Airway Clearance Technique: Chest Physical Therapy
Chest Physiotherapy is a cornerstone airway clearance therapy when treating pulmonary disorders such as cystic fibrosis and bronchiectasis in order to improve lung function. When a patient is unable to clear mucus, breathing becomes hard work. He or she must expend extra effort and energy in order to get oxygen. This difficulty can lead to a vicious cycle of recurrent episodes of inflammation, respiratory infections, lung damage, increased production of excess mucus, and possibly airway obstruction.
The purpose of chest physiotherapy, also know as chest physical therapy (CPT), is to clear mucus from the five lobes of the lungs by moving mucus into the main larger airways so that it can be coughed out. Chest physical therapy includes postural drainage, chest percussion, chest vibration, deep breathing exercises, and coughing. Chest physical therapy is normally done in conjunction with other treatments to rid the airways of secretions to prevent lung infections. Generally, each treatment session can last for 20 to 40 minutes and is performed several times a day.
Respiratory therapists, nurses, and family members who have been taught the correct procedure may administer manual hand CPT by using cupped hands to percuss and vibrate the chest wall to loosen mucus from the chest wall. Percussion and vibration help loosen and move mucus and secretions from the lungs and airways. A strong cough is encouraged during and after chest physiotherapy to aid in the movement of the mucus up the airways and out of the lungs.
The three cornerstone components of CPT are percussion, vibration and postural drainage.
Percussion is done by a steady beat on the chest wall with cupped hands or through mechanical means such as a High Frequency Chest Wall Oscillation (HFCWO) device. The purpose of percussion is to break up thick secretions in the lungs so they can more easily be removed. Percussion is performed on each of the 5 lobes of the lungs for approximately five minutes, while the patient is encouraged to perform coughing and deep breathing techniques. This process is repeated until each segment of the lung is percussed.
The role of vibration is to help break up thick and sticky lung secretions. Vibration can be either performed by mechanical or manual CPT. When done manually, the individual performing the vibration places his or her hands against the patient’s chest and creates vibrations by quickly contracting and relaxing arm and shoulder muscles while the patient exhales. The procedure is repeated several times each day.
Postural drainage uses gravity to assist in effectively draining and mobilizing loosened secretions from the smaller airways into the main airway, where they can either be coughed up or suctioned out. The patient is placed in various positions