7.1 : Chest Physiotherapy

Chest Physiotherapy (CPT) is a therapeutic technique used in respiratory care to improve ventilation, clear bronchial secretions, and enhance the efficiency of respiratory muscles. This therapy includes three primary procedures: postural drainage, percussion, and vibration. It can be performed on spontaneously breathing patients and those who are intubated and mechanically ventilated.

Purpose

CPT is primarily used for patients with excessive bronchial secretions who have difficulty clearing them. This therapy helps loosen and mobilize these secretions, increasing mucous clearance and making it easier for the patient to expectorate. Conditions such as atelectasis, cystic fibrosis (CF), chronic obstructive pulmonary disease (COPD), and pneumonia can all benefit from this therapy.

Procedure Guide for Nurses

Postural Drainage

Postural drainage utilizes positioning techniques to facilitate the drainage of secretions from targeted lung and bronchial segments into the trachea. The position used depends on the affected areas of the lungs. The patient stays in the chosen posture for about 5 minutes during percussion and vibration. Procedures should be scheduled at least one hour before or three hours after meals.

It's important to note that postural drainage can also be assisted by using a Chest physiotherapy vest or hospital beds equipped with vibration and percussion features, which can provide chest physiotherapy without manual techniques.

Percussion

Percussion is performed by placing the hands in a cup-like position with the fingers and thumbs closed. The cupped hand should create an air pocket between the patient's chest and the hand. Both hands alternate rhythmically, promoting the movement of thick mucus. To prevent tissue damage, it is essential to avoid performing percussion on bare skin and surgical incisions below the ribs, over the breasts, or over the spine.

Vibration

Vibration promotes the movement of secretions to the larger airways. It is performed by repeatedly tensing the hand and arm muscles and pressing mildly with the flat of the hand on the affected area while the patient slowly exhales a deep breath. To avoid causing discomfort, vibration should never be performed over the patient's breasts, spine, sternum, or lower rib cage.

Conclusion

Chest Physiotherapy is a critical procedure in managing patients with excessive bronchial secretions or conditions like CF, COPD, and pneumonia. When properly executed, it can significantly improve a patient's respiratory function and overall comfort.