Airway Clearance Techniques

Chest Physiotherapy (CPT) is indicated for clearance of airway secretions. Airway clearance techniques can be utilized in the home. The concept of postural drainage, percussion, and vibration is that the secretions are mobilized by the cest wall movement in a position that uses gravity to aid drainage. Percussion is performed using a cupped hand or a device such as plastics or rubber handled substitute. Vibrationnis usually applied with a mechanical device with increased pressure during expiration. Infants and small children can be held on a pillow or the lap of treater. Older children can be tilted using a board or bed or can learn to self-administer. Caregivers need to be taught the techniques.

If the secretion are moved from the periphery of the lung toward the central airway, they can then be coughed out. Huffing is coughing with an open golttis. It is thought to be more efficient in removal of mucus and is also called forced expiratory technique. It is usual to perform perucussion or vibration for 1 minute per segment except that extended therapy is recommended for cystic fibrosis patients and 2 minutes per segment is used. Additional methods for ACT include the flutter valve, positive expiratory pressure (PEP) valve, and autogenic drainage.

It is usual to utilize bronchodilator medications prior to strarting chest PT. The contraindications to CPT include hemoptysis and pneumothorax. Chest pain and rib tenderness may be significant and lead to modification of the therapy. Chouging may be difficult if there is pain in the chest or abdomen.

Suction machines are used at home for aspiration of secretions. A tonsillar or Yankauer catheter is used for oropharyngeal suctioning and suction catheter for endotracheal secretions. It is sensible to have both electric and battery-operated machines.