Is Prolonged Slow Expiration a Reproducible Airway Clearance Technique?

Abstract

Background Prolonged slow expiration (PSE) is a manual chest physical therapy technique routinely performed in clinical practice. However, the reliability and agreement of the technique have not been tested. Objective The objective of this study was to assess reliability and agreement between physical therapists during the application of PSE in infants with wheezing. Design This was a cross-sectional study. Methods Infants with a mean age of 59 weeks (SD = 26 weeks) were included in this study. Two physical therapists (physical therapist 1 and physical therapist 2) randomly performed 3 PSE sequences (A, B, and C). The expiratory reserve volume (ERV) was measured with a pneumotachograph connected to a face mask. ERV was used to evaluate the reproducibility of the technique between sequences and between physical therapist 1 and physical therapist 2. Results The mean ERV of the infants was 63 mL (SD = 21 mL). There was no statistically significant difference between the ERV values in the 3 sequences for physical therapist 1 (A: mean = 46.6 mL [SD = 17.8 mL]; B: mean = 45.7 mL [SD = 19.9 mL]; C: mean = 53.3 mL [SD = 26.3 mL]) and physical therapist 2 (A: mean = 43.5 mL [SD = 15.4 mL]; B: mean = 43.2 mL [SD = 18.3 mL]; C: mean = 44.8 mL [SD = 25.0 mL]). There was excellent reliability between the sequences for physical therapist 1 (ICC = 0.88 [95% CI = 0.63–0.95]) and physical therapist 2 (ICC = 0.82 [95% CI = 0.48–0.93]). Moderate agreement was observed between physical therapist 1 and physical therapist 2 (ICC = 0.67 [95% CI = 0.01–0.88]). According to Bland-Altman analysis, the mean difference between physical therapist 1 and physical therapist 2 was 4.1 mL (95% CI = −38.5 to 46.5 mL). Limitations The data were collected in infants with wheezing who were not in crisis. This decreased lung mucus; however, it also reduced evaluation risks. Conclusions PSE was a reproducible chest physical therapy technique between physical therapists.

Effectiveness of chest physiotherapy using passive slow expiratory techniques in dogs with airway fluid accumulation: A randomized controlled trial

“…These methods have been adapted to the small size of the individuals and their respiratory physiology. [11][12][13][14] In these patients, EFIT seem more effective than conventional techniques such as thorax percussion, manual vibration or postural drainage. 8,9,15,16 Among the EFIT, 2 manual techniques appear to be safe and effective in infants: prolonged slow expiration (PSE) and assisted cough (AC).…”

“…Expiratory flow increase techniques (EFIT) have been developed for the management of airway obstructions in children. These methods have been adapted to the small size of the individuals and their respiratory physiology 11‐14 . In these patients, EFIT seem more effective than conventional techniques such as thorax percussion, manual vibration or postural drainage 8,9,15,16 .…”

Comparison of Prolonged Slow Expiration Technique and Lung Squeezing Technique on Saturation of Peripheral Oxygen (SpO2) and Respiratory Rate (RR) in Infants with Acute Respiratory Distress Syndrome: An Experimental Study

“…16 This pressure difference improves pulmonary air flow from the alveoli to the trachea, which removes mucus. 18 Although PSE has been described in the literature since the 1990s, the studies have mostly focused on the clinical aspects of the technique, such as respiratory distress, SpO2, and heart rate frequency. 18 However, it is known that tidal volume and expiratory reserve volume (ERV) are better variables for assessing the results of this technique.…”

A deep look into the rib cage compression technique in mechanically ventilated patients: a narrative review

“…( 26 , 40 ) On the other hand, soft and gradual RCC is comparable to the prolonged slow expiration technique, which is applied during the late phase of expiration up to the residual volume to improve the interaction of the expiratory airflow with the mucus layer, specifically within the distal narrower airways. ( 26 , 41 , 42 ) However, in affected lungs, excessive compression over the whole expiratory phase can impair the residual lung volume, explaining some of the negative findings regarding mucus removal and compliance when soft RCC is applied.…”