From the Guidelines
Tidal percussion is a technique used in conjunction with other methods such as postural drainage (PD) and chest physiotherapy (CPT) to aid in airway clearance, but its specific definition and application in the context of airway clearance therapies are not explicitly detailed in the provided evidence.
Definition and Application
- Tidal percussion, in a broader medical context, refers to a technique that might be utilized in assessing or managing conditions affecting the lungs, but the provided studies focus more on the effectiveness of various airway clearance therapies such as CPT, PD, and percussion (P) in patients with conditions like cystic fibrosis (CF), chronic bronchitis (CB), and bronchiectasis (B) 1.
- The evidence provided in the table suggests that different techniques, including CPT, PD, and P, have varying degrees of effectiveness in clearing sputum and improving lung function in patients with different respiratory conditions 1.
Evidence for Airway Clearance Therapies
- Studies have shown that CPT can produce more sputum than control subjects in patients with COPD and CF 1, and when combined with exercise, it can be even more effective 1.
- PD has also been shown to be effective in clearing sputum, especially when compared to other methods like high-frequency chest wall oscillation (HFCWO) 1.
- The addition of percussion to other therapies like PD and forced expiratory technique (FET) can improve clearance, as indicated by increased sputum weight 1.
Clinical Application and Recommendation
- Given the focus on morbidity, mortality, and quality of life, the most effective approach to airway clearance would involve a combination of therapies tailored to the individual patient's condition and response, with CPT and PD being considered standard care for patients with CF.
- The choice of therapy should be based on the patient's specific needs, the underlying condition, and the availability of resources, with the goal of improving lung function, reducing morbidity, and enhancing quality of life 1.
- It's crucial for healthcare providers to assess the patient's response to different therapies and adjust the treatment plan accordingly, considering the evidence that supports the use of these therapies in improving outcomes for patients with respiratory conditions 1.
From the Research
Definition of Tidal Percussion
- Tidal percussion refers to the administration of bursts of small tidal volume at high frequency, as seen in Intrapulmonary Percussion Ventilation (IPV) 2.
- The principle of IPV is to promote airway clearance, recruit areas of lung, and improve pulmonary gas exchange.
Characteristics of Tidal Percussion
- The frequency of percussion in IPV can range from 80-200 cycles/min in patients with restrictive pulmonary disease, to more than 300 cycles/min in patients with obstructive respiratory disease 2.
- The proximal airway pressure in IPV can range from 10-20cm H2O in patients with obstructive respiratory disease, to 40cm H2O in patients with restrictive pulmonary disease 2.
- Tidal volume is an important factor in ventilation, and high tidal volumes have been shown to increase morbidity and mortality in patients with acute respiratory distress syndrome (ARDS) 3, 4.
Clinical Applications of Tidal Percussion
- IPV is frequently used for airway clearance, together with delivery of aerosolized medications 5.
- Tidal flow/volume measurements can be used to assess lung function and provide important information in research and clinical settings 6.
- Protective ventilation strategies, including lower tidal volumes, can be beneficial for mechanically ventilated patients, including those with and without ARDS 4.