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Printed at: 12:44:54 / 27-09-2021

Lung Volume Recruitment (LVR) Bag

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What is it?
Lung volume recruitment bags (LVR) are a simple piece of equipment which can help you take a bigger breath or breath stack (taking multiple single breaths in before breathing out). The kit consists of:
• a flexible plastic bag with a one-way valve
• a filter
• either a face mask, mouthpiece/nose clip or tracheostomy connector.

How does it work?
Keeping your chest clear requires an effective cough which requires a high flow of air. People with neuromuscular diseases often have weakness of their respiratory muscles which impacts on being able to take a big breath and/or cough. Because of this they may be unable to create a high flow of air which can increase the risk of chest infections. Lung and chest wall movement also reduces over time with neuromuscular conditions – breath stacking can help to maintain lung and chest wall movement.

It may be needed due because the patient has:
• Muscle problems which make breathing or coughing difficult.
• Bone problems which reduce the size of the chest impairing your ability to take a deep breath.

Benefits
There are many benefits to breath stacking including:
1. Keeping your rib cage mobile and to stretch the muscles used in breathing and coughing.
2. Increasing lung volumes.
3. Improving the effectiveness of your cough.
4. Assisting with taking deeper breaths which can facilitate airway clearance and help to prevent chest infections.

Considerations/Risks
There are very few risks with using the LVR bags and the breath stacking technique. Your physio will have discussed this with you and ensured that you can use the equipment appropriately.

Positioning
It is best to perform your breath stacking exercises in an upright position to allow you to take the deep breaths required to make breath stacking effective.

Assembling the LVR bag:
Attach the filter and facemask/ mouthpiece as the picture below shows.

Breath Stacking
A breath stacking cycle is 3- 4 breaths IN followed by a breath OUT or a cough.
1. Breathe out fully
2. Place the mask over your mouth and nose creating a tight seal (or the mouth piece and use the nose clip if needed).
3. Take a deep breath IN and simultaneously squeeze the bag.
4. Hold the breath IN (the 1-way valve will help this).
5. Try to take another breath IN on top of the deep breath while you simultaneously squeeze the bag again.
6. Repeat 3-5 times until you get a full deep satisfactory breath IN.
7. Remove the mask or mouthpiece, try and hold the breath for 3-5 seconds and breathe OUT gently.
8. Repeat steps 1-7 up to 5 times. If you feel sputum try and produce a strong cough instead of breathing out.

General Advice
• Check the bag and all parts before using for any visible damage.
• Check there are no parts missing. If you have any concerns do not use the LVR bag.
• The bag should be replaced if it is damaged.
• The filter must be changed if it becomes visibly soiled or damaged.
• It is best to wash your mask/ mouth piece after every use in warm soapy water – leave it to air dry before the next use.
• Replace the mouthpiece or mask if it looks worn, damaged or visibly soiled.
• If there are any problems, please contact your physiotherapist on the details overleaf.

When to use your LVR bag
The frequency per day will be advised by the prescribing physiotherapist. It is recommended that you do some breath stacking every day.

When NOT to use it
You should not perform breath stacking:
• For 1 hour after food and drink (excludes sips of water)
• If you have chest pain or any blood in your mucus
• If you are allergic to latex
• If you have ever had a pneumothorax (punctured lung)
• If you are feeling unwell seek medical advice from your own GP.