Physiotherapy and airway clearance techniques and devices.

The focus of this talk is on the use of airway clearance techniques to assist in the removal of secretions from the lungs with particular emphasizes on their use in the NICU and PICU setting. Until the early 1990’s the term, ‘‘Chest Physiotherapy’’ was synonymous with the terms, ‘‘airway clearance techniques, or postural drainage and percussion’’ with the latter being the traditional method of airway clearance used by Physiotherapists. Over the past 15 years, it has been recognized that we must be more comprehensive in our approach to the cardiopulmonary system Modalities now used by Physiotherapists to treat cardiopulmonary pathology include airway clearance techniques, exercise, positioning, re-education of breathing, thoracic mobility exercises and inhalation therapy. There are currently a number of airway clearance techniques available for use, although not all of them have been validated by scientific data. Postural drainage and percussion was first described by William Ewart in 1901 who referred to it as ‘‘empty bronchus treatment by posture in the bronchiectasis of children’’. To enhance clearance of secretions chest wall clapping or percussion was added to postural drainage. Flower showed mechanical percussion increases intra-thoracic pressure, but no studies have been performed to examine the effects of manual percussion. Physiological rationale for the use of postural drainage to assist in the clearance of secretions is based on the use of gravity to assist with the mucociliary action. However, for gravity to be effective, the patient would have to be placed in head down positions for between 60–100 minutes. MacKenzie et al. in a study on 42 ventilated patients, were able to demonstrate an increase in total lung compliance following chest phy-