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Chest physiotherapy and tracheobronchial suction in the ICU 

Chest physiotherapy and tracheobronchial suction in the ICU
Chapter:
Chest physiotherapy and tracheobronchial suction in the ICU
Author(s):

Gianluigi Li Bassi

and J. D. Marti

DOI:
10.1093/med/9780199600830.003.0121
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date: 21 February 2020

The airway lining fluid is a biphasic layer covering the respiratory tract epithelium. It has antimicrobial and immunomodulatory properties, and it is formed by a gel-phase (mucus), and a low-viscosity inner layer (sol-phase) that provides lubrication for ciliary beating. Mucus is continuously cleared from the airways through the ciliated epithelium and via the two-phase gas–liquid flow mechanism (i.e. coughing). Mucus production in healthy subjects is approximately 10–100 mL/day. Whereas, mucociliary clearance rates range between 4 and 20 mm/min. Critically-ill, mechanically-ventilated patients often retain mucus. Several chest physiotherapy techniques are applied to promote mucus clearance in these patients. The role of chest physiotherapy in mechanically-ventilated patients is debated, due to the lack of evidence from well-designed clinical trials. Retained mucus is aspirated through tracheobronchial suctioning. Closed suctioning is beneficial in patients with severe lung failure and at risk of alveolar collapse upon ventilator disconnection.

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