Failure of Secretion Clearance:

• Failure of secretion clearance is common in critically ill patients and can be due to factors such as increased secretion production, impaired cough reflex, weakness, and pain.
• This can lead to an increased risk of aspiration, atelectasis, and pneumonia, which are detrimental to critically ill patients.

Adjunctive Respiratory Therapies:

• Adjunctive respiratory therapies aim to prevent and treat respiratory complications encountered in critically ill patients.
• Therapies include methods to improve pulmonary mucociliary clearance, lung expansion, oxygenation, and ventilation.

Methods to Improve Pulmonary Mucociliary Clearance:

• Chest physiotherapy, including percussion and postural drainage, aids in secretion clearance by mobilizing secretions from the pulmonary tract.
• High-frequency chest compression (HFCC) enhances mucus clearance and is primarily used in cystic fibrosis patients.

Manual Techniques for Secretion Clearance:

• Manual hyperinflation aims to improve oxygenation, lung recruitment, and clearance of airway secretions but only leads to transient improvements in oxygenation.
• Mechanical insufflation–exsufflation assists in secretion clearance from the peripheral airways and is generally well-tolerated, but may lead to side effects.

Considerations for Use of Manual Techniques:

• Manual hyperinflation and insufflation–exsufflation have contraindications and potential disadvantages that need to be considered before use in critically ill patients.
• Mobilization of patients in the ICU may improve overall patient well-being and lead to better patient outcomes in the long term.

Positioning for Improved Gas Exchange:

• Elevating the head of the bed to at least 30 degrees reduces aspiration risk and improves gas exchange.
• Upright positioning increases lung volumes, benefiting gas exchange and work of breathing.

Ventilation/Perfusion Matching:

• Positioning the affected lung side up can improve V/Q matching.