ABSTRACT
Chest physical therapy is used in the intensive care unit (ICU) to minimize pulmonary secretion retention, to maximize oxygenation, and to reexpand atelectatic lung segments. This article reviews how chest physical therapy is used with patients who are critically ill. A brief historical review of the literature is presented. Chest physical therapy treatments applicable to patients in the ICU are discussed. Postural drainage, percussion, vibration, breathing exercises, cough stimulation techniques, and airway suctioning are described in detail, with current references. The importance of patient mobilization is emphasized. The advantages of chest physical therapy over therapeutic bronchoscopy also are discussed. Two patient examples are used to demonstrate the beneficial effects that may be obtained with chest physical therapy. Following the removal of retained secretions, arterial oxygenation and partial pressure of arterial oxygen/fraction of inspired oxygen concentration ratios improved, and atelectasis resolved without the negative hemodynamic side effects of therapeutic bronchoscopy. Physical therapists trained in the ICU can safely perform chest physical therapy with the majority of patients who are critically ill.
Subject(s)
Critical Care/methods , Pulmonary Atelectasis/therapy , Respiratory Therapy/methods , Adult , Blood Gas Analysis , Breathing Exercises , Early Ambulation , Hemodynamics , Humans , Male , Posture , Pulmonary Atelectasis/blood , Pulmonary Atelectasis/diagnostic imaging , Radiography , Suction , Treatment OutcomeABSTRACT
This study compared the use of abdominal weights (AbWts) to inspiratory resistive muscle training (IMT) on selected measures of pulmonary function. Eleven patients, aged 16 to 41 years (mean = 27.8, SD = 8.3) with complete cervical injuries were randomly assigned to either an AbWts or IMT treatment group. Subjects in both treatment groups received daily treatments (five times weekly) for 7 weeks. Forced vital capacity (FVC), inspiratory capacity (IC), maximal voluntary ventilation (MVV), peak expiratory flow rate (PEFR), and inspiratory mouth pressure (PImax) were measured weekly. Analysis of variance for repeated measures showed no difference between the AbWts and IMT treatments; there were significant differences within each respective treatment group for all five variables. Although the data did not support the effectiveness of one method of training over the other, the larger increase in MVV with the IMT protocol may be indicative of an endurance training effect with this protocol. Future research should compare the effects of breathing exercise training to spontaneous recovery of the respiratory muscles in control subjects.
Subject(s)
Breathing Exercises , Exercise Therapy/methods , Quadriplegia/rehabilitation , Adolescent , Adult , Female , Humans , Male , Physical Endurance/physiology , Quadriplegia/physiopathology , Respiratory Function Tests , Weight LiftingABSTRACT
Chest physical therapy is the preferred treatment in the MIEMSS for both preventing and treating pulmonary complications caused by retained secretions. The beneficial results of chest physical therapy in our facility, including improvement in chest roentgenogram appearance, arterial blood gases, and lung compliance, have been documented. The cases presented illustrate the successful use of chest physical therapy despite the presence of severe trauma and possible contraindications. The potential benefits of chest physical therapy may outweigh the existing possible contraindications.
