Implications of Manual Chest Physiotherapy and Technology in Preventing Respiratory Failure after Extubation

Respiratory physiotherapy techniques for augmenting normal mucociliary clearance, lung expansion, and cough efficacy have been used for many years to treat patients with respiratory disorders. Inspiratory and expiratory muscle aids are devices and techniques that involve the manual or mechanical application of forces to the body or intermittent pressure changes to the airway to assist inspiratory or expiratory muscle function. In recent years, new technologies and more advanced techniques have been developed to be more comfortable and effective for airway clearance and lung expansion. Airway clearance refers to two separate, but connected, mechanisms: mucociliary clearance and cough efficacy. Mucociliary clearance refers to the escalator mechanism in which the ciliated respiratory epithelial cells beat, propelling a thin layer of mucus in the direction of the airway opening. The function of cough is to clear inhaled foreign materials captured in the mucociliary system, retained secretions, or excessive secretions associated with respiratory infection. Illness and death in patients with ventilatory failure is almost always due to respiratory difficulty that occurs because of a weak cough. Additionally, a weakened cough can further complicate pulmonary infection if the individual cannot adequately clear the increased mucous secretions associated with infection. This review describes comprehensive and practical aspects of respiratory physiotherapy (RPT) interventions in patients under mechanical ventilation. The goal of this chapter is to explore the potential of updated RPT techniques as a complement to noninvasive ventilation to promote a better quality of life in patients with respiratory disorders.