From the Guidelines
Pulmonary toileting refers to a set of techniques used to clear secretions from the lungs and airways, also known as bronchopulmonary hygiene or chest physiotherapy, which includes methods such as chest percussion, vibration, postural drainage, mechanically assisted cough, and airway oscillation. These techniques help mobilize and remove mucus that can obstruct airways, particularly in patients with conditions like chronic obstructive pulmonary disease (COPD), cystic fibrosis, pneumonia, or those on mechanical ventilation 1. The primary role of pulmonary toileting is to facilitate the clearance of lower airway secretions in conditions associated with the hypersecretion of mucus and the inability to expectorate effectively.
Key Techniques
- Deep breathing exercises: inhaling slowly through the nose for 3-4 seconds, holding for 1-2 seconds, and exhaling through pursed lips for 6-8 seconds, repeating 5-10 times every hour while awake
- Controlled coughing techniques: sitting upright, taking two deep breaths, and coughing forcefully on the second exhale while leaning slightly forward
- Adequate hydration: 2-3 liters of water daily unless contraindicated, to help thin secretions and make them easier to clear
Importance of Pulmonary Toileting
Pulmonary toileting is essential because retained secretions can lead to atelectasis (collapsed air sacs), pneumonia, and respiratory failure by blocking airways and creating environments for bacterial growth. Regular pulmonary toileting is particularly important for bedridden patients, those recovering from surgery, or individuals with chronic respiratory conditions.
Evidence-Based Practice
The evidence for the effectiveness of pulmonary toileting in improving symptoms and quality of life in patients with chronic respiratory diseases is modest, but it is considered a mainstay in the treatment of bronchiectasis and other conditions associated with hypersecretion of mucus 1. However, the long-term effectiveness of these interventions is unknown, and more research is needed to optimize the effectiveness of pulmonary toileting and to develop strategies to maintain the benefits over time.
From the Research
Definition and Purpose of Pulmonary Toileting
- Pulmonary toileting, also known as airway clearance therapy, is a technique used to remove secretions from the lungs and airways.
- The goal of pulmonary toileting is to improve lung function, reduce the risk of respiratory complications, and enhance overall health outcomes 2, 3.
Techniques and Methods
- Various techniques are used for pulmonary toileting, including postural drainage, percussion, vibration, and breathing exercises 3.
- The choice of technique depends on the individual patient's needs and the underlying condition being treated 4.
- Mucoactive agents, such as mucolytics and bronchodilators, may also be used to aid in airway clearance 5, 6.
Clinical Applications and Benefits
- Pulmonary toileting is commonly used in patients with respiratory conditions, such as chronic bronchitis, cystic fibrosis, and bronchiectasis 2, 6.
- The benefits of pulmonary toileting include improved lung function, reduced hospitalization rates, and enhanced quality of life 6.
- However, the evidence for the effectiveness of pulmonary toileting techniques is limited, and further research is needed to determine the most effective approaches 2, 5.