Chest physiotherapy in the ICU

Question 12 from the second paper of 2001 asked the candidates to not only recall some details as to the role of chest physiotherapy in the ICU, but to list the manoeuvres and provide  the rationale for them. The pass rate was not reported, but one might expect it to have been low. This question has never been repeated since. The college answer was pulled straight 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
  • Stimulates cough
• Recruitment manoeuvres:
  • Transiently improve oxygenation
• Suctioning:
  • Improves clearance of secretions
  • Stimulates cough
  • Actually removes the secretions mechanically
• Inspiratory muscle training
  • May improve the chances of successful ventilator weaning
  • However, it increases the work of breathing
• 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
• Continuous rotational therapy
  • Continuously  and  slowly  turning the patient up to an angle of 60° onto each side
  • Prevents  dependent  airway  closure and dependent atelectasis
  • Increases lung compliance
  • Prevents pooling  and  stagnation  of  pulmonary  secretions
• Active cycle of breathing techniques (ACBT)
  • Breathing exercises to remove excess secretions