Assisting with Respiratory Health for Patients with COVID-19

by | Mar 25, 2020 | All Blogs | 20 comments

 

 

Written by: Julie Barnett, PT, DPT, MTC

Introduction:

As COVID -19 advances across our cities in the United States, I want to remind our rehabilitation professionals of a potentially life-saving technique to assist with respiration.  PT/PTA programs include Percussion and Postural Drainage (P&PD or PD) in your cardiopulmonary training.  Hospitals often use respiratory therapists and/or vests to perform these techniques currently.  These resources may not be available in the numbers anticipated in the foreseeable future with the COVID-19 pandemic.

Discussion: 

An individual with potential COVID-19 symptoms will be triaged if they have a fever over 100°F, shortness of breath and a cough.  This P&PD technique is for the individual who has not admitted into the hospital setting and is being treated at home with early signs of congestion OR perhaps has chosen not to enter the healthcare system.  I think of our seniors with Do Not Resuscitate (DNR) orders in place and are at home or senior living facilities. 

The CDC outlined precautions regarding spread of the virus and prevention recommendations.  If an individual has multiple risk factors and if the fever is advancing/unresponsive to acetaminophen, (Tylenol) and the shortness of breath is worsening, then steps should be accelerated to seek treatment outside of the home.

For more stable conditions at home, P&PD such as postural drainage can be considered as an intervention to assist in providing more oxygen to various lobes of the lunges by using postures and gravity.

The research on this technique in regards to evidence based medicine for theCOVID-19 virus is scant; however, the use of postural drainage for viral pneumonia has cited in our rehab literature for decades as an effective intervention.  These techniques are most recognized in our pediatric cystic fibrosis community and other chronic pulmonary diagnosis.

Postural Drainage can also be taught to an individual without putting another family member or care giver at risk of exposure to the expectorant/mucus. 

I have included pictures of 3 possible postures that can be used for postural drainage. In addition, I was given permission to use a video link by Amelia Lindberg PT.  Her 8 minute video link offers gentle postures and descriptions with calming music to incorporate for a home postural program.  Please share:

 

POSTURAL DRAINAGE: maintain 10-15 minutes

I also wanted to share from a peer doctor of PT, Lauren Hebert PT, DPT, OCS, about his experience with postural drainage.  

POTENTIALLY LIFESAVING ADVICE:

If you end up with pulmonary symptoms of corona virus pneumonia… there can be lethal damage from effusion (mucous filling lungs) or cytokine storm (body over-reacts with more effusion).

This kills people… ESPECIALLY when the number of patients is greater than the number of ICU beds or ventilators. You will be left to drown in your mucous. That mucous can also be infected by other germs during your struggle. That is happening in Italy where there are 5x more patients than they have hospital beds. And the USA has far FEWER beds per population than does Italy.

Many years ago, physical therapists have successfully treated this with POSTURAL DRAINAGE… where the patient is tipped over a wedge to tilt the lungs and bronchial tubes upside down… to allow the mucous to flow out, where it can be coughed out.

Google it. It is EASY to do for yourself and family members.

Simply get in position and let it flow, helping it along with breathing techniques that emphasize full, prolonged exhale, while puffing your cheeks and you blow out long and steady. Follow CDC guidelines for mucus.  Have a lot of paper towels to collect the mucous.

Start as soon as you feel lungs getting filled. Don’t wait until you are too sick to bother. 3-5 minutes several times per day.

A PT did this inside a nursing home in VT during the 1976 flu epidemic for resident patients. They did not lose anyone, while other nursing homes lost dozens. It is an old PT technique that has faded away since we have ventilators and related machines. BUT this time, we will NOT have nearly enough ventilators, not the ICU beds where they are provided.

One easy way to get into position is to lie over an EXERCISE BALL.

One more 5 min YouTube instructional link for Postural drainage, percussion, vibration technique is below. Please share!

 

Resources:

To learn more from Julie Barnett, click here! 

20 Comments

  1. Kathleen Wikstrom on April 17, 2020 at 7:49 am

    Covid 19 presents similar symptoms as high elevation sickness. Has anyone thought of using that medication?

  2. Guy on April 4, 2020 at 10:54 am

    I never heard of this technique.seems easy enough to do independently in desperate times.
    Great article and videos.

  3. Julie Barnett PT, DPT, MTC on April 3, 2020 at 1:16 pm

    APTA guidelines for hospital care were released after the blog was posted with support for airway clearance.
    Table 3 Screening guidelines for physiotherapy involvement with COVID-19 in this document states: for COVID-19 patient presentation (confirmed or suspected)
    Mild symptoms and/or pneumonia AND
    evidence of exudative consolidation with difficulty clearing or inability to clear secretions independently e.g. weak, ineffective and moist sounding cough, tactile fremitus on chest wall, moist/wet sounding voice, audible transmitted sounds.
    Physiotherapy referral for airway clearance.

    AGPs such as postural drainage is being discussed for the risks, the indications and the benefits in the severe cases. The role of evidence based medicine is to have dialogue not accusations. Prone positioning in essence in ARDS is a postural technique in severe conditions.
    The goal is to slow down the lung damage: yes there is hypoxic failure. Increasing O2 is the goal. PT has a role. Continue following the current evidence and guidelines published. Airway clearance needs continued review.

  4. Juliette Vifquain on April 2, 2020 at 11:11 am

    great! I remember when I was a little girl my physical therapist did this and many other techniques to help with my chronic bronchitis. Thanks so much for sharing

  5. Sarina Karwande on April 1, 2020 at 11:17 am

    http://www.apta.org/uploadedFiles/APTAorg/News_and_Publications/Latest_News/News_Items/2020/Physiotherapy_Guideline_COVID-19.pdf

    This outlines what PTs should consider with respiratory care. Page 19/20 goes into use of percussion and assistive coughing techniques. However it is mentioned these come with risk of releasing aerosols leading to disease transmission. Overall for COVID it supports the use of prone positioning and our role in encouraging “prone teams” in the ICU.

  6. Siga Andrew on March 31, 2020 at 9:09 pm

    excellent reminder that we have these skills– I remember doing this decades ago. Thanks for the blog!

  7. Julie Tanner on March 31, 2020 at 8:26 pm

    great to share this. I’m an OT but I know I’d be more valuable in assisting patients even with some techniques that are not of my profession. We may be cross-training to help with this covid crisis and I’d gladly like to learn and share these techniques. Thank you

  8. Nancy Terrebonne on March 31, 2020 at 2:04 pm

    Fabulous visual review of techniques as demonstrated.

  9. roselyn schuster on March 31, 2020 at 11:39 am

    Thank you for sharing this highly informative and timely information!

  10. Emilie Cohen, PT,CLT on March 31, 2020 at 10:04 am

    OMG Thank you!
    I used to perform percussion and postural drainage in the early 1980’s at a pediatric rehab on our CF kids. I have always incorporated this in my practice to some degree but will now definitely employ P&PD more.
    I am now in an acute care setting and some of the patients become orthopnic or have a heart failure condition so I’ll be cautious with positions. Thank you for bringing this great old technique to the forefront.

  11. Michele Relvas on March 31, 2020 at 9:29 am

    Great reminder and review about some other valuable tools in the tool box.
    Thank you and be well!

  12. Brenda L Hedgren on March 31, 2020 at 8:52 am

    Thank you!! this was very helpful. Where can we find the other videos you posted/mentioned?

  13. Alisha Rudd on March 31, 2020 at 8:52 am

    I cannot see the videos that are supposed to be attached

  14. Rasha Dove on March 31, 2020 at 8:20 am

    That was extremely helpful !! Good refresher .
    Thanks !!

  15. Esther Reynolds on March 31, 2020 at 7:13 am

    Thank you for sharing this timely news

  16. Staci Protz on March 31, 2020 at 7:09 am

    Thank you for the wonderful information to remind us we have a part in this pandemic.

  17. Zach Boswell, PT, DPT on March 31, 2020 at 7:02 am

    This information contradicts the most recent resources published and backed by the APTA, and specifically the AACPT and CVP sections. Typically postural drainage/percussion is appropriate for pneumonias, however COVID-19 is impact pulmonary tissue differently. The hypoxic respiratory failure is due to viral infestation in the blood stream causing leakiness in the capillaries resulting in damage to alveoli as opposed to pneumonias typically seen which impact the lung tissue itself. Due to the fact that percussion and postural drainage techniques are used to elicit coughing, these are considered aerosol generating procedures (AGPs) and are currently contraindicated. I find it unethical and inappropriate to be broadcasting misinformation that can be particularly dangerous for patients, families, and therapists.

  18. Angie Rischpater on March 31, 2020 at 6:45 am

    This is so helpful. I work in home health in NY and am just awaiting the flood of patients heading our way.