Chest physiotherapy is a term for group treatments designed to eliminate secretions thus helps to decrease work of breathing, promote expansion of the chest of the lungs and prevent the lungs from collapse

Patients unable to take a deep breath can be assisted with intermittent positive-pressure breathing or a manual resuscitation bag

Caution is indicated when performing vibration & shaking in patients with a stiff inelastic chest wall or a history of osteoporosis, as the risk of rib fracture is increased with these techniques

Rib springing is contraindicated in these patients as well as in those with rib or spinal fractures, other bone abnormalities involving the chest or with pain.

• The therapist’s hand can be placed on both sides of the patient’s chest or one hand can be placed on top of the other depending on therapist preference.

• The patient is instructed to take a deep inspiration and then chest compression with vibration/shaking/rib springing is performed throughout exhalation, following the movement of the chest wall. (repeated for 6 breaths)

• For patients with rapid respiratory rates, these maneuvers can be performed on alternate breaths, which may help reduce the breathing rate & allow better therapist coordination with exhalation.

• Performed during exhalation only, these techniques are purported to achieve more rapid & efficient mobilization of secretions by moving the secretions that were dislodged during percussion toward the larger airways in the bronchial tree, from which they can be expectorated.

Conventional chest physiotherapy can be self-administered or performed with assistance of another person (a physiotherapist, parent or caregiver) for example when performing those techniques that involve manual handling such as manual vibration, thoracic squeezing and percussion

Premedication for pain is important in post-surgical surgical patients and others in whom ventilation and cough are limited by discomfort.
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Allow at least 20 to 30 minutes for analgesics to take affect before initiating treatment. Incisional pain may be reduced by having the patient hold a pillow or rolled travel over the painful site during percussion.

The therapist should monitor the patient’s oxygen saturation as it may fall during percussion. This can be eliminated by implementing thoracic mobility exercises ( as described earlier in this chapter) and pausing for breath control.

Percussion should be continued for 2 to 5 minutes per lung segment followed by vibration and coughing or suctioning.

When chest radiography or clinical assessment reveals a new atelectasis, treatment is continued with repeating cycles of percussion, vibration, and coughing/suction until
resolution is clinically apparent. (Eg: improved breath sounds, resolution of crackles, return of normal midline position of the trachea)
and coughing/suctioning is no longer productive.

Percussion is performed with the patient in the appropriate bronchial drainage position for each segment although modified positions may be indicated.

Percussion should be performed over a layer of thin cloth such as a hospital gown or T shirt. A towel will damper most of the force of percussion and drastically reduce the effectiveness of cupping.

If percussion is painful for the patient the therapists should ensure proper technique and decrease the amount of force being used so that it is not uncomfortable

percussion is a treatment technique that consists of rhythmically and alternately striking the chest wall with cupped hands to mechanically jar and dislodge retained secretions in underlying lung segments.

• Factors that influence the amount of force used are

Instrumental techniques such as non-invasive ventilation have been considered useful adjunct therapy to airway clearance and to provide respiratory support

Non-invasive ventilation has been shown to produce favorable outcomes in people with respiratory distress

Modern techniques use variation of flow through breath control to mobilize secretions