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?

[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

Saeed849@mail.com

[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]

Originally Posted by saeidphysio

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.