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Chest physiotherapy and tracheobronchial suction in the ICU 

Chest physiotherapy and tracheobronchial suction in the ICU
Chest physiotherapy and tracheobronchial suction in the ICU

Gianluigi Li Bassi

and J. D. Marti

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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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