Chest physiotherapy (PT) includes postural drainage, chest percussion and vibration, and coughing and deep-breathing exercises. Together, these techniques mobilize secretions, help to reexpand lung tissue, and promote efficient use of respiratory muscles. Of critical importance to the bedridden patient, chest PT helps prevent or treat atelectasis and may also help prevent pneumonia—two respiratory complications that can seriously impede recovery.

Postural drainage performed in conjunction with percussion and vibration encourages peripheral pulmonary secretions to empty by gravity into the major bronchi or trachea and is accomplished by sequential repositioning of the patient. Usually, secretions drain best with the patient positioned so that the bronchi are perpendicular to the floor. Lower and middle lobe bronchi usually empty best with the patient in the head-down position; upper lobe bronchi, in the head-up position. (See Positioning patients for postural drainage, pages 162 and 163.)

Percussing the chest with cupped hands mechanically dislodges thick, tenacious secretions from the bronchial walls. Vibration can be used with percussion to enhance secretion mobility or as an alternative to it in a patient who is frail, in pain, or recovering from thoracic surgery or trauma.

Candidates for chest PT include patients who produce large amounts of sputum, such as those with bronchiectasis and cystic fibrosis.¹,² The procedure hasn’t proved effective in treating patients with status asthmaticus, lobar pneumonia, or acute exacerbations of chronic bronchitis when the patient has scant secretions and is being mechanically ventilated. Chest PT has little value for treating patients with stable, chronic bronchitis.

Contraindications may include active pulmonary bleeding with hemoptysis and the immediate posthemorrhage stage, fractured ribs or an unstable chest wall, lung contusions, pulmonary tuberculosis, untreated pneumothorax, acute asthma or bronchospasm, lung abscess or tumor, bony metastasis, head injury, and recent myocardial infarction.¹