Hemodynamic and ventilatory effects of manual respiratory physiotherapy techniques of chest clapping, vibration, and shaking in an animal model

Abstract

Chest clapping, vibration, and shaking were studied in 10 physiotherapists who applied these techniques on an anesthetized animal model. Hemodynamic variables (such as heart rate, blood pressure, pulmonary artery pressure, and right atrial pressure) were measured during the application of these techniques to verify claims of adverse events. In addition, expired tidal volume and peak expiratory flow rate were measured to ascertain effects of these techniques. Physiotherapists in this study applied chest clapping at a rate of 6.2 ± 0.9 Hz, vibration at 10.5 ± 2.3 Hz, and shaking at 6.2 ± 2.3 Hz. With the use of these rates, esophageal pressure swings of 8.8 ± 5.0, 0.7 ± 0.3, and 1.4 ± 0.7 mmHg resulted from clapping, vibration, and shaking respectively. Variability in rates and “forces” generated by these techniques was <20% in average coefficients of variation. In addition, clinical experience accounted for 76% of the variance in vibration rate ( P = 0.001). Cardiopulmonary physiotherapy experience and layers of towel used explained ∼79% of the variance in clapping force ( P = 0.004), whereas age and clinical experience explained >80% of variance in shaking force ( P = 0.003). Application of these techniques by physiotherapists was found to have no significant effects on hemodynamic and most ventilatory variables in this study. From this study, we conclude that chest clapping, vibration, and shaking 1) can be consistently performed by physiotherapists; 2) are significantly related to physiotherapists' characteristics, particularly clinical experience; and 3) caused no significant hemodynamic effects.