Chest physical therapy for patients in the intensive care unit

Chest physical therapy is used in the intensive care unit (ICU) to minimize pulmonary secretion retention, to maximize oxygenation, and to reexpand atelectatic lung segments. This article reviews how chest physical therapy is used with patients who are critically ill. A brief historical review of the literature is presented. Chest physical therapy treatments applicable to patients in the ICU are discussed. Postural drainage, percussion, vibration, breathing exercises, cough stimulation techniques, and airway suctioning are described in detail, with current references. The importance of patient mobilization is emphasized. The advantages of chest physical therapy over therapeutic bronchoscopy also are discussed. Two patient examples are used to demonstrate the beneficial effects that may be obtained with chest physical therapy. Following the removal of retained secretions, arterial oxygenation and partial pressure of arterial oxygen/fraction of inspired oxygen concentration ratios improved, and atelectasis resolved without the negative hemodynamic side effects of therapeutic bronchoscopy. Physical therapists trained in the ICU can safely perform chest physical therapy with the majority of patients who are critically ill.