Bronchial Hygiene Modalities

Definition
Bronchial hygiene modalities are non-invasive therapies or interventions which assist in the movement of secretions out of the lungs.

There are several specific bronchial hygiene modalities:

• Chest physiotherapy (CPT)
• May be performed with cupped hands or an appropriate sized palm cup.
• Vibration can be performed with a mechanical vibrator. 
• Performed for no longer than necessary, usually 2-3 minutes per each segment. 
• Should be done prior to eating or at least 30 minutes after a meal.  
• Done in conjunction with postural drainage
• Postural drainage (PD)
• Drainage of secretions by gravity from one or more lung segments to the central airways.
• A variety of 10 positions are used to place the target lung segment superior to the carina.
• Intrapulmonary Percussive Ventilation (IPV)
• Uses a pneumatic interface called a “Phasitron”.
• Delivers high flow mini-bursts of air into the lungs at a rate of 100-300 times each minute.
• Also delivers a therapeutic aerosol or saline.
•  Cough Assist device (Mechanical Insufflator-Exsufflator)
• Clears secretions by gradually applying a positive pressure to the airway, then rapidly shifting to negative pressure.
•  Rapid shift in pressure produces a high expiratory flow, simulating a natural cough.
• Assists in clearing secretions for patients with ineffective coughs. This may be due to neuromuscular disorders affecting the muscles of respiration or artificial airways in children..
• High-Frequency Chest Wall Oscillation (HFCWO) Vest
• Vest that looks like a life jacket connected to an air compressor with flexible plastic hoses.
• Air compressor delivers bursts of air to rapidly inflate and deflate vest 25 times per second.

• Not all children with a tracheostomy will need assistance moving secretions out of the airways.
• Specific bronchial hygiene modalities will be prescribed to meet an individual child’s needs.