Indications for chest physiotherapy techniques

Intermittant lateral turning is indicated for sedated patients and those presenting a neuromuscular disease, or hypoxemia in certain positions, when patients present risk factors for atelectasis or proven sputum retention, or when patients are intubated or tracheostomized.

Postural drainage is indicated to eliminate secretions in patients who have excessive production, ineffective cough, cystic fibrosis, or bronchiectasis, in patients who are intubated, and as treatment for atelectasis and sputum retention.

Percussion is effective when the proximal airways are obstructed. The indications are the same as for other physiotherapy techniques. Preventive or curative percussion can be of benefit to intubated or tracheostomized patients. Incentive spirometry is indicated for all clinical conditions with risk of atelectasis. It can also be used as therapy for minor atelectasis.

Postoperative chest physiotherapy does not provide any benefit when secretions are not abundant. Therefore it is only indicated postoperatively when the patient presents chronic bronchopulmonary pathology (inhaled bronchodilators can be used in combination with physiotherapy), when cough is ineffective, or when atelectasis or sputum retention is established.

In all cases, patients must be monitored (pulse oximeter) and their tolerance evaluated because some can become hypoxemic without warning. All the chest physiotherapy techniques must be reviewed regularly. Therapy should only be continued if there is improvement in expectoration, clinical state, blood gases, or on the chest radiograph.

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