chest physiotherapy

chest physiotherapy?
Chest physiotherapy (CPT) is a treatment often used with children who have had heart surgery and who may have partial collapse of their lung tissue or lung secretions which they are unable to clear by themselves.
Chest physiotherapy is also known as "chest physical therapy," or "postural drainage and percussion."
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What is the treatment?
Chest physiotherapy is designed to use gravity to aid in draining secretion from various areas of the lungs. The patient lays in special ways to drain secretions from the smaller airways into their larger airways.
While the patient is lying down, rhythmic clapping (percussion) is applied with moderate to vigorous strength. The percussion is applied to the chest wall.
This helps loosen secretions from the respiratory tract, and forces the mucus from the smaller airways into the larger airways. The secretions can either be coughed up by the patient, or suctioned out.
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Why chest physiotherapy would be recommended
Chest physiotherapy is used for different reasons. When patients cannot bring up secretions, chest physiotherapy may be helpful.
Chest physiotherapy is also used for patients with pneumonia or patients with cystic fibrosis. Patients may have trouble taking deep breaths after surgery. When this happens, the lungs may not fully inflate. Chest physiotherapy has been helpful in treating this condition.
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How is chest physiotherapy done? It is painful or uncomfortable?
Chest physiotherapy is done by lying the patient in various positions. These positions include: sitting up, lying on their back, lying on their side, and lying with their head down.
While in these positions, the therapist's hand is cupped. The hand repeatedly hits the chest wall. If the child is small, the therapist may use a mask instead of their hand. This treatment itself will not hurt the patient.
Some patients may be very sore because of surgery. When this happens, a machine that gently vibrates can be applied to the chest.
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Who orders or performs chest physiotherapy, and where is the treatment performed? When or how often is the treatment done?
The doctor taking care of the patient will order chest physiotherapy. The respiratory therapist or the nurse will perform the treatment.
Chest physiotherapy is done at the patient's bed, which is made to be positioned for this type of treatment.
The treatment may be performed as often as every two hours. Most of the time, the treatment is done four times every day.
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What are the risks or possible complications of chest physiotherapy?
Chest physiotherapy should be not used on every patient. Patients with brittle bones or broken rib bones should not receive chest physiotherapy. This may cause the bone problem to become worse.
Chest physiotherapy should not be performed when a patient is unstable. This may lead to the patient condition becoming more serious.
Chest physiotherapy should not be used if the patient has increased pressure in their skull. If the patient is coughing up blood, has a lot of pain, has just eaten, or is vomiting, chest physiotherapy should be postponed until these conditions are no longer present.
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Does chest physiotherapy work?
Although chest physiotherapy has only been shown to work in patients with cystic fibrosis, it is felt to be useful in patients in the intensive care unit who are not very mobile after heart surgery or for other reasons when they are unable to keep all areas of the lung open.
Chest physiotherapy has been successful in some patients in preventing the need for more aggressive treatment (i.e., mechanical ventilation).
Chest Physiotherapy




Chest physiotherapy (CPT) is a means of clearing the lungs of accumulated mucus. It uses gravity and physical therapy to help move the secretions out of the lungs and stimulate coughing. It is used for persons with increased amounts of mucus or thick secretions, those with weak breathing muscles, or individuals with ineffective coughs. CPT consists of clapping, vibration, deep breathing, and coughing.

Clapping With the Cupped Hand

Clapping with the cupped hand on the chest wall over the section of the lungs to be drained starts vibrations which are transmitted to the air passages (bronchi), stimulating the movement of secretions. These vibrations may help to remove secretions sticking to the walls of the air passages.

The hand is cupped by holding the fingers together so that the shape of the cupped hand conforms with the chest wall. The cupped hand tends to trap a cushion of air which softens the blow of the clapping. Clapping should be vigorous but not painful. Clapping should not be done on bare skin, but over soft comfortable clothing or towels. Rings should be removed before clapping. Ribs are strong and flexible but can be broken by a blow with the hand. The cupping technique cushions the blow of the hand during clapping by trapping air between the hand and chest wall.

Vibration

Vibration is more difficult than clapping, but is valuable because it helps stimulate the flow of secretions. The assistant presses flattened hand firmly over the proper section of the child's chest wall, then tenses his upper arm and shoulder muscles (isometric contractions). At the same time, the child should make an "fff" or "sss" sound as he exhales as slowly and completely as possible.

Deep Breathing

Deep breathing assists in the movement of secretions and may stimulate coughing. With inhalation (breathing in), the airways widen and lengthen; with exhalation (breathing out), the airways narrow and shorten. A forced but not strained exhalation following a deep inhalation may move secretions and may stimulate a productive cough. An effective cough is an essential part of clearing the airways.

Cough

An adequate cough is an essential part of the chest physiotherapy program. The ability to cough effectively is the major defense against retaining mucus in the lungs. An effective cough is accomplished by taking two or three deep breaths, exhaling slowly, followed by a deep intake of breath and a deep cough. This should be done at least two times, or more as necessary, following chest physiotherapy. To minimize the chance of vomiting, chest physiotherapy is best done before meals or no sooner than one hour after eating. Early morning and bedtime are usually recommended. CPT exercises before bedtime help clear airways of accumulated secretions and may reduce nighttime coughing.

Mechanical Percussors/Vibrators

Various mechanical percussors and vibrators are available commercially, but your physician should be consulted before any purchase is made.

CPT Do's and Dont's

The chest should be protected by one layer of clothing or by a towel. This prevents irritation caused by clapping the bare chest with the hand. Clap over each area shown in the illustrations for one minute with a cupped hand.

Vibrate over each area following CPT five times while child is exhaling.

CPT is to be done prior to meals or no sooner than one hour following meals, to prevent vomiting. Do not clap over any bony portions of the chest, for example, the breastbone or the spine. Never clap below the bottom of the rib cage. Encourage the child to cough following CPT.

Upper Lobes

Child is in sitting position. Clap over upper shoulder and blade on each side of the back.

Child lies flat on back. Clap just below collar bone on each side of chest.
Middle Lobes

Child lies head down, on his side and rotates 1/4 turn backward. A pillow may be placed behind child for support. Clap over the nipple on each side.
Lower Lobes

Child lies head-down, on his side. Clap on lower part of chest toward the front, and upper part of chest on the back. Since these two positions are done at the same time, allow longer time for clapping (2-3 minutes).

Child lies on abdomen in a head-down position. Clap on lower back on each side of spine.