Help me in Chest Physiotherapy

[saeidphysio]

Is there anybody to tell me contraindications in chest physio? Let's start with postural drainage and using percusion & vibration in coma patients?

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[angela1]

Cautions would be: elderly(70yrs+), emphysema, osteoperotic victims.

I'm sure there are others that I cannot think of at present

[alfi786_alfu]

hi
the contraindications of chest physio are rib fracture ,hemoptysis,if feed is given to ventilated patients,cardiac conditions,if SPO2 of patient is very low then wait for it.check moniter during chest physio and also after it.

[junior_physiotherapist]

hi all,
thanks to all previouse inputs...
u have to remember a very important item which is if his/her cultures showed negative or positive , and if not it yet ready may u have to look at his sputum!!,as you being suseptable to source of infection,u have to know too if there is cardiac problems don't make some methods of adjusting hight of his bed as that method or other may increases internal cranial pressure!!

of course there may be others...
all best

[alinguyen]

there is evidence out there, especially for the treatment of children with cystic fibrosis, mainly evidence in the form of 'conventional physio' versus 'no physio' or one physio technique versus other techniques (check out: Main et al 2005 - Conventional Chest physiotherapy compared with Other Airway Clearance Techniques for Cystic Fibrosis). you'll find evidence in the form of systematic reviews, but overall, I remember the findings are something like 'chest physio is better than no chest physio, although there is no particular technique which is most beneficial' - there isn't however, much evidence based upon the effectiveness of techniques in the treatment of adults as you can imagine why.

[saeidphysio]

Thanks

How much SPO2 should be to stop chest physiotherapy? or Why in low SPO2 we should stop chest physio?

thanks

[email protected]

[junior_physiotherapist]

hi saediphysio

would u plz feed us on this topic,i'm not familiar with this abbreviation!!

regards

[sdkashif]

It is a highly non specific question. Chest physiotherapy is indicated in a number of conditions that require that. There will be certainly many conditions in which it is not indicated. It is certain techniques of chest physiotherapy which are contraindicated in certain conditions just like postural drainage is contraindicated in some medical conditions. Please, make your question more specific for an effective response.

[physiobob]

Hi saeidphysio,

We would like to thank you for your post. Unfortunately the nature of this post is that it does not provide us with enough information to give an educated response. A small amount of time writing a detailed and interesting posting will result in many more friendly and beneficial responses. As sdkashif has mentioned, there are many conditions and each may have some similar and some very different contraindications. This is not the place to outline the whole or respiratory physiotherapy so please be more specific with your question.

Please consult the Physio Forum rules (link on top of the homepage) for some guidelines for your future postings and please try to make them as specific as possible so that other members can provide timely and appropriate responses.

Many thanks from all of us here at The Physio Forum.

regards, PhysioBob

[saeidphysio]

Thanks to all,
Let's start with postural drainage and using percusion & vibration in coma patients?

[Mel]

A low SpO2 is not a contraindication of chest physiotherapy, I believe its even more important at that time. I recently walked in to see a patient and found their SpO2 was in the low 50s! Of course I immediately sent someone to get the Registrar and started chest physio on the patient. We managed to get her up to 90% within 15mins

[saeidphysio]

Hi Mel
What kind of Chest physio you did for a patient with SPO2 50 ?

[Mel]

I increased her FiO2 so she had 100% O2 (only while stabilising and due to us needing to remove her mask frequently to suction) High levels of FiO2 cause toxicity, it was later decreased to 40%. We sat her bolt upright in bed, did expiratory vibes while trying to stimulate a cough. I used a yanker suction to the back of her throat, which cleared quite alot but also had to go deeper so inserted a nasopharyngeal airway. In this treatment session we mainly cleared the central airways as she could only tolerate limited amounts in that state.
Just abit of background on this patient, the main cause of her acute deterioration was sputum plugging due to aspiration pneumonia. She also had respiratory muscle weakness due to a recent intubation and neuromuscluar disease. She did pull through and returned home several weeks later.
I notice in some previous threads people are questioning the effectiveness of chest physiotherapy and also mentioning that we don't do anything nurses can't do. Its true that some of our treatment strategies are quite simple but it is critical how and when they are applied. Nurses do not have the training or assessment and rationalisation skills that we have in this area and I believe many people such as the above patient would not be with us today if it wasn't for many of the cardiorespiratory physiotherapist out there! Sorry if its abit off the topic but just wanted to get my point across :-)

[rana_sh]

hi there is many precusion for postural drainage.. if the pt have hypertension avoid head down position. take care if the pt use steroid medication so u dnt cause him fracture, if the pt have malignance avoid the site of it.. and be creative

[rabia]

theoraticaly it is100%but practicaly it is90%.below this we give oxygen.Then start giving chest physiotherapyBUT I dont no much about it

[sdkashif]

Thanks to all,
Let's start with postural drainage and using percusion & vibration in coma patients?

Well Saeidphysio I'm just adding the chart of postural drainage for easy rememberance and precautions that should be followed while doing the postural drainage. It is as an attachment with this post. Have a look over that.

[rahul]

plz tell about MODIFIED POSTURAL DRAINAGE

[sdkashif]

Every postural drainage position has been discussed in detail in the attachment and you may have a look over that.

[sdkashif]

plz tell about MODIFIED POSTURAL DRAINAGE

Postural Drainage positioning has been explained fully as above. You can adapt these positioning or in other words can modify them according to the suitability or needs of the patients. For example, many patients with head injury or raised intracranial pressure can not tolerate the head down positions. Some patients can not lie flat without become dyspnoeic. In some patients ventilation/perfusion mismatch results as a result of some positioning and so these patients may require those positioning in which maximum oxygen saturation is expected. If a patient is likely to become dyspnoeic or breathless by conventional postural drainage, it is better to position him in high side lying position or as flat as possible. The foot of the bed can be elevated as the patient condition improves. Oxygen saturation is maximum in half lying and high side lying and decreases with head down positions.

In some circumstances, it is possible to raise the head of bed, an alternative position can be used. Two or three pillows are used over a 15 cm piles of news papers or magazines and the patient can lie over this so that the chest is tilted downward. It is important that shoulders do not rest on pillows supporting patient's head. This method can be used for drainage of lower segments when necessary and is often a useful method for home postural drainage.

Postural drainage contra indications and precautions should be followed to select the suitibility of postural drainage positions for patients. Have a look over them.

1- Head injuries including CVA (Stroke) because intracranial pressure would be increased.

2- Severe Hypertension as venour return is increased with tipping and this can overload the heart.

3- Following oesophagectomy there can be undue stress on the anastmosis and tipping may cause regurgitation.

4- Severe haemoptysis, when all forms of physiotherapy should be discontinued until there has been discussion with doctors.

5- Aortic aneurysm which would be put under tension as the patient is tipped.

6- Pulmonary oedema which collects in the dependent areas; postural drainage would cause extreme dyspnoea and probably worsen the situation.

7- Surgical emphysema which might track towards the face if the patient is tipped and might result in dyspnoea.

8- Tension Pneumothorax without an intercostal drain. This condition should not require physiotherapy, but must never be tipped as cardiac embarrasment may lead to cardiac arrest.

9- Cardiac Arrhythmias which can be worsened by postural drainge; in some conditions myocardial oxygen demand would be greater and so its sensitivity to abnormal rhythm is increased.

10- Hiatus hernia should not be tippedas the patient may regurtitate gastric juices.

11- The filling cycle of peritoneal dialysis. The descent of diaphragm is impeded during this phase and tipping may cause more respiratory distress.

12- Facial oedema from burns will be inreased with tipping.

13- Eye operations where there may some associated oedema which may be increased in tipping.

[sdkashif]

More information on modified postural drainage positions as under

Five Year Study Investigating the Effects of Standard Physiotherapy with Head down Tilt (SPT) Compared to Modified Physiotherapy without Head Down Tilt (MPT) on Gastro-Oesophageal Reflux

The Effect of Postural Drainage Positioning on Ventilation Homogeneity in Healthy Subjects

Physiotherapist attitudes and practices regarding head-down and modified postural drainage in the presence of heart disease

Postural drainage therapy

Modified Postural Drainage Positions

[preet]

hi
can u please tell me wat to do for a patient who is sedated on ventilator having pneumothorax with icd on right side?

[rabia]

pls tell me is postural drainage god after coronary bypass .thanks

[ratri]

hi, well patient sedated with ventilator we can give deep breathin exs, segmental breathin,chest mobility exs .....etc

[drshrutikumari]

Can any one suggest me good Thesis topic for Cardio Pulmonary(MPT) ?
Regards

[dr.pavansinghal]

positioning is important and breathing exercise will help to increase the spo2 level