Tidal Percussion Technique
Tidal percussion is not a recognized clinical technique in respiratory medicine—you are likely referring to either chest percussion (a physical examination technique) or intrapulmonary percussion ventilation (IPV), a mechanical airway clearance modality.
If You Mean Chest Percussion (Physical Examination)
Chest percussion is performed by tapping the chest wall with fingers to assess underlying lung and pleural conditions based on the acoustic quality of the sound produced 1.
Proper Technique
Position the patient sitting upright with arms crossed over the chest to move the scapulae laterally, exposing maximum lung surface area 1
Place your non-dominant hand's middle finger firmly against the chest wall in the intercostal space, with other fingers lifted off the chest to avoid dampening vibrations 1
Strike the middle phalanx of the positioned finger sharply with the tip of your dominant hand's middle finger, using a quick wrist-flicking motion rather than arm movement 1
Compare symmetrical areas systematically from apex to base, moving posteriorly, laterally, and anteriorly, percussing every 5 cm 1
Interpretation of Sounds
Resonant (normal): Low-pitched, hollow sound over healthy lung tissue 1
Hyperresonant (tympanic): Louder, lower-pitched sound indicating increased air (pneumothorax, emphysema, asthma) 1
Dull: High-pitched, short sound indicating fluid (pleural effusion) or consolidation (pneumonia) 1
Critical Pitfall
The sensitivity of manual chest percussion is inherently low due to human ear limitations and operator subjectivity 1. Do not rely solely on percussion findings—always correlate with imaging and other clinical data 1.
If You Mean Intrapulmonary Percussion Ventilation (IPV)
IPV is a mechanical device that delivers high-frequency bursts of small tidal volumes to promote airway clearance and lung recruitment 2.
Device Setup
The Phasitron® provides the dynamic interface between the pneumatic gas source and the patient, delivering percussive bursts 2
Connect to the patient via mouthpiece, mask, or endotracheal tube depending on clinical scenario 2
Settings for Obstructive Disease (COPD, Asthma) with Ventilatory Autonomy
Set frequency >300 cycles/min to create vibrations and percussions that mobilize secretions 2
Maintain proximal airway pressure at 10-20 cm H₂O to avoid barotrauma while achieving therapeutic effect 2
Use this "percussive pattern" to promote secretion clearance in patients who can breathe spontaneously 2
Settings for Restrictive Disease without Ventilatory Autonomy
Set frequency at 80-200 cycles/min (slower than obstructive disease protocol) to improve gas exchange 2
Proximal airway pressure may reach 40 cm H₂O in these patients who require ventilatory support 2
Alternate between percussive pattern (high frequency) for secretion mobilization and ventilatory pattern (slow frequency) for alveolar ventilation during treatment sessions 2
Critical Monitoring
Always monitor plateau pressures and avoid exceeding 30 cm H₂O to prevent ventilator-induced lung injury, particularly in patients with underlying lung disease 3, 4.