Chest Physiotherapy

7/17/2019 Chest Physiotherapy

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ChestPhysiotherapy



Chest Physiotherapy

-Collection of therapeutic techniquesdesigned to aid clearance of secretions,improve ventilation and enhance the

conditioning of the respiratory muscles;includes positioning techniques, chestpercussion and vibration, directedcoughing and various breathing and

conditioning exercises.



Importance of CPT

• The aims of airway clearancetechniques (CT! in patients are toassist sputum clearance in an

attempt to reduce symptoms, slowthe decline in lung function, reduceexacerbation frequency and hasten

the recovery from exacerbations.



Goal

• The primary goal of airway clearancetherapy is to help mobili"e andremove retained secretions, with the

ultimate aim to improve gasexchange, promote alveolarexpansion, and reduce the wor# of

breathing.



Need for Airway Clearance Therapy(Proper initial and going patient assessment)

• $oose ine%ective cough

• $abored breathing pattern

• &ecreased bronchial breath sounds

• Coarse inspiratory and expiratory crac#les

• Tachypnea

• Tachycardia

• 'ever may indicate potential problem withretained secretions.



CHEST PHSICA! "ETH#$SAN$ THEI% TECHNI&'ES

• )*+ *T/&0 /' C0T 0)C+$ T+

• T+1T)C /0)T)/2)23

-involves using gravity to achieve speci4c clinicalob5ectives or by simply turning the patient in di%erent

positions.

1/0 /' T12)23 T +T)2T )2 &)''2T/0)T)/20 +;

6.To promote lung expansion7.To improve arterial oxygenation

8.To mobili"e secretions(postural drainage!

9.To prevent retention of secretions



• TC2):10 /' T+1T)C/0)T)/2)23

-patients may turn themselves orwith a help of an T or using therotational bed.

-special rotational bed such as/T/-0T &.

/T/-0T &

- rotate continuously on their longaxis through a 679 degrees arc for



•/0T1+$ &+)2+3

-lacing the body in position that allowsgravity to assist drainage of mucus from

the lung periphery to the segmentalbronchus and upper airway.

• Tracheal 0uctioning

-&eep suctioning is necessary to thepatient who cannot mobili"e secretion.



CHEST PE%C'SSI#N AN$I%ATI#N

• )nvolve the application of mechanicalenergy to the chess wall using either handsor various electrical or pneumatic devices.

• ercussion should help 5ar retain secretionsloose from the tracheobronchial treema#ing them easier to remove bycoughing or suctioning.



TECHNI&'ES #* PE%C'SSI#N

• +pplied over the surface landmar#sof the arc being drain.

• *anual percussion is accomplish thehands in a cupped position with4ngers and thumb close.



I%ATI#N TECHNI&'E

• This is used together with percussion butlimited application typically the C laysone hand on the patient chest over the

involved area and places to the hand ontop of the 4rst alternatively the handsmaybe placed on either side of the chest.

• The C exerts slight to moderate pressure

on the chest wall and initiates a rapidvibration on hands throughout expiration.



C#'GHING AN$ %E!ATE$ P%#CE$'%ES

• C/13

-/ne of our most important protectivere<exes.

-y ridding the larger airways of excessivemucus and foreign matter, the coughcomplements normal mucocilliary clearance,and helps ensure airway patency.



"ECHANIS" #* N#%"A!C#'GH

• + Cough begins when sensory endings ofcertain nerves become irritated.

• + cough can also be induced by stimulation

of nerve endings in the mucousmembranes of the esophagus, pleuralsurface, and auditory canal.

• /nce generated , these impulses travel tothe C/13 C2T in the *&1$$+,which re<exly stimulates the muscles ofthe chest and larynx to initiate the cough

sequence.





+ $ISTINCT PHASES

6. ))T+T)/2 +0

7. )20)+T)/2 +0

8. C/*00)/2 +09. =1$0)/2 +0



Co,gh %e-e.



Irritation Phase

• )n the initial irritation phase, anabnormal stimulus provo#es sensory4bers to send a%erent impulses to

the cough center.

• This stimulus normally is eitherin<ammatory, mechanical, chemical,

or thermal.



Inspiration Phase

• /nce these a%erent impulses arereceived and processed, the coughcenter stimulates the respiratory

muscles to initiate a deep inspiration(the second phase!.

• )n normal adults, this inspiration

averages one to two liters.



Compression Phase

• &uring the third or compression phase,e%erent nerve impulses cause glotticclosure and a forceful contraction of the

expiratory muscles.• $asting about >.7 sec, this compression

phase results in a rapid rise in alveolarpressures, often in excess of 6>> mm g.



E/P'!SI#N PHASE

• +t this point the glottis opens, initiating theexpulsion phase. ?ith the glottis open, a largepressure gradient is established between thealveoli and airway opening.

• Together with the continued contraction of theexpiratory muscles, this pressure gradient causes aviolent, expulsive <ow of air from the lungs, withvelocities often as high as @>> miles per hour.

• ecause the nasopharynx is closed when theglottis opens, foreign material expelled from therespiratory tract enters the mouth, where it can beexpectorated or swallowed.



Clinical 'se

• + cough also may be initiated voluntarily,without the presence of irritating stimuli.

• + cough generally is an e%ective

clearance mechanism only down to aboutthe sixth or seventh branching of thetracheobronchial tree.

• )nterference with any one of its four phasescan result in an ine%ective cough, therebyimpairing the patientAs ability to clearrespiratory tract secretions.



• )t is important to identify and treat theunderlying disease and origin of the cough.+voiding smo#ing and direct contact withpeople experiencing cold or <u symptoms isrecommended.

• ?ashing hands frequently during episodes ofupper-respiratory illnesses is advised.

•

arents should followrecommended vaccination schedules forpertussion (whooping cough! to help preventthe disease from occurring.



Controlled Co,ghing Techni0,e

• Controlled coughing is one of the essentialtechniques in good respiratory care.

• The abdominal muscles are very powerful musclesused in coughing and exhaling.

/C&1

• )nhale deeply through the nose.

• ause.

• Cough 7 to 8 sharp staccato cough with properhandDarm placement.

• reathe in easily through the nose.



$irected Co,gh

• )s a deliberate maneuver that is taught,supervised, and monitored.

• +ims to mimic the features of an e%ective

spontaneous cough, to help to providevoluntary control over re<ex, and tocompensate for physical limitations thatcan impair this re<ex.



IN$ICATI#NS *#% $I%ECTE$C#'GH

• The need clear retained secretions fromthe central airways

• The presence of atelectasis

• To help prevent postoperative pulmonarycomplications

• +s a component of other bronchial hygienetherapies

• To obtain sputum specimens for diagnosticanalysis



C#NT%AIN$ICATI#NS T#$I%ECTE$ C#'GH

• )nability to control infection spread bydroplet nuclei

• resence of an elevated )C or #nown

intracranial aneurysm• resence of reduced coronary artery

perfusion

• +cute unstable head, nec#, or spine in5ury



TECHNI&'ES IN APP!IG$I%ECTE$ C#'GH

• stablish a need

• +ssess the patient to determine if any factorsexist which could limit the success of directedcough.

• ain or fear of pain caused by coughing may limitthe success of directed cough.

• 0ystemic dehydration, thic#, tenacioussecretions, arti4cial airways, or the use of C20

depressants or antitussiveness can thwart e%ortsto implement an e%ective directed coughregimen.



2 "#ST I"P#%TANT ASPECTSIN#!E$ IN PATIENT TEACHING

• /0)T)/2)23

• +T)23 C/2T/$

•

0T23T2)23 T =)+T/*10C$0



"#$I*ICATI#NS INTECHNI&'E

• 0urgical patients

• C/& patients prone to bronchiolarcollapse

• atients with neuromuscularconditions



SA!IA% SEC%ETI#NS AN$*#%EIGN #$ %E"#E

• /0T1+$ &+)2+3



• Than# youE

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Chest Physiotherapy