Abstract
The management of bronchial secretions is one of the main problems encountered in a wide spectrum of medical conditions ranging from respiratory disorders, neuromuscular disorders and patients undergoing either thoracic or abdominal surgery. The purpose of this review is illustrate to the reader the different ACTs currently available and the related evidence present in literature. Alongside methods with a strong background behind as postural drainage, manual techniques or PEP systems, the current orientation is increasingly aimed at devices that can mobilize and / or remove secretions. Cough Assist, Vacuum Techniques, systems that modulate airflow have more and more scientific evidence. Different principles combination is a new field of investigation that goes toward an increasing of clinical complexity that will facing us.
Highlights
The management of bronchial secretions is one of the main problems encountered in a wide spectrum of medical conditions ranging from respiratory disorders (e.g., COPD, bronchiectasis, cystic fibrosis) to neuromuscular disorders (e.g., ALS) to patients undergoing either thoracic or abdominal surgery
A wide range of treatments, techniques and devices are present in the scientific literature for managing bronchial encumbrance in respiratory physiotherapy; but their very multiplicity begs the question in daily clinical practice: “which of these treatments is it better to use to obtain the better result in my patient?.”
Postural drainage (PD) has been shown to have little or no effect in diseases associated with low content of secretions, the signs indicating PD are largely limited to patients who have secretion production >30 ml per day. . . .” Some authors, such as Bott [17], suggest that if severely affected patients find PD helpful during exacerbations, concomitant use of Intermittent Positive Pressure Breathing (IPPB) or NonInvasive Ventilation (NIV) might help overcome the sense of increased dyspnoea with the additional benefits of Positive Expiratory Pressure (PEP) therapy for secretion management
Summary
Clearance Techniques: The Right Choice for the Right Patient. The management of bronchial secretions is one of the main problems encountered in a wide spectrum of medical conditions ranging from respiratory disorders, neuromuscular disorders and patients undergoing either thoracic or abdominal surgery. The purpose of this review is illustrate to the reader the different ACTs currently available and the related evidence present in literature. Alongside methods with a strong background behind as postural drainage, manual techniques or PEP systems, the current orientation is increasingly aimed at devices that can mobilize and / or remove secretions. Different principles combination is a new field of investigation that goes toward an increasing of clinical complexity that will facing us
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