Chest physiotherapy is a phrase used in research to describe physiotherapy treatment strategies that target secretion elimination and increase airway clearance, improving respiratory efficiency. Chest physiotherapy techniques refer to a series of therapies aimed at removing secretions from the lungs, hence reducing the labor of breathing, promoting lung expansion, and preventing collapse.
Bronchial hygiene uses non-invasive airway clearing treatments to assist mobilize and eliminating secretions while also improving gas exchange.
The Purposes of Chest Physiotherapy
The goal of chest physiotherapy delivered by a physical therapist is to:
To reduce breathing labor
To enhance lung compliance and prevent collapsing
To increase gas exchange by optimizing the ventilation-perfusion ratio.
Make it easier to remove any trapped or excessive airway secretions.
Classification of Chest Physical Therapy
Chest physiotherapy incorporates a variety of physiotherapy treatments along with chest physiotherapy steps. Based on changing research, chest physiotherapy approaches can be traditional, contemporary, or instrumental.
Techniques that have been Used Before
Traditional chest physiotherapy is another term for conventional chest physiotherapy. It was initially proposed in 1915. Manual handling techniques are used to aid mucociliary clearance. It was then expanded to include coughing exercises and forceful expiratory procedures (huffing). PDPV is more effective when combined with bronchodilator medication.
Drainage of the postural muscles
Postural drainage is a technique that includes situating a person with the help of gravity to help the body’s natural airway clearance system. The location of postural drainage changes depending on whether parts of the lungs have a lot of secretions. The target lung segment(s) must be superior to the carina.
Percussion
Cupping, clapping, and tapotement are all terms for percussion. The goal of percussion is to impart kinetic energy to the chest wall and lungs regularly. This is achieved by pounding the thorax rhythmically with a cupped hand or mechanical instrument directly over the drained lung segment(s).
Vibration
A fast vibratory impulse is conveyed through the chest wall from the therapist’s flattened hands via isometric alternating contraction of the forearm flexor and extensor muscles to loosen and remove airway secretions.
Coughing
Coughing may be done in various ways, including focused coughing and other aided coughing techniques.
Forced Expiratory Technique (FET):
Diaphragmatic inspiration, relaxation of the scapulohumeral region, and forceful expiration from mid to low lung volumes while keeping an open glottis are all examples of forced expiratory procedures (“huffing” exercises). It works better than coughing.
Techniques Used Today/ Innovative Techniques:
Several more non-invasive clearing approaches have been developed to supplement this standard strategy. It comprises a vigorous breathing cycle as well as autogenic drainage.
Breathing Method with an Active Cycle
This one is a progressive respiration approach conducted by the individual that can be utilized to mobilize and remove excess mucus from the lungs while also improving lung capacity. The three primary steps are breathing control, thoracic expansion, and forceful expiratory technique.
Drainage that is Caused by the Body
The receiver is seated, back erect, head somewhat hyperextended, and hands-on the upper left and right chests. Because it enhances independence, autogenic drainage has the potential to be beneficial. There is no need for special equipment, and it may be used in a variety of contexts and everyday life. The following are the three phases of autogenic drainage.
Displacement:
Collection:
Instrumental strategies for elimination
Instrumental Approaches:
Instrumental approaches, such as non-invasive ventilation, have been suggested to supplement airway clearing and respiratory support. The following are some examples of standard instrumental techniques:
Positive Airway Pressure (CPAP)
Continuous positive airway pressure (CPAP) is created by exhaling versus continuous opening pressure, resulting in positive end pressure (PEEP). Commercially available pressure drivers can also produce constant positive airway pressure. These usually need nasal prongs that fit snugly or a CPAP facemask. Bubble CPAP is suitable for usage in low-resource settings and with children.
Percussive Ventilation Intrapulmonary
IPV was created to help mobilize bronchial secretions and enhance breathing efficiency and distribution by using intrathoracic percussion and vibration and a different method of delivering positive pressure to the lungs. Each percussive cycle’s duration is manually regulated using a thumb button. PAP is always maintained in the airway during the process.
Positive Expiratory Pressure (PEP)
Positive expiratory pressure is a chest physiotherapy technique that uses a piece of equipment that opposes exhalation using a mouthpiece or face shield, accompanied by forceful expirations. The inhaling volume is tidal, and the expiry is mildly active against the devices. Flutter, Acapella, lung flute, and other gadgets are among them.
Chest Wall Oscillation at a High Frequency (HFCWO)
In high-frequency chest wall oscillation (HFCWO), an airway clearance treatment, exterior thoracic vibrations are applied to the thorax to use an inflating jacket covering the chest. In this chest PT technique, Pulses of varied frequency and magnitude have been used these gadgets to release and reduce mucous and remove it from the respiratory passages.
