The role of chest physiotherapy in mucus hypersecretion

Effectiveness of a chest physiotherapy care map in hospitalized patients

BACKGROUND

Conventional chest physiotherapy (chest PT) has been widely used to facilitate airway clearance. However, conventional chest PT is time consuming, unnecessary prescriptions result in heavier workloads for therapists. Therefore, judicious prescription of chest PT is important.

PURPOSE

To develop a chest physiotherapy care-map and evaluate its efficacy.

METHOD

Seventy-eight hospitalized patients who were consulted for chest PT were enrolled and consecutively allocated into two groups of 39 patients. Group I and II was enrolled before and after the implementation of the chest PT map, respectively.

RESULT

After the care-map was implemented, the chest PT prescription rate decreased from 56.4% to 33.3%, (p = 0.040). The duration of conventional chest PT trended to lower but not reaching significance from 4.5 (1-28) to 4 (2-9) days, (p = 0.582). The mean cost of chest PT was reduced by 38.2% (p = 0.019).

CONCLUSION

Chest PT care-map is an effective tool to reduce unnecessary chest PT prescriptions, lower costs, and more effectively allocate therapist time.

Pulmonary contusions and critical care management in thoracic trauma

Many victims of thoracic trauma require ICU care and mechanical ventilatory support. Pressure and volume-limited modes assist in the prevention of ventilator-associated lung injury. Ventilator-associated pneumonia is a significant cause of posttraumatic morbidity and mortality. Minimizing ventilator days, secretion control, early nutritional support, and patient positioning are methods to reduce the risk of pneumonia.

Nonpharmacologic airway clearance therapies: ACCP evidence-based clinical practice guidelines

BACKGROUND

Airway clearance may be impaired in disorders associated with abnormal cough mechanics, altered mucus rheology, altered mucociliary clearance, or structural airway defects. A variety of interventions are used to enhance airway clearance with the goal of improving lung mechanics and gas exchange, and preventing atelectasis and infection.

METHOD

A formal systematic review of nonpharmacologic protussive therapies was performed and constitutes the basis for this section of the guideline. In addition, the articles reviewed were found using the same methodology but were not limited to those that focused only on cough as a symptom. The MEDLINE database was searched for this review and consisted of studies published in the English language between 1960 and April 2004. The search terms used were "chest physiotherapy," "forced expiratory technique," "positive expiratory pressure," "high frequency chest compression," "insufflation," and "exsufflation."

RESULTS

In general, studies of nonpharmacologic methods of improving cough clearance are limited by methodological constraints, and most were conducted only in patients with cystic fibrosis. Chest physiotherapy, including postural drainage, chest wall percussion and vibration, and a forced expiration technique (called huffing), increase airway clearance as assessed by sputum characteristics (ie, volume, weight, and viscosity) and clearance of the radioaerosol from the lung, but the long-term efficacy of these techniques compared with unassisted cough alone is unknown. Other devices that allow patients to achieve the same benefits derived from chest physiotherapy without the assistance of a caregiver appear to be as effective as chest physiotherapy in increasing sputum production.

CONCLUSIONS

Some nonpharmacologic therapies are effective in increasing sputum production, but their long-term efficacy in improving outcomes compared with unassisted cough alone is unknown.

Rate and force of application of manual chest percussion by physiotherapists

The rate and force of manual chest percussion as applied by 35 physiotherapists was investigated. The influence of gender, body weight, body mass index (BMI), rate and frequency of usage on force were examined. Percussion was applied to a healthy male for 35 seconds and the rate and force were measured using a force platform. The rate and force varied among subjects. The mean (SD) rate and force of percussion were 6.60 (1.00) Hertz and 58.10 (15.32) Newtons respectively. There was no relationship between force and 1) gender, 2) body weight, 3) BMI or 4) frequency of usage of percussion. A weak relationship was found between rate and force (r = -0.358, p = 0.034). Thirty-two subjects demonstrated a hand dominance.

Stressing the critically ill patient: the cardiopulmonary and metabolic responses to an acute increase in oxygen consumption

Critically ill patients frequently have compromised respiratory and hemodynamic function. Chest physical therapy has been previously shown to increase oxygen demand and therefore was used to examine how postoperative mechanically ventilated patients responded to an increased oxygen demand. We found that during chest physical therapy, oxygen consumption increased 52% +/- 37% (SD) over baseline values. There was a 35% +/- 32% increase in oxygen extraction and a 17% +/- 33% increase in oxygen delivery. Arterial and pulmonary artery pressures also increased. The cardiac output increase was due to increased heart rate with no change in stroke volume. The increases in minute ventilation and alveolar ventilation were not sufficient to eliminate the greater quantity of carbon dioxide produced, resulting in a small increase in PaCO2. There was no significant change in systemic vascular resistance. The increase in oxygen demand caused by chest physical therapy triggered an integrated physiological response that resulted in increased respiratory and cardiac performance. This in some ways, such as the lack of increase in systemic vascular resistance, resembles the response to exercise.