Conventional Chest Physiotherapy Research Articles

Instantaneous responses to high-frequency chest wall oscillation in patients with acute pneumonic respiratory failure receiving mechanical ventilation: A randomized controlled study.

Background:Endotracheal intubation and prolonged immobilization of patients receiving mechanical ventilation may reduce expectoration function. High-frequency chest wall oscillation (HFCWO) may ameliorate airway secretion movement; however, the instantaneous changes in patients’ cardiopulmonary responses are unknown. Moreover, HFCWO may influence ventilator settings by the vigorous oscillation. The aim of this study was to investigate these issues.Methods:Seventy-three patients (52 men) aged 71.5 ± 13.4 years who were intubated with mechanical ventilation for pneumonic respiratory failure were recruited and randomly classified into 2 groups (HFCWO group, n = 36; and control group who received conventional chest physical therapy (CCPT, n = 37). HFCWO was applied with a fixed protocol, whereas CCPT was conducted using standard protocols. Both groups received sputum suction after the procedure. Changes in ventilator settings and the subjects’ responses were measured at preset intervals and compared within groups and between groups.Results:Oscillation did not affect the ventilator settings (all P > 0.05). The mean airway pressure, breathing frequency, and rapid shallow breathing index increased, and the tidal volume and SpO2 decreased (all P < 0.05). After sputum suction, the peak airway pressure (Ppeak) and minute ventilation decreased (all P < 0.05). The HFCWO group had a lower tidal volume and SpO2 at the end of oscillation, and lower Ppeak and tidal volume after sputum suction than the CCPT group.Conclusions:HFCWO affects breathing pattern and SpO2 but not ventilator settings, whereas CCPT maintains a steadier condition. After sputum suction, HFCWO slightly improved Ppeak compared to CCPT, suggesting that the study extends the indications of HFCWO for these patients in intensive care unit. (ClinicalTrials.gov number NCT02758106, retrospectively registered.)

Application value of high frequency chest wall oscillation after operation of abdominal incisional hernia

Objective To investigate the application value of high frequency chest wall oscillation (HFCWO) after operation of abdominal incisional hernia. Methods A prospectively randomized double-blind study was adopted. Fifty patients who underwent operation of abdominal incisional hernia at the Huadong Hospital Affiliated to Fudan University between January 2014 and September 2015 were allocated into the HFCWO group (undergoing postoperative HFCWO) and control group [undergoing postoperative conventional chest physiotherapy (CPT )] using random number table. Observation indicators included: (1) adverse events, (2) pain perception index: postoperative pain intensity from 1 day to 5 days was assessed by visual analogue scale (VAS), (3) respiratory function: arterial oxygen saturation (SaO2), oxygenation index (OI), arterial partial pressure of oxygen (PaO2) and arterial partial pressure of carbon dioxide (PaCO2) at postoperative day 1, 3 and 5, (4) follow-up. The follow-up using outpatient examination and telephone interview was performed to detect the recovery of patients up to March 2016. Measurement data with normal distribution were represented as ±s. The comparisons between groups were evaluated with the t test. The repeated measurement data were done using the repeated measures ANOVA and the count data were analyzed using the chi-square test. Results Fifty patients were screened for eligibility and were allocated into the 2 groups, 25 in each group. (1) Adverse events: all the patients in the 2 groups underwent successfully treatment, without the occurrence of hypoxemia, hemodynamic instability, arrhythmia, bronchospasm, vomiting, wound dehiscence, shedding catheter and so on. (2) Pain perception index: VAS from before chest treatment to postoperative day 5 was from 1.7±1.0 to 1.5±1.1 in the HFCWO group and from 1.4±0.8 to 1.8±0.6 in the control group, with a statistically significant difference in the change trend of pain intensity between the 2 groups (F=0.02, P 0. 05). (4) Follow-up: 43 patients were followed up after discharge from hospital for 1-6 months, with a median time of 5 months. During the follow-up, patients were not complicated with chest tightness and shortness of breath, with good wound healing. Conclusion Compared with conventional chest physiotherapy, HFCWO could improve tolerability of patients and reduce the pain after operation of abdominal incisional hernia. Key words: Abdominal incisional hernia; Surgical procedures, operative; High frequency chest wall oscillation

Active cycle of breathing technique for cystic fibrosis.

People with cystic fibrosis experience chronic airway infections as a result of mucus build up within the lungs. Repeated infections often cause lung damage and disease. Airway clearance therapies aim to improve mucus clearance, increase sputum production, and improve airway function. The active cycle of breathing technique (also known as ACBT) is an airway clearance method that uses a cycle of techniques to loosen airway secretions including breathing control, thoracic expansion exercises, and the forced expiration technique. This is an update of a previously published review. To compare the clinical effectiveness of the active cycle of breathing technique with other airway clearance therapies in cystic fibrosis. We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched the reference lists of relevant articles and reviews.Date of last search: 25 April 2016. Randomised or quasi-randomised controlled clinical studies, including cross-over studies, comparing the active cycle of breathing technique with other airway clearance therapies in cystic fibrosis. Two review authors independently screened each article, abstracted data and assessed the risk of bias of each study. Our search identified 62 studies, of which 19 (440 participants) met the inclusion criteria. Five randomised controlled studies (192 participants) were included in the meta-analysis; three were of cross-over design. The 14 remaining studies were cross-over studies with inadequate reports for complete assessment. The study size ranged from seven to 65 participants. The age of the participants ranged from six to 63 years (mean age 22.33 years). In 13 studies, follow up lasted a single day. However, there were two long-term randomised controlled studies with follow up of one to three years. Most of the studies did not report on key quality items, and therefore, have an unclear risk of bias in terms of random sequence generation, allocation concealment, and outcome assessor blinding. Due to the nature of the intervention, none of the studies blinded participants or the personnel applying the interventions. However, most of the studies reported on all planned outcomes, had adequate follow up, assessed compliance, and used an intention-to-treat analysis.Included studies compared the active cycle of breathing technique with autogenic drainage, airway oscillating devices, high frequency chest compression devices, conventional chest physiotherapy, and positive expiratory pressure. Preference of technique varied: more participants preferred autogenic drainage over the active cycle of breathing technique; more preferred the active cycle of breathing technique over airway oscillating devices; and more were comfortable with the active cycle of breathing technique versus high frequency chest compression. No significant difference was seen in quality of life, sputum weight, exercise tolerance, lung function, or oxygen saturation between the active cycle of breathing technique and autogenic drainage or between the active cycle of breathing technique and airway oscillating devices. There was no significant difference in lung function and the number of pulmonary exacerbations between the active cycle of breathing technique alone or in conjunction with conventional chest physiotherapy. All other outcomes were either not measured or had insufficient data for analysis. There is insufficient evidence to support or reject the use of the active cycle of breathing technique over any other airway clearance therapy. Five studies, with data from eight different comparators, found that the active cycle of breathing technique was comparable with other therapies in outcomes such as participant preference, quality of life, exercise tolerance, lung function, sputum weight, oxygen saturation, and number of pulmonary exacerbations. Longer-term studies are needed to more adequately assess the effects of the active cycle of breathing technique on outcomes important for people with cystic fibrosis such as quality of life and preference.

Chest physiotherapy compared to no chest physiotherapy for cystic fibrosis.

Chest physiotherapy is widely used in people with cystic fibrosis in order to clear mucus from the airways. This is an updated version of previously published reviews. To determine the effectiveness and acceptability of chest physiotherapy compared to no treatment or spontaneous cough alone to improve mucus clearance in cystic fibrosis. We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register which comprises references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings.Date of the most recent search of the Group's Cystic Fibrosis Trials Register: 02 June 2015. Randomised or quasi-randomised clinical studies in which a form of chest physiotherapy (airway clearance technique) were taken for consideration in people with cystic fibrosis compared with either no physiotherapy treatment or spontaneous cough alone. Both authors independently assessed study eligibility, extracted data and assessed the risk of bias in the included studies. There was heterogeneity in the published outcomes, with variable reporting which meant pooling of the data for meta-analysis was not possible. The searches identified 157 studies, of which eight cross-over studies (data from 96 participants) met the inclusion criteria. There were differences between studies in the way that interventions were delivered, with several of the intervention groups combining more than one treatment modality. One included study looked at autogenic drainage, six considered conventional chest physiotherapy, three considered oscillating positive expiratory pressure, seven considered positive expiratory pressure and one considered high pressure positive expiratory pressure. Of the eight studies, six were single-treatment studies and in two, the treatment intervention was performed over two consecutive days (once daily in one, twice daily in the other). This enormous heterogeneity in the treatment interventions prevented any meta-analyses from being performed. Blinding of participants, caregivers or clinicians in airway clearance studies is impossible; therefore this was not considered as a high risk of bias in the included studies. Lack of protocol data made assessment of risk of bias unclear for the majority of other criteria.Four studies, involving 28 participants, reported a higher amount of expectorated secretions during chest physiotherapy as compared to a control. One study, involving 18 participants, reported no significant differences in sputum weight. In five studies radioactive tracer clearance was used as an outcome variable. In three of these (28 participants) it was reported that chest physiotherapy, including coughing, increased radioactive tracer clearance as compared to the control period. One study (12 participants) reported increased radioactive tracer clearance associated with all interventions compared to control, although this was only reported to have reached significance for postural drainage with percussion and vibrations; and the remaining study (eight participants) reported no significant difference in radioactive tracer clearance between chest physiotherapy, without coughing, compared to the control period. Three studies, involving 42 participants reported no significant effect on pulmonary function variables following intervention; but one further study did report significant improvement in pulmonary function following the intervention in some of the treatment groups. The results of this review show that airway clearance techniques have short-term effects in the terms of increasing mucus transport. No evidence was found on which to draw conclusions concerning the long-term effects.

Pulmonary complications after cardiac surgery: breathing down the patient’s neck

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Comparison between active cycles of breathing with postural drainage versus conventional chest physiotherapy in subjects with bronchiectasis

IntroductionBronchiectasis is a chronic debilitating condition with abnormal permanent dilatation of the airways causing impaired mucus clearance, despite regular chest physiotherapy being mainstay of management for bronchiectasis, there is little evidence supporting regular chest physiotherapy in bronchiectasis which aims to mobilize secretions and facilitate effective expectoration, providing control of cough and improving airway clearance. The objective of this study was to compare between the efficacy of 2 techniques of chest physiotherapy ACBT with postural drainage and conventional chest physical therapy as a method of airway clearance in adults with productive bronchiectasis. MethodsThe study included 30 subjects, 20 males and 10 females; all having bronchiectasis, the study was carried out on October 6 at the University Hospital. The participating subjects underwent conventional chest physical therapy or ACBT following postural drainage as the airway clearance technique in random order on 14 successive days with twice daily frequency. ResultsThere was a significant difference regarding mMRC before and after both ACBT and conventional physiotherapy, there was a significant improvement regarding FVC and MMEF after ACBT while there was a significant improvement of FEV1 and MMEF after conventional physiotherapy. As regards arterial blood gas data comparison, there were significant improvements regarding PaCO2, PaO2 and PAO2 while there was no significant difference as regards P (A-a) O2 after both types of physiotherapy techniques. Comparison between the 2 groups regarding mMRC dyspnea score, spirometry, arterial blood gas data, Leicester cough questionnaire (LCQ) and sputum wet volume before starting physiotherapy shows no significant difference while there were significant differences in advance to post ACBT physiotherapy sessions as regards PaO2, P (A-a) O2 gradient, LCQ (physical domain score and total score) and sputum wet volume. ConclusionACBT with postural drainage is found to be more effective than conventional chest physical therapy management of bronchiectasis during infective exacerbation.

Efficacy of the addition of positive airway pressure to conventional chest physiotherapy in resolution of pleural effusion after drainage: protocol for a randomised controlled trial.

Chest drainage for pleural effusion can cause pain and changes in respiratory function. It can also increase the risk of pulmonary complications and impair functional ability, which may increase length of hospital stay and the associated costs. For these reasons, surgical and clinical strategies have been adopted to reduce the duration of chest drainage. To evaluate the efficacy of the addition of intermittent positive airway pressure applied by the Muller reanimator via a rubber facial mask versus conventional physiotherapy on the duration of chest drainage (primary objective), and its effect on the recovery of respiratory function, length of hospital stay and incidence of pulmonary complications (secondary objectives). Randomised, controlled trial. Inpatients with pleural effusion, aged over 18 years, who have had chest drainage in situ for < 24hours will be recruited from two university hospitals. Patients will be excluded if they have any contraindication for the use of non-invasive positive airway pressure. After initial assessments of lung function, 156 patients will be randomised into a positive airway pressure group (positive airway pressure at 15 cmH2O plus conventional chest physiotherapy), a conventional chest physiotherapy group (conventional chest physiotherapy plus non-therapeutic positive airway pressure at 4 cmH2O) or a control group (non-therapeutic positive airway pressure at 4 cmH2O). All groups will receive treatment three times per day for 7 consecutive days. A blinded assessor will conduct all assessments. Peripheral oxygenation and chest drainage output will be measured over 7 consecutive days. Lung function will be re-assessed on Day 4 and Day 8. The criteria for removal of the chest drain will be a transudate output ≤ 200ml over 24hours and full lung expansion on chest radiography, as assessed by a blinded physician. Duration of chest drainage, length of hospital stay, and any pulmonary complications diagnosed during hospitalisation will be recorded. Intention to treat using: survival analysis for duration of chest drainage, and length of hospital stay; analysis of variance for chest-tube output, lung function and peripheral oxygen saturation; and chi-square tests for comparing the incidence of pulmonary complications between groups. Conventional chest physiotherapy and intermittent positive airway pressure breathing are widely indicated for people with pleural effusion and chest drains; however, no studies have evaluated the real benefit of this type of treatment. Our hypothesis is that optimised lung expansion achieved through the application of intermittent positive airway pressure will accelerate the reabsorption of pleural effusion, decrease the duration of chest drainage and respiratory system impairment, reduce the length of hospital stay, and reduce the incidence of pulmonary complications.

Ventilatory Response For Inspiratory Muscle Training Versus Aerobic Training On Post Lung Decortication.

Abstract Objective: Decortication is a surgical procedure that consists in restoring the ventilatory function of the lung and there is in need to establish the efficacy of inspiratory muscle training versus aerobic training on pulmonary functions post lung decortications, as the diaphragmatic dysfunction is a major factor in the etiology of postoperative pulmonary complications after lung decortications. Materials and Methods: Thirty patients, second day post lung decortication surgery would participate in this study, the participants from both gender, their age 20-50 years old Patients would be assigned randomly into two equal groups of (15) patients who post lung decortication surgery in each group would receive 12 sessions of treatment, 6 each weeks,Group (I) consist from 15 patients would receive inspiratory muscle training (IMT) in addition to conventional chest physiotherapy,Group (II) consist from 15 patients would receive aerobic training (AT) in addition to conventional chest physiotherapy. Results: The results showed that IMT and AT increased significantly (P< 0.05) FVC, FEV1, MVV within each group, Significant differences of the post treatment mean values between both groups in favor of group AT were recorded (p0.05) on FEV1/FVC ratio within each group or on comparing the two groups. Conclusion: Both IMT and AT provided a significant improvement in the ventilatory functions due to increasing the respiratory muscles strength ,efficiency and endurance , IMT and AT offers important benefits and should be considered in rehabilitation of patients underwent lung decortications surgery.

Immediate effects of Active Cycle of Breathing Technique and Conventional Chest Physiotherapy in Subjects with Bronchiectasis - A Comparative Study

Background: The prevalence of Bronchiectasis in India, is 10 fold increase in in persons with high exposure to Arsenic caused skin lesions in West Bengal in 2005.The prevalence was higher among women than men 71 vs 32/1, 00,000 and increased markedly with age 4/1, 00,000 for people aged 18- 34 yearsa272/1, 00,000 for those aged 75. Aim: The aim of the study is to compare the Immediate effects of Active Cycle of Breathing Technique and Conventional Chest Physiotherapy in subjects with Bronchiectasis. Methodology: StudyDesign-Experimental Design; Study Type-Comparative Study;Sample Size- 30Subjects; Sampling Method - Convenient Sampling;Sampling Specification - Group A-15 subjectsaGroup B-15 subjects; Study Setting - Department of TUBERCULOSIS AND CHEST DISEASES, SRM Medical college HospitalaResearch centre, Kattankulathur. chennai. Tamilnadu, India. Study Duration - 3 months. Results: Comparing the values of Sputum volume between Group A and Group B, Group B showed a significant difference than Group A. (P 0.05). Conclusion: The results of this study thus concluded that subjects who underwent Conventional Chest Physiotherapy showed good improvement in their Sputum clearance than subjects who underwent Active Cycle of Breathing Technique and there was a good improvement between Pre and Post Peak expiratory flow rate with both Conventional Chest Physiotherapy and Active Cycle of Breathing Technique.Thus, this study will be useful for selection of intervention in subjects with Bronchiectasis.

Effects of conventional chest physical therapy versus expiratory flow increased technique on cardio pulmonary stress in infants with oxygen therapy

In this study we were compared two chest physical therapy techniques conventional chest physical therapy and expiratory flow increase technique on fragile infants who were on oxygen therapy & admitted in NICU. Both the techniques were already proven to be effective for removing secretions.Small change in environment can be a stressful to the infants. So, in this study our aim is to find out among these two techniques which is less stressful, effective and safer for infants which can be follow in clinical practice & by that infants obtained benefits.

Chest physiotherapy techniques in neurological intensive care units of India: A survey.

Context:Neurological intensive care units (ICUs) are a rapidly developing sub-specialty of neurosciences. Chest physiotherapy techniques are of great value in neurological ICUs in preventing, halting, or reversing the impairments caused due to neurological disorder and ICU stay. However, chest physiotherapy techniques should be modified to a greater extent in the neurological ICU as compared with general ICUs.Aim:The aim of this study is to obtain data on current chest physiotherapy practices in neurological ICUs of India.Settings and Design:A tertiary care hospital in Karnataka, India, and cross-sectional survey.Subjects and Methods:A questionnaire was formulated and content validated to assess the current chest physiotherapy practices in neurological ICUs of India. The questionnaire was constructed online and a link was distributed via E-mail to 185 physiotherapists working in neurological ICUs across India.Statistical Analysis Used:Descriptive statistics.Results:The response rate was 44.3% (n = 82); 31% of the physiotherapists were specialized in cardiorespiratory physiotherapy and 30% were specialized in neurological physiotherapy. Clapping, vibration, postural drainage, aerosol therapy, humidification, and suctioning were used commonly used airway clearance (AC) techniques by the majority of physiotherapists. However, devices for AC techniques such as Flutter, Acapella, and standard positive expiratory pressure devices were used less frequently for AC. Techniques such as autogenic drainage and active cycle of breathing technique are also frequently used when appropriate for the patients. Lung expansion therapy techniques such as breathing exercises, incentive spirometry exercises, and positioning, proprioceptive neuromuscular facilitation of breathing are used by majority of physiotherapists.Conclusions:Physiotherapists in this study were using conventional chest physiotherapy techniques more frequently in comparison to the devices available for AC.

Chest physiotherapy for pneumonia in children

Pneumonia is an inflammatory lung disease and it is the greatest cause of deaths in children younger than five years of age worldwide. Chest physiotherapy is widely used in the treatment of pneumonia because it can help to eliminate inflammatory exudates and tracheobronchial secretions, remove airway obstructions, reduce airway resistance, enhance gas exchange and reduce the work of breathing. Thus, chest physiotherapy may contribute to patient recovery as an adjuvant treatment even though its indication remains controversial. To assess the effectiveness of chest physiotherapy in relation to time until clinical resolution in children (from birth up to 18 years old) of either gender with any type of pneumonia. We searched CENTRAL 2013, Issue 4; MEDLINE (1946 to May week 4, 2013); EMBASE (1974 to May 2013); CINAHL (1981 to May 2013); LILACS (1982 to May 2013); Web of Science (1950 to May 2013); and PEDro (1950 to May 2013).We consulted the ClinicalTrials.gov and the WHO ICTRP registers to identify planned, ongoing and unpublished trials. We consulted the reference lists of relevant articles found by the electronic searches for additional studies. We included randomised controlled trials (RCTs) that compared chest physiotherapy of any type with no chest physiotherapy in children with pneumonia. Two review authors independently selected the studies to be included in the review, assessed trial quality and extracted data. Three RCTs involving 255 inpatient children are included in the review. They addressed conventional chest physiotherapy, positive expiratory pressure and continuous positive airway pressure. The following outcomes were measured: duration of hospital stay, time to clinical resolution (observing the following parameters: fever, chest indrawing, nasal flaring, tachypnoea and peripheral oxygen saturation levels), change in adventitious sounds, change in chest X-ray and duration of cough in days. Two of the included studies found a significant improvement in respiratory rate and oxygen saturation whereas the other included study failed to show that standardised respiratory physiotherapy and positive expiratory pressure decrease the time to clinical resolution and the duration of hospital stay. No adverse effects related to the interventions were described. Due to the different characteristics of the trials, such as the duration of treatment, levels of severity, types of pneumonia and the techniques used in children with pneumonia, as well as differences in their statistical presentation, we were not able to pool data. Two included studies had an overall low risk of bias whereas one included study had an overall unclear risk of bias. Our review does not provide conclusive evidence to justify the use of chest physiotherapy in children with pneumonia due to a lack of data. The number of included studies is small and they differed in their statistical presentation.

The use of dornase alpha for post-operative pulmonary atelectasis after congenital heart surgery

To investigate the efficacy of dornase alpha, a mucolytic agent, in children who developed pulmonary atelectasis after congenital heart surgery. Retrospective case-control study. Paediatric cardiac intensive care unit at a tertiary care hospital. Between July, 2011 and July, 2012, 41 patients who underwent congenital cardiac operations and developed post-operative pulmonary atelectasis that was resistant to conventional treatment and chest physiotherapy. In all, 26 patients received dornase alpha treatment. As a control group, 15 patients were treated with conventional medications and chest physiotherapy. The median age of patients was 25.5 (3-480) days in the study group and 50.0 (3-480) days in the control group. A total of 15 (57.6%) patients in the study group and 8 (53.3%) patients in the control group were male. The median weight was 4.2 (2.9-14.2) kg and 4.0 (3.5-13.6) kg in the study and control group, respectively. In the study group, pulmonary atelectasis was diagnosed at a median period of 5 (2-18) days after operations, whereas in the control group atelectasis was diagnosed at a median period of post-operative 6 (3-19) days. In the study group, the median atelectasis score decreased from 3.4 (1-6) to 0.8 (0-3) (p = 0.001). The median pO2 level increased from 69 (17-142) mmHg to 89 (30-168) mmHg (p = 0.04). In addition, heart rate and respiratory rate per minute were significantly decreased (p < 0.05). There were no significant changes in these parameters in the control group. The use of dornase alpha can be effective for the management of pulmonary atelectasis that develops following congenital heart surgery.

Chest physiotherapy for pneumonia in adults

Despite conflicting evidence, chest physiotherapy has been widely used as an adjunctive treatment for adults with pneumonia. To assess the effectiveness and safety of chest physiotherapy for pneumonia in adults. We searched CENTRAL 2012, Issue 11, MEDLINE (1966 to November week 2, 2012), EMBASE (1974 to November 2012), Physiotherapy Evidence Database (PEDro) (1929 to November 2012), CINAHL (2009 to November 2012) and CBM (1978 to November 2012). Randomised controlled trials (RCTs) assessing the efficacy of chest physiotherapy for treating pneumonia in adults. Two authors independently assessed trial eligibility, extracted data and appraised trial quality. Primary outcomes were mortality and cure rate. We used risk ratios (RR) and mean difference (MD) for individual trial results in the data analysis. We performed meta-analysis and measured all outcomes with 95% confidence intervals (CI). Six RCTs (434 participants) appraised four types of chest physiotherapy (conventional chest physiotherapy; osteopathic manipulative treatment (which includes paraspinal inhibition, rib raising and myofascial release); active cycle of breathing techniques (which include active breathing control, thoracic expansion exercises and forced expiration techniques); and positive expiratory pressure).None of the physiotherapies (versus no physiotherapy or placebo) improved mortality rates of adults with pneumonia.Conventional chest physiotherapy (versus no physiotherapy), active cycle of breathing techniques (versus no physiotherapy) and osteopathic manipulative treatment (versus placebo) did not increase the cure rate or chest X-ray improvement rate.Osteopathic manipulative treatment (versus placebo) and positive expiratory pressure (versus no physiotherapy) reduced the mean duration of hospital stay by 2.0 days (mean difference (MD) -2.0 days, 95% CI -3.5 to -0.6) and 1.4 days (MD -1.4 days, 95% CI -2.8 to -0.0), respectively. Conventional chest physiotherapy and active cycle of breathing techniques did not.Positive expiratory pressure (versus no physiotherapy) reduced fever duration (MD -0.7 day, 95% CI -1.4 to -0.0). Osteopathic manipulative treatment did not.Osteopathic manipulative treatment (versus placebo) reduced the duration of intravenous (MD -2.1 days, 95% CI -3.4 to -0.9) and total antibiotic treatment (MD -1.9 days, 95% CI -3.1 to -0.7).Limitations of this review are that the studies addressing osteopathic manipulative treatment were small, and that six published studies which appear to meet the inclusion criteria are awaiting classification. Based on current limited evidence, chest physiotherapy might not be recommended as routine additional treatment for pneumonia in adults.

Accessory Inspiratory Muscles Energy Technique effect on Pulmonary Function in COPD Subjects

Aim & Objectives: Chronic Obstructive Pulmonary Disease (COPD) accounts 17 million lives in India, which will rise to 22 million by 2016 & it kills 250 people every hour. Global initiative for Obstructive Lung Disease (GOLD) portrayed skeletal muscle dysfunction as a significant contributor to severity in these patients resulting in reduced exercise capacity and impaired Quality of life. Muscle Energy technique (MET) had been a well known treatment in musculoskeletal disorders, yet literature supporting its use in chronic respiratory disorders is limited. So the present research is design to study the effects of MET on pulmonary function in COPD subjects and describes its impact on Conventional chest Physiotherapy. Method: 30 Moderate & Severe staged COPD patients in 40-60 years age group were allocated into two groups: Conventional Chest Physiotherapy (CPT) and Conventional Chest Physiotherapy with MET(CPT + MET) group. Chest expansion, Dyspnea, Exercise tolerance, Respiratory rate, Heart rate, Oxygen saturation and Quality of life were the variables that recorded prior and after the intervention for three days. Results: Significant improvement was seen in both groups on all 3 days with greater improvements in CPT with MET group in form of increased chest expansion, reduced Dyspnea, increased exercise tolerance, regulation of autonomic dysfunction and improved Quality of life. Discussion: Study reveals the potential benefits of MET on pulmonary function and its efficacy in upgrading the Conventional chest Physiotherapy in COPD subjects. It also recognizes the importance of management of Accessory Inspiratory muscle dysfunction in providing a better Quality of life in COPD patients. Conclusion: MET proved to be a highly magnificent technique in improving pulmonary function and must be thus incorporated as a basic part of pulmonary rehabilitation in COPD subjects.

Chest physical therapy is effective in reducing the clinical score in bronchiolitis: randomized controlled trial

To evaluate the effectiveness of chest physical therapy (CP) in reducing the clinical score in infants with acute viral bronchiolitis (AVB). Randomized controlled trial of 30 previously healthy infants (mean age 4.08 SD 3.0 months) with AVB and positive for respiratory syncytial virus (RSV), evaluated at three moments: at admission, then at 48 and 72 hours after admission. The procedures were conducted by blinded assessors to each of three groups: G1 - new Chest Physical therapy- nCPT (Prolonged slow expiration - PSE and Clearance rhinopharyngeal retrograde - CRR), G2 - conventional Chest Physical therapy- cCPT (modified postural drainage, expiratory compression, vibration and percussion) and G3 - aspiration of the upper airways. The outcomes of interest were the Wang's clinical score (CS) and its components: Retractions (RE), Respiratory Rate (RR), Wheezing (WH) and General Conditions (GC). The CS on admission was reduced in G1 (7.0-4.0) and G2 (7.5-5.5) but was unchanged in G3 (7.5-7.0). We observed a change 48 hours after hospitalization in G1 (5.5-3.0) and G2 (4.0-2.0) and in 72 hours, there was a change in G1 (2.0-1.0). The CP was effective in reducing the CS in infants with AVB compared with upper airway suction only. After 48 hours of admission, both techniques were effective and nCPT techniques were also effective in the 72 hours after hospitalization compared with cCPT techniques.

A Randomized Trial of Conventional Chest Physical Therapy Versus High Frequency Chest Wall Compressions in Intubated and Non-intubated Adults

Conventional chest physical therapy (CCPT), applied by therapists using cupped hands to perform percussion, is commonly used in hospitalized adults. However, increased work load demands and occupational health concerns (eg, carpal tunnel syndrome) limit the overall utilization of this therapy. Therefore, we conducted a study to compare the overall effectiveness of CCPT to high-frequency chest wall compressions (HFCWC) applied via a vibratory vest. A single-center, randomized trial among hospitalized intubated and non-intubated adult patients requiring chest physical therapy comparing CCPT and HFCWC. The primary outcome measure was hospital stay. A total of 280 per-protocol patients (out of an a priori estimated 320 patients required to demonstrate a 20% relative reduction in hospital stay) were randomly assigned to receive CCPT (no. = 146, 52.1%) or HFCWC (no. = 134, 47.9%). The hospital stay was 12.5 ± 8.8 days for patients randomized to CCPT and 13.0 ± 8.9 days for patients randomized to HFCWC (P = .62). Patient comfort was assessed using a visual analog scale (increasing score reflects greater discomfort) and was statistically greater for patients randomized to CCPT compared to HFCWC (2.2 ± 0.8 vs 1.9 ± 0.8, P = .009). The duration of time until radiographic resolution of lobar atelectasis trended less for CCPT compared to HFCWC (5.2 ± 4.3 d vs 6.5 ± 5.2 d, P = .051). All other secondary outcomes, including hospital mortality and nosocomial pneumonia, were similar for both treatment groups. This study was inadequately powered for the primary outcome of interest and hence we cannot make recommendations on the preferential use of HFCWC or CCPT for intubated and non-intubated adult patients. HFCWC was associated with statistically better comfort scores. (ClinicalTrials.gov registration NCT00717873.).

High-frequency Chest Wall Oscillation Therapy: Clinical Effectiveness in the Patients with Pulmonary Contusion

Background: Pulmonary contusion is the most common pulmonary parenchymal injury in blunt chest trauma and may constitute a life-threatening thoracic injury. In this study, we evaluated the usefulness of high-frequency chest wall oscillation (HFCWO) therapy in patients with pulmonary contusion. Methods: Patients with lung contusion either received HFCWO therapy using the Vest system (Vest group; n = 18) or received conventional chest physiotherapy (non-Vest group; n = 23). The physiological parameters of the patients, length of stay in hospital and ICU, and the duration of mechanical ventilation were compared between the two groups. Variables, including pulmonary contusion score, percentage of patients receiving mechanical ventilation therapy, and PaO2/FiO2 ratio, were also analyzed. Results: The pulmonary contusion score was higher in the Vest group (p < 0.01), and mechanical ventilation was used more frequently in the Vest group (p = 0.027). Improvement in the PaO2/FiO2 ratio over the first 48 h did not differ between the Vest and Non-Vest groups. No significant differences in the physiological parameters, hospital and ICU stays, and duration of mechanical ventilation were observed between the two groups. Conclusions: The therapeutic effect of the Vest system in patients with pulmonary contusion was similar to that of conventional chest physiotherapy. Therefore, the Vest system could be considered as an airway clearance technique in the management of patients with pulmonary contusion.

1341 Positive Expiratory Pressure (PEP) for Lobar Collapse in Infants

Background and aims: PEP is a commonlyapplied modality of chest physiotherapy in infantswith chronic respiratory conditions such as cysticfibrosis. We report two cases of infants with acuteright upper lobe collapse treated with PEP. Patient 1: A two month old baby was admittedwith pertussis chest infection and was invasivelyventilated for nine days and on CPAP for seventeendays. The baby had right upper-lobe collapse withongoing oxygen requirement on day 31 of illness, having not resolved with conventional chestphysiotherapy. PEP was initiated in supported sittingusing an infant face mask and a 1.5mm resistor. Hereceived a total of 3 treatments over 2 days andwas discharged home with no oxygen requirementand resolution of X-ray changes prior to discharge. Patient 2: Four week old ex-premature baby (31weeks) was admitted with RSV positive bronchiolitis, ventilated for six days and on CPAP for five days. Radiographic findings showed a right upper lobecollapse, persisting despite regular conventionalchest physiotherapy. PEP was started on day 12using an infant face mask and a 1.5mm resistor. On day 14, a repeat chest x-ray showed completeresolution of the right upper lobe collapse and thepatient was discharged home the next day. Conclusions: The use of PEP in infants is anunder-reported but potentially beneficial modality inresolution of lobar collapse during acute illness.

Positive expiratory pressure techniques in respiratory patients: old evidence and new insights

Educational aims To describe the rationale for the use of positive expiratory pressure (PEP) techniques as a means of chest physiotherapy in respiratory patients. To compare both the effectiveness and problems of the most popular PEP devices in clinical practice. To introduce the impact and potential interest of temporary PEP (TPEP) techniques in this field. Summary In recent years, a large number of PEP devices, used to assist in airway clearance or, at the very least, to allow for effective self-administered physiotherapy, have been developed. A secondary clinically relevant objective of these devices is to prevent recurring infections and atelectasis, or to improve pulmonary mechanics and facilitate gas exchange, thus lowering the impact of disease progression. The use of PEP devices in this field has become widely accepted for two main reasons: 1) their clinical efficacy, which is as great as that of conventional chest physiotherapy practice, and 2) the high level of acceptance and compliance by patients, which makes PEP devices very useful in the domiciliary environment. The functional and clinical response of any specific PEP device, with or without vibration effect, may vary according to a specific diagnostic group. Ultimately, the choice of airway clearance strategy may be the one that is clinically effective, cost-effective and preferred by the patient and which, therefore, supports adherence. Recent technology has enabled the development of a new machine, which is able to apply a TPEP at a level several times lower than that applied with previous devices; thus, at least potentially, it is able to reduce the risk of mechanical stress injury to the bronchial tree and lung parenchyma. In this review, we will discuss the rationale for the use of PEP devices and compare both their effectiveness and problems in clinical practice. Finally, we will introduce the application and potential interest of TPEP as a new means for treating patients with hypersecretion.