Hemodynamic and ventilatory effects of manual respiratory physiotherapy techniques of chest clapping, vibration, and shaking in an animal model

Abstract

Chest clapping, vibration, and shaking were studied in 10 physiotherapists who applied these techniques on an anesthetized animal model. Hemodynamic variables (such as heart rate, blood pressure, pulmonary artery pressure, and right atrial pressure) were measured during the application of these techniques to verify claims of adverse events. In addition, expired tidal volume and peak expiratory flow rate were measured to ascertain effects of these techniques. Physiotherapists in this study applied chest clapping at a rate of 6.2 +/- 0.9 Hz, vibration at 10.5 +/- 2.3 Hz, and shaking at 6.2 +/- 2.3 Hz. With the use of these rates, esophageal pressure swings of 8.8 +/- 5.0, 0.7 +/- 0.3, and 1.4 +/- 0.7 mmHg resulted from clapping, vibration, and shaking respectively. Variability in rates and "forces" generated by these techniques was <20% in average coefficients of variation. In addition, clinical experience accounted for 76% of the variance in vibration rate (P = 0.001). Cardiopulmonary physiotherapy experience and layers of towel used explained approximately 79% of the variance in clapping force (P = 0.004), whereas age and clinical experience explained >80% of variance in shaking force (P = 0.003). Application of these techniques by physiotherapists was found to have no significant effects on hemodynamic and most ventilatory variables in this study. From this study, we conclude that chest clapping, vibration, and shaking 1). can be consistently performed by physiotherapists; 2). are significantly related to physiotherapists' characteristics, particularly clinical experience; and 3). caused no significant hemodynamic effects.

Prolonged Slow Expiration Technique in Infants: Effects on Tidal Volume, Peak Expiratory Flow, and Expiratory Reserve Volume

“…1,31 Manual physiotherapy techniques are always dependent on the ability and practice of the physical therapist, and are susceptible to practice differences and variation. 32,33 In the present study all the PSE sequences were applied by the same physiotherapist, and we found no important practice variation in the PSE sequences. Research is needed on PSE practice variation between compressions and between physiotherapists.…”

Investigation of the Frequency and Force of Chest Vibration Performed by Physiotherapists

“…5 Both that study and ours showed the mean frequencies of vibration lower than those in other studies with recorded frequencies of 10 to 16 Hz. 6,7,9 The seven physiotherapists in our study who performed shaking instead of vibration (in at least one of the three conditions) applied frequencies outside those demonstrated in previous literature of 6.3 Hz 9 and 2 Hz 6,7 (see Table 1). Those studies evaluated vibration, shaking, or both techniques, performed on a black anaesthetic bag 6 or on intubated and ventilated sheep; 9 one study failed to indicate the method of measurement used.…”

“…Studies have reported the frequency for chest vibration and chest shaking to be 12-16 Hz 6,7 and 2-6 Hz, 6,7,9 respectively. Some claim that vibration is chest shaking (12-16 Hz).…”

Effect of Pulmonary Care on the Occurrence of Atelectasis in Infants at the First Year of Life under Abdominal Surgeries

“…After that secretions are drained from one or more lung segments to the central airways under the effect of gravity. Position should be held for 3-15 minutes ( 9 ) Vibrations Is performed manually by pressing in the direction that the ribs and soft tissues of the chest move during expiration over the draining area. Vibration is the placement of hands along the ribs in the direction of expiratory movement of the chest.…”