Bronchial hygiene techniques in patients on mechanical ventilation: what are used and why?

Abstract

ObjectiveTo analyze and describe the maneuvers most commonly used in clinical practice by physical therapists and the reasons for choosing them.MethodsA prospective multicenter study using a questionnaire. The sample consisted of physical therapists from five hospitals (three private hospitals, a teaching hospital and a public hospital).ResultsA total of 185 questionnaires were filled in. Most professionals had graduated 6 to 10 years before and over had over 10 years of intensive care unit experience. The most often used maneuvers were vibrocompression, hyperinflation, postural drainage, tracheal suction and motor mobilization. The most frequent reason for choosing these maneuvers was “I notice they are more efficient in clinical practice.”ConclusionPhysical therapy is mostly based on individual experience acquired in the clinical practice, and not on the scientific literature.

Maneuvers and strategies in respiratory physical therapy: time to revisit the evidence

“…Bag squeezing and manual hyperinflation, when compared with the stimulation of cough or tracheal aspiration without the prior use of physical therapy maneuvers, have so far been shown not to be effectively capable of demonstrating an increase in the mobilization and in the amount of fluid. 8 …”

“…Cough depends on inspiratory and expiratory muscles being preserved; however, after prolonged ICU stays and use of mechanical ventilation, in addition to the evolution of various diseases, these muscles might become impaired and end up compromising effective coughing. 8 In this context, maneuvers that improve the patient’s ability to perform deep and sustained inhalations are very important to make coughing more effective, revert possible areas of atelectasis, and prevent other pulmonary complications due to accumulation of secretions. 8 …”

“… 8 In this context, maneuvers that improve the patient’s ability to perform deep and sustained inhalations are very important to make coughing more effective, revert possible areas of atelectasis, and prevent other pulmonary complications due to accumulation of secretions. 8 …”

“…A recent study 8 evaluated the major bronchial hygiene techniques used by physical therapists: vibrocompression, hyperinflation, postural drainage, tracheal aspiration, and motor physical therapy. The authors found that the most frequent reason for using one or the other maneuver was the personal experience of the professional (not scientific evidence), which demonstrates the need for further studies on this topic because techniques/maneuvers have always been used and recommended in the routine of such professionals.…”

“…The authors found that the most frequent reason for using one or the other maneuver was the personal experience of the professional (not scientific evidence), which demonstrates the need for further studies on this topic because techniques/maneuvers have always been used and recommended in the routine of such professionals. 8 Based on these findings, interventions were started to help improve or simulate the physiological mechanisms of fluid clearance.…”