Chest Physiotherapy
Chest physiotherapy refers to a variety of maneuvers applied to
a patient by a therapist or by a device designed to facilitate mobilization of airway
secretions.[33]
These techniques include percussion/vibration
of the chest wall to loosen airway secretions and postural drainage using gravity
to facilitate drainage of airway secretions. Chest physiotherapy has been evaluated
in clinical trials primarily in patients with bronchiectasis and COPD,[36]
[37]
but in clinical practice, these techniques
are
often extrapolated to include patients with copious secretions or with difficulty
in clearing secretions.
Manual percussion and vibration of the chest wall by rhythmically
striking the thorax with cupped hands by a therapist is one of the oldest and simplest
physiotherapy techniques and has been shown to facilitate sputum clearance in some
patients.[38]
[39]
However, manual percussion is labor-intensive and time-consuming, limiting the frequency
and duration of this therapy. Simple oral devices with a flutter valve create positive
expiratory pressure and oscillatory vibrations transmitted to the airways during
expiration ( Fig. 75-5
).
Flutter devices have been shown to be effective in sputum clearance in small clinical
trials.[38]
[39]
Figure 75-5
Flutter device (Varioraw SARL, Scandipharm Inc, Birmingham,
AL). The patient expires forcefully into the mouthpiece, briefly displacing a dense
steel ball. As the ball rapidly oscillates during a sustained exhalation, vibrations
are transmitted to the airways.
Other, more complex apparatuses have been used to apply chest
physiotherapy. Mechanical percussors, such as vests and kinetic beds, apply high-frequency
oscillations to the chest wall to facilitate clearance of airway secretions. Intrapulmonary
percussive ventilation (IPV) delivers rapid positive-pressure mini-bursts of air
and aerosolized medications to the patient through a mouthpiece. The goal of IPV
is to transmit vibrations to the airways, loosen secretions and enhance distribution
of aerosolized medications. These devices are expensive and have thus far been studied
only in small clinical trials with inconclusive results.[42]
[43]
[44]
