Our lungs are amazing organs, but they are prone to issues caused by diseases or environmental factors. One of the consequences of a lung “insult” is extra mucus production. If mucus cannot be expelled properly from the lungs, it may cause shortness of breath, low oxygen levels, and pneumonia. This can lead to being hospitalized, ventilated, or may even cause death to a patient who is vulnerable.
Since approximately 1915, medical staff has been trying different procedures to help drain the patient’s lungs of mucus. One measure that has stood the test of time is chest physiotherapy, aka chest PT. This procedure uses gravity and physical manipulation of the body to help release mucus from the smaller airways of the lungs into the larger airways to facilitate mobilization out of the lungs. Chest physiotherapy consists of several procedures that, up until the 1990s, were done by hand.
1. Percussion:This technique has the healthcare professional “cup” their hands and beat on the patient’s chest and back to help to release secretions and evoke a cough. The sound of the hand on the patient should be “hollow”.
2. Vibration: This technique has the medical professional use both hands to gently shake the areas that are percussed in an attempt to move the secretions to a larger airway and away from the lung walls.
3. Postural Drainage: This technique involves turning the patient into various positions to facilitate the movement of the secretions by using gravity. “ Trendelenburg” is one of these positions where the patient is tipped to head down and feet up, to hopefully move secretions out of the lungs and into the larger airways where they can be coughed out.
Chest PT can be done at home as well. If a patient is discharged from the hospital and is ordered to be on chest PT, the patient will be given a discharge paper showing how to do the maneuvers on their own or with the assistance of a caregiver. It is not difficult to use objects such as tables and chair backs to mimic the procedures done in the hospital.
Chest physiotherapy is rarely done by hand anymore. In the 1990s the “hand-held” electric percussor was first introduced. Initially, it was used in the medical setting along with other hospital supplies and then released for home use, this device can be used by the patient or caregiver to do what manual percussion was meant to do, but only more efficiently. It plugs into a standard electrical outlet and can be used as often as needed or prescribed.
Vest therapy is a mucus clearing device that is worn like a life vest. Inside the vest are tiny motors that are stitched into specific spots to perform chest physiotherapy on specific areas of the lungs. Most who are ordered on vest therapy have been diagnosed with cystic fibrosis or bronchiectasis. These diseases are notorious for producing large amounts of sticky mucus that the patient may have great trouble coughing out of the lungs.
The vest, depending on the manufacturer can run on electricity or batteries. They come in various sizes and a client should be measured by their healthcare provider to obtain correct sizing. The newer generations of vests are portable so the client is no longer tethered to a wall outlet while receiving therapy. This is especially beneficial when treating children or very independent clients.
During this Covid 19 crisis, chest physiotherapy has been an important adjunct therapy for the most critical in-hospital cases. The use of “pronation” or putting the patient on their belly to help move the fluids and mucus in the lungs is now standard procedure in most hospitals.
Chest PT is a great adjunct therapy for anyone who has a difficult time mobilizing secretions out of their lungs. It is recommended that you always consult with your physician before trying this therapy on your own at home.
There are “contra-indications” for chest physiotherapies such as cancer with metastasis to the bones, brittle bone issues, the ability of the patient to be turned or tipped, blood pressure concerns, and various other issues. Vest therapy can only be obtained by prescription.
Author Profile: Laura Castricone, Respiratory Therapist
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