Question 12

College Answer

Chest physiotherapy encompasses many manoeuvres, which are used to aid sputum clearance, recruit  areas  of  collapse  and  prevent  the  effects  of  suppressed  cough,  disrupted  mucociliary clearance and reduced FRC. The evidence for much of these procedures is scant.

A list of manoeuvres may include:

•    Endotracheal suctioning

•    Nasopharyngeal suctioning

•    Bagging

•    Percussion

•    Assisted coughing

•    Recruitment manoeuvres

A simple rationale for each was expected.

Discussion

The role of physiotherapy in ICU is discussed more generally in Question 24 from the second paper of 2013.

This question, focusing on purely chest physiotherapy, is pulled stright out of Oh's Manual, Chapter 5.

In summary, the following techniques are discussed in that chapter:

• Manual lung hyperinflation
  • Improves recruitment of atelectatic lung
  • Mobilises bronchial secretions
  • Improves lung compliance
• Recruitment manoeuvres:
  • Transiently improve oxygenation
• Suctioning:
  • Improves clearance of secretions
• Inspiratory muscle training
  • May improve the chances of successful ventilator weaning
• Chest shaking and vibration
  • Aid mucociliary clearance
• Chest wall compression
  • Enhances expiratory manoeuvres and aids secretion clearance
• Percussion
  • May mobilise secretions
• Neurophysiological facilitation of respiration
  • Stimulates increased V_T and cough
• Positioning
  • May reduce the work of breathing
• Gravity-assisted positioning
  • May enhance secretion clearance
• Active cycle of breathing techniques (ACBT)
  • Breathing exercises to remove excess secretions

Oh's Manual (7th ed) Chapter 5 (pp.38)  Physiotherapy  in  intensive  care   by Fiona  H  Moffatt  and  Mandy  O  Jones

Stiller, Kathy. "Physiotherapy in intensive care: towards an evidence-based practice." CHEST Journal 118.6 (2000): 1801-1813.