Manual chest percussion

Manual chest percussion, sometimes referred to as chest clapping, is very well known in the respiratory physiotherapy community and it consists in manual application of rhythmic clapping with cupped hands to the ventral, lateral, and dorsal side of the thorax of the patient at a frequency of approximately 3 to 6 Hz. It is often applied in PD positions and used for 10- to 20-minute treatment sessions whenever there is auscultatory or oximetry evidence of airway secretion retention. 

Approaches to preventing airway secretion retention include pharmacotherapy to reduce mucus hypersecretion or to liquefy secretions, and the application of chest physiotherapy (CPT) techniques. (CPT) can be defined as the external application of a combination of forces to increase mucus transport that include PD, special breathing exercises, manual chest vibration and percussion, autonomous instmmental techniques, and manually assisted coughing. 

Another manual chest physical therapy technique is vibration. Vibration is a sustained cocontraction of the upper extremities of a caregiver to produce a vibratory force that is transmitted to the thorax over an involved lung segment. Vibration is applied throughout exhalation concurrently with mild compression of the patient s chest wall. Vibration is proposed to enhance mucociliary transport from the peripheral of the lung fields to the larger airways. Since vibration is used in conjunction with PD (Fig. 5) and percussion, many studies do not isolate the effects of vibration from the other components. 

Whereas the mucociliary elevator is the primary mechanism for clearing the peripheral 21 divisions of the airway, coughing clears the most central 6 divisions. Chest percussion and vibration can help mobilize peripheral airway secretions but they are not substitutes for coughing and, unlike for assisted coughing, have never been shown to decrease pulmonary morbidity and mortality. Cough can be assisted by manual and mechanical means. 

Aspiration, atelectasis and pneumonia are common in potential donors, and therefore endotracheal suctioning, percussion, turning for postural drainage and occasional manual lung inflation are critically important. Mucopurulent secretions are frequent in donors with a normal chest radiograph and do not preclude lung donation. 

---