Chest physiotherapy consists of external mechanical maneuvers, such as chest percussion, postural drainage, and vibration, to augment mobilization and clearance of airway secretions. It is indicated for patients in whom cough is insufficient to clear thick, tenacious, copious, or loculated secretions (1). Examples include patients with
Bronchiectasis (cystic fibrosis–related and non-cystic fibrosis–related)
COPD (chronic obstructive pulmonary disease), in certain clinical situations (2)
Neuromuscular disorders
Pneumonias in dependent lung regions
Contraindications
Contraindications to chest physiotherapy are all relative and include the following:
Bleeding diathesis (including therapeutic anticoagulation)
Discomfort due to physical positions or manipulations
Elevated intracranial pressure
Recent hemoptysis
Rib fractures
Vertebral fractures or osteoporosis
Procedure
Chest physiotherapy may be administered by a respiratory therapist, although the techniques can often be taught to family members of patients.
The most common procedure used is
Postural drainage and chest percussion
In postural drainage and chest percussion, the patient is rotated to facilitate drainage of secretions from a specific lung lobe or segment while being clapped with cupped hands to loosen and mobilize retained secretions that can then be expectorated or drained. The procedure is somewhat uncomfortable and tiring for the patient. Alternatives to chest percussion by hand include use of mechanical vibrators and inflatable vests.
Other methods that help clear airways include using controlled patterns of breathing, positive expiratory pressure devices to maintain airway patency, suctioning, and ultra-low-frequency airway oscillation devices to mobilize sputum. The methods of airway clearance are comparable, and methods should be selected based on individual patient needs and preferences.
Complications
Complications are unusual but include position-related hypoxia and aspiration of freed secretions in other lung regions.
General references
1. McCool FD, Rosen MJ: Nonpharmacologic airway clearance therapies: AACP evidence-based clinical practice guidelines. Chest 129:(1 suppl):250S–259S, 2006. doi: 10.1378/chest.129.1_suppl.25OS
2. Osadnik CR, McDonald CF, Jones AP, Holland AE: Airway clearance techniques for chronic obstructive pulmonary disease. Cochrane Database Syst Rev Mar 14;(3):CD008328, 2012. doi: 10.1002/14651858.CD008328.pub2
