From the Guidelines
Tidal percussion is a technique that involves rhythmic clapping or percussion on the chest wall, synchronized with the patient's breathing pattern, to help clear secretions from the lungs, as seen in studies such as 1.
Definition and Mechanism
Tidal percussion is a respiratory therapy technique used to aid in the clearance of secretions from the lungs. It involves the application of rhythmic clapping or percussion on the chest wall while the patient breathes in and out normally. The percussion is typically synchronized with the patient's breathing pattern, with stronger percussion during exhalation and gentler percussion during inhalation. This technique is designed to use mechanical energy to dislodge mucus from the bronchial walls, making it easier to cough up and expel.
Application and Effectiveness
The technique of tidal percussion is commonly used for patients with conditions like cystic fibrosis, bronchiectasis, or chronic bronchitis who have difficulty clearing secretions. According to the study 1, chest physiotherapy, which includes techniques like tidal percussion, is considered the standard of care in patients with cystic fibrosis, although there is still insufficient evidence to recommend this therapy for patients with other disorders. For best results, tidal percussion should be performed in different positions to target various lung segments, and should be followed by deep breathing exercises and effective coughing techniques to help remove the loosened secretions.
Performance and Training
This technique is most effective when performed by a trained respiratory therapist or physical therapist, though caregivers can be taught to perform it properly at home. The proper technique involves placing one hand flat against the patient's chest and striking it with the cupped palm of the other hand, creating vibrations that help loosen mucus in the airways. As noted in the study 1, the combination of percussion with other techniques like postural drainage (PD) and forced expiratory technique (FET) can enhance the clearance of radiotracer, indicating improved mucus clearance.
Key Points
- Tidal percussion is used to help clear secretions from the lungs.
- It involves rhythmic clapping or percussion on the chest wall, synchronized with the patient's breathing pattern.
- The technique is commonly used for patients with cystic fibrosis, bronchiectasis, or chronic bronchitis.
- It should be performed by a trained therapist, but can also be taught to caregivers.
- The technique is most effective when combined with deep breathing exercises and effective coughing techniques, as supported by studies such as 1.
From the Research
Definition of Tidal Percussion
- Tidal percussion is not directly defined in the provided studies, but it can be inferred to be related to the concept of tidal volume in ventilation.
- Tidal volume refers to the volume of air that moves in and out of the lungs with each breath 2, 3, 4.
Relationship to Intrapulmonary Percussive Ventilation (IPV)
- Intrapulmonary Percussive Ventilation (IPV) is a technique that uses bursts of small tidal volume at high frequency to promote airway clearance and improve pulmonary gas exchange 5, 6.
- The principle of IPV involves administering percussive patterns at high frequencies to mobilize secretions, and ventilatory patterns at slow frequencies to encourage alveolar ventilation and clearance of secretions 5.
Tidal Volume in Ventilation
- High tidal volumes have been shown to increase morbidity and mortality in patients suffering from acute respiratory distress syndrome (ARDS) 3, 4.
- Recent data supports the use of lower tidal volumes for all critically ill patients, as a protective ventilation strategy to prevent ARDS 3.
- The recommended tidal volume is 6 mL/kg of predicted body weight, but this is often not followed in clinical practice 3, 4.