of breath, a pep valve is a resistance that can complicate ventilation.

  • Document in the patient record.
  • Breathing bottle – PEP bottle
  • Preparations

Fill a clean bottle preferably of glass with about 10 cm, or prescribed amount of sterile water. If sterile water is not available, take boiled water that has cooled. [21]
Insert a hose, with an inner diameter greater than 1 cm, into the water. It is through this tube that the patient must exhale.

Mark the height of the water column on the bottle. The resistance during exhalation is determined by the height of the water column [11,12,17-19].


Ask the patient to take the tube in the mouth and then inhale a slightly deeper breath through the nose. Ask the patient to blow the air out through the tubing so that it bubbles in the water. The blow-out must be carried out slowly, be easily active and not too industrious, ie it must not be performance-oriented with a violent bubbling in the water. The patient should not blow out all the air but save a little for the next breath if you want to raise the FRC.
Repeat with new inhalation through the nose and exhalation via the tube [11,12,17-19].


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