PT Critically Appraised Topics
 

Document Type

Critically Appraised Topic

Publication Date

2010

Clinical Scenario

Throughout my current acute internship, chest PT is never practiced. This hospital has a large number of patients admitted with respiratory complications and therefore, has an ICU dedicated to respiratory issues. The respiratory ICU (RICU) is known for the “care process model, focusing on best practices and improvement in care, including early mobility”6. Due to the large number of patients suffering from acute exacerbations of COPD in the respiratory ICU and its ability to provide advanced care, I wondered why chest physical therapy was not a treatment provided.

Clinical Question

Does chest physical therapy consisting of postural drainage, percussion and/or vibration promote sputum production and improve oxygen saturation in patients with acute exacerbations of chronic obstructive pulmonary disease?

Clinical Bottom Line

Based on the articles by Anthonisen et al. and Buscagla et al., chest physical therapy is not effective for reducing sputum in the lungs or increasing PaO2 and SpO2 for patients hospitalized with acute exacerbations of COPD. However, both articles had such significant flaws in internal validity (PEDro scores of 1/10 and 4/10, respectively) that the outcomes should be looked at with extreme caution. Furthermore, due to the poor validity of these articles, the outcomes cannot be generalized to other COPD populations. Future studies should include stronger protocols, randomization, control groups and subjects with sputum production, which is the primary indication for chest PT.

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