Chest Physiotherapy Vibration

Adam

April 18, 2022

262

Chest Physiotherapy Vibration

Abstract

Objective: To examine the effect of timing and chest vibration on air flow in ventilated lungs models.

Design: An experimental bench study.

Participants: Thirty physiotherapists with experience in intensive care.

Intervention: Three sets of eight vibrations were applied to a mechanically ventilated, intubated mannequin by physiotherapists. The vibrations were performed at the end of expiration (optimal), in mid to late inspiration (early), as well as early to middle expiration. Continuous measurements of air flow, peak pressure, and volume were made. The force generated by vibrations was measured using the force-sensing mat that was placed below the hands and fingers of physiotherapists.

Results: During optimal and early vibrations, peak expiratory flow increased significantly compared with baseline ventilation [mean difference for optimal vibrations 8.8l/minute, 95% confidence interval (CI) 6.0 to 11.6; mean difference for early vibrations 7.0l/minute, 95% CI 4.3 to 9.9]. Late vibrations did not enhance expiratory flow. The average difference in peak inspiratory power between baseline and early vibrations was 5.6cmH(2)O (95% CI 2.9 to 8.2). Peak inspiratory tension generated in early vibrations was on average 8.4cmH(2)O lower than optimal timing.

End result: Time of breath vibrations can have a significant impact on how effective and safe respiratory physiotherapy treatments work. Peak inspiratory pressures can be dangerously high when early vibrations are generated. Late vibrations, although not harmful, are not effective at increasing peak expiratory flow. This is an important consideration when training physiotherapists and evaluating outcomes of treatments in intensive care.

Chest Physiotherapy

Andrea R. Levine Jason Stankiewicz. To learn more, please click here. Chest-physiotherapy uses mechanical techniques such as postural drainage, vibration and chest percussion to enhance mobilization. The treatment is used for patients who have difficulty clearing their coughs. Read more Examples include patients with Bronchiectasis Bronchiectasis Bronchiectasis is dilation and destruction of larger bronchi caused by chronic infection and inflammation. The most common causes include cystic Fibrosis and immune defects. Recurrent infections can also be a factor. COPD (Chronic Obstructive Pulmonary Disease): Chronic obstructive lung disease (COPD). Chronic pulmonary disease is a condition that restricts airflow due to an inhaled chemical, commonly cigarette smoke. Alpha-1 Antitrypsin Deficiency, various occupational… (chronic Obstructive Pulmonary disease) may be present in certain clinical cases. ( General References Chest physiotherapy is a combination of mechanical and external techniques, including chest percussion and postural drainage. This helps to boost mobilization, clearance, and activation of the airway secretions. This treatment is recommended for… Read More Cystic Fibrosis. Cysticfibrosis refers to an exocrine disease that affects the respiratory and gastrointestinal systems. It leads to chronic lung disease, exocrine pancreatic insufficiency… read more Neuromuscular disorders Pneumonias Overview of Pneumonia Pneumonia is acute inflammation of the lungs caused by infection. Initial diagnosis is usually based on chest x-ray and clinical findings. Causes, symptoms, treatment, preventive measures, and… read more in dependent lung regions Despite relatively few high-quality clinical trials providing strong evidence-based support, chest physiotherapy remains an important component of care in patients with cystic fibrosis Cystic Fibrosis Cystic fibrosis is an inherited disease of the exocrine glands affecting primarily the gastrointestinal and respiratory systems. This can lead to exocrine pancreatic dysfunction, chronic lung disease and even exocrine lung cancer.

Mechanical Ventilation – Chest Therapy

Some patients can lose their spontaneous breathing due to mechanical ventilation. This can predispose the patients to developing lung collapse and ventilator-associated pneumonia. In such circumstances, chest physiotherapy can be used to reduce the length of stay in both a mechanical ventilator and ICU and prevent ventilator-associated pneumonia ( ). Additionally, patients intubated with high frequency chest wall oscillation had a higher dry sputum and PaO levels on days 3 and 4, and less lung collapse on days 2 through 3. Culture positivity increased on day 3 (). The patient received eleven sessions of physical therapy, which consisted of standing, mobilization, and exercise. It was followed by the active cycle breathing exercise technique, every two hours, for 12 hours. This resulted in an increase in arterial oxygen. Since chest physiotherapy can reverse pathological progression and prevent atelectasis as well as improving impaired gas exchange and decreasing culture positivity (which are some of the hallmarks of COVID-19), it is possible to be used in patients suffering from this condition.

Patients who use a ventilator should be aware of the following: airway clearing techniques, lung maneuver recruitment and endotracheal succioning. The airway clearance techniques recommended include positioning, active cycle of breathing, manual and/or ventilator hyperinflation, percussion and vibration, positive expiratory pressure (PEP), and mechanical insuflation-ensufflation ( ). These techniques are not described in detail, nor have there been any studies on patients suffering from COVID-19 that show their effectiveness. Details of positioning therapy can be found in Table 1. In addition, lung maneuver recruitment needs to be used with caution since it may have severe adverse effects ( ). Chest physiotherapy is not recommended during this time. This depends on how the patient’s neurological, respiratory and cardiovascular functions are. For more information on the contraindications, see Table 2.

Physiotherapeutic Intervention

Subjects in this study underwent chest physiotherapy. They received vibrations, expiratory rib cage compression, manual hyperinflation, and tracheal aspiration. The subjects included in this study received their first chest physiotherapy after the diagnosis of septic shock. For the chest maneuvers to be performed, subjects were placed in dorsal supine. The purpose of expiratory rib compression is to produce mechanical force through the chest wall and into the airways during an expiratory phase. This allows for increased and directed airflow, and for airway clearing and pulmonary reexpansion.

In order to improve mucociliary filtration, vibrations were produced by an isometric contraction in the forearm muscle.

Manual hyperinflation was done using an Ambu (Glen Burnie) device. The inspiratory Pressure was 40 cm HO and F at 0.6, causing an increase in the tidal volume and subsequent improvements in respiratory compliance, inspiratoryflow, and bronchial secretion.

As part of the tracheal aspiration process, manual hyperinflation took place simultaneously. There were 5-6 ventilatory rounds at each tracheal aspiration. A size 10 or 12-inch aspiration needle (CPL Medicals Sao Paulo Brazil) was used to perform tracheal aspiration. The solution was 0.9% and was administered slowly and gently in order to extract secretions.

The quantity of secretions the subject produces determined how many aspirations could be performed. The standard vacuum level was 30 cm Hg.

S, Heart Rate, Breathing Frequency, and Mean Arterial Pressure were all monitored during the implementation of these techniques to monitor the effects (data not displayed).

How Is Vibration Done In Chest Physiotherapy?

The technique tends to be applied on expiration (breathing out), and involves the physiotherapist using both hands to vibrate the lower chest wall in order to loosen secretions and allow them to be coughed out. Vibrations can be applied to both lungs or just one lung.

How is Vibration in Physiotherapy Different?

Vibration therapy is a treatment that uses vibrations as a tool. Vibration can be described as the propagation or deformation or tension of elastic waves in continuous media. Nov 2, 2021

What Does Chest Vibration Look Like?

To vibrate the chest, the hands are placed on the patient’s chest and the oscillatory action is applied in the direction that the normal movements of the ribs occur during expiration. The physiotherapist uses the body weight. 1.Nov 12, 2008

How do I get my stomach to vibrate?

Step 4: While the person breathes OUT, place your hands on the congested area. Once the congestion has subsided, vibrate it at least three time and then help with the cough. Keep the fingers and wrists tight when vibrating. Apply pressure downward and vibrate hands and arms.

.Chest Physiotherapy Vibration

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