Pulmonary Toilet Comprehensive Overview Illustration

Pulmonary Toilet: A Comprehensive Overview (2024)

by | Updated: Jan 11, 2024

Pulmonary toilet, a term referring to a set of therapeutic strategies focused on lung health, plays an integral role in the management of patients with acute or chronic respiratory conditions.

These techniques are designed to enhance lung capacity, clear the airways of mucus and secretions, prevent lung infections, and facilitate the weaning process from mechanical ventilation.

By understanding and implementing these strategies, healthcare professionals can significantly impact the prognosis and quality of life for patients suffering from respiratory diseases or recovering from lung injuries.

What is Pulmonary Toilet?

Pulmonary toilet is a term used in medicine to describe a set of therapies aimed at promoting lung health and preventing complications associated with lung disease or injury. It’s primarily used in critically ill patients, particularly those on mechanical ventilation in intensive care units, or in those with chronic respiratory conditions like cystic fibrosis.

This includes techniques such as:

  • Deep Breathing Exercises: These help to open up the alveoli (the small air sacs in the lungs), enhancing lung capacity and improving oxygenation.
  • Coughing Techniques: These techniques help to clear mucus and other secretions from the airways. In some cases, a patient might need assistance to cough effectively, either through manual techniques (like chest physiotherapy) or with the use of devices (like a cough assist machine).
  • Postural Drainage and Chest Physiotherapy: These techniques use gravity and physical manipulation to help clear secretions from the lungs. The patient is positioned in a way that helps drain mucus from specific parts of the lung, and the chest and back may be percussed (tapped or clapped on) to help loosen secretions.
  • Suctioning: For patients who are unable to cough effectively (such as those on a ventilator), suctioning may be used to remove secretions from the airway.
  • Nebulizer Treatments: Medications (such as bronchodilators or mucolytics) may be administered via a nebulizer to help open the airways and break up mucus.
  • Incentive Spirometry: This is a device used to encourage deep breathing and help prevent complications like pneumonia, especially after surgery.

The goal of all these techniques is to maintain or improve lung function, prevent infections (like pneumonia), and facilitate weaning from mechanical ventilation if applicable.

It’s important to note that the specific methods used can vary depending on the individual patient’s condition and needs.

Pulmonary Toilet Meaning

Pulmonary toilet refers to methods used to promote lung health and prevent respiratory complications. Techniques include exercises to enhance lung capacity, clear airways, and prevent infections, particularly in critically ill or chronic respiratory disease patients.

Indications

Pulmonary toilet is often indicated for patients who have difficulties with airway clearance, either from chronic conditions or acute events that affect respiratory health. These may include:

  • Chronic Obstructive Pulmonary Disease (COPD): This includes conditions like emphysema and chronic bronchitis, where mucus clearance is often impaired.
  • Cystic Fibrosis: This genetic disease causes the production of thick, sticky mucus that can clog the airways and lead to infections.
  • Neuromuscular Diseases: Conditions like muscular dystrophy or ALS can weaken the muscles involved in coughing and breathing, making it harder to clear the lungs of mucus.
  • Pneumonia: In some severe or recurrent cases, pulmonary hygiene can help clear the lungs and prevent further infections.
  • Postoperative Care: After thoracic surgery or any surgery that might impair normal breathing or coughing, pulmonary toilet can help prevent complications like pneumonia.
  • Mechanical Ventilation: Patients on ventilators, especially those in intensive care units, often need assistance with mucus clearance.
  • Bronchiectasis: This condition, characterized by permanent enlargement of parts of the airways, leads to excessive mucus production and recurrent infections.
  • Asthma: In some severe or poorly controlled cases, pulmonary hygiene techniques can help clear the airways and improve control.
  • Acute Respiratory Distress Syndrome (ARDS):  In ARDS, where the lungs are severely inflamed and filled with fluid, pulmonary hygiene may help to improve lung function and patient outcomes .

As always, the specific techniques used, and their frequency and intensity, should be individualized to each patient’s condition and needs.

Contraindications

While pulmonary toilet is generally a safe and beneficial practice for many patients with respiratory conditions, there are certain situations in which some aspects may be contraindicated. Here are a few examples:

  • Unstable Cardiovascular Status: Chest physiotherapy and other vigorous respiratory exercises may be contraindicated in patients with unstable cardiovascular status, as these techniques could potentially place additional strain on the heart.
  • Rib Fractures or Chest Trauma: Manual techniques like chest percussion or vibration could potentially cause harm in the presence of rib fractures or recent chest trauma.
  • Recent Surgery: Patients who have recently undergone chest or abdominal surgery may not be suitable candidates for certain pulmonary toilet techniques until they have had sufficient time to heal.
  • Bleeding Disorders or Risk of Bleeding: Chest physiotherapy and other physical manipulation techniques might not be appropriate for individuals with bleeding disorders or a high risk of bleeding due to medications or underlying conditions.
  • Severe Shortness of Breath or Dyspnea: Patients experiencing severe shortness of breath may not be able to tolerate certain respiratory exercises or positions used in pulmonary toilet.
  • Increased Intracranial Pressure: Some techniques may be avoided in patients with increased intracranial pressure, as changes in body position or straining during coughing can potentially increase this pressure further.
  • Tuberculosis or Other Infectious Diseases: Certain precautions may need to be taken when performing pulmonary toilet techniques on patients with contagious respiratory infections to prevent the spread of the disease.

Remember: These are potential contraindications, and the specific techniques used should be individualized to each patient’s condition and needs. The healthcare team should always consider the potential benefits and risks before initiating any aspect of respiratory care.

What is Pulmonary Hygiene?

Pulmonary hygiene is another term for pulmonary toilet. It refers to the practices and therapies used to maintain or improve lung health, particularly in patients with lung diseases or those recovering from lung surgery or other forms of chest trauma.

The techniques used in pulmonary hygiene aim to clear mucus and other secretions from the lungs, increase lung capacity, and prevent respiratory complications such as infections.

They include deep breathing exercises, coughing techniques, postural drainage, chest physiotherapy, suctioning, nebulizer treatments, and the use of incentive spirometry.

Pulmonary Toilet vs. Pulmonary Hygiene

Pulmonary toilet and pulmonary hygiene essentially refer to the same set of practices. Both terms are used in the field of respiratory therapy to describe the techniques used to clear the lungs and airways of mucus and other secretions, enhance lung capacity, and prevent infections.

These methods are particularly important in the care of patients with chronic respiratory diseases or those who are recovering from lung surgery or other forms of chest trauma.

The choice of term can sometimes vary depending on regional or institutional preferences, but the underlying concepts and techniques are the same.

These include deep breathing exercises, coughing and huffing techniques, postural drainage, chest physiotherapy, suctioning, nebulizer treatments, and the use of incentive spirometry.

Both “pulmonary toilet” and “pulmonary hygiene” underscore the importance of routine care and maintenance of lung health in these patient populations.

FAQs

What Does Pulmonary Toilet Mean?

Pulmonary toilet refers to a set of therapies aimed at promoting lung health, primarily in critically ill patients or those with chronic respiratory conditions.

The goal is to clear the airways of mucus and other secretions, improve lung function, and prevent respiratory complications.

What is Pulmonary Toilet Used for?

Pulmonary toilet is used to maintain or improve lung health in patients with conditions that affect respiratory function.

This can include chronic diseases like COPD or cystic fibrosis, acute conditions like pneumonia, or situations like post-operative care or mechanical ventilation.

The techniques help to enhance lung capacity, clear the airways, and prevent lung infections.

What is Chest Physiotherapy?

Chest physiotherapy is a group of therapies designed to help clear the airways of mucus and other secretions.

Techniques can include chest percussion (tapping on the chest to break up mucus), vibration, postural drainage (using gravity to help clear mucus by positioning the body in specific ways), and breathing exercises.

What is Controlled Coughing?

Controlled coughing is a technique used to help clear mucus from the lungs. It involves taking a deep breath and holding it for a few seconds, then using the muscles of the chest and diaphragm to force air out in a controlled manner.

This can help to move mucus up into the throat, where it can be more easily expelled.

What is Deep Breathing?

Deep breathing is a technique that involves taking slow, deep breaths in order to maximize the amount of oxygen that gets into the lungs.

This can help to open up the alveoli (small air sacs in the lungs), improve gas exchange, and promote relaxation. It’s often used as part of pulmonary toilet to improve lung function and clear mucus from the airways.

What is Incentive Spirometry?

Incentive spirometry is a breathing exercise technique that encourages deep breathing to maximize lung capacity.

The patient uses a device that provides visual feedback as they inhale forcefully, helping to keep the lungs fully inflated and prevent or reduce the risk of complications like atelectasis (collapse of part or all of a lung).

What is Chest Percussion?

Chest percussion is a technique used in chest physiotherapy that involves rhythmically clapping on the chest and back to help loosen and mobilize secretions in the lungs, making them easier to cough up. It’s typically performed using cupped hands or special devices.

What is the Chest Vest?

A chest vest, or high-frequency chest wall oscillation device, is a device used in the treatment of conditions that produce excessive mucus in the lungs, such as cystic fibrosis.

The vest vibrates at a high frequency, helping to loosen and thin mucus so it can be more easily cleared from the airways.

What is Postural Drainage?

Postural drainage is a technique used in chest physiotherapy where the patient is positioned in specific ways to use gravity to help drain mucus from different parts of the lungs.

It’s often combined with chest percussion or vibration to help clear mucus from the airways.

What is a Bronchoscopy?

Bronchoscopy is a medical procedure where a doctor inserts a bronchoscope (a thin tube with a light and camera on the end) into the airways through the nose or mouth to examine the trachea and bronchi.

It can be used to diagnose conditions, take tissue samples, or perform treatments like removing blockages or administering medication.

Final Thoughts

Pulmonary toilet (i.e., pulmonary hygiene) is a crucial component of respiratory care, particularly for patients with chronic lung conditions or those recovering from lung injury or surgery.

Through a combination of techniques such as deep breathing exercises, controlled coughing, chest physiotherapy, incentive spirometry, and others, healthcare professionals can assist patients in maintaining optimal lung function, clearing their airways, and preventing respiratory complications.

The implementation of these strategies requires careful patient assessment, individualized planning, and consistent follow-through.

As our understanding of respiratory health continues to evolve, so too will the methods and practices of pulmonary toilet, all with the end goal of enhancing patient outcomes and improving quality of life.

Written by:

John Landry, BS, RRT

John Landry is a registered respiratory therapist from Memphis, TN, and has a bachelor's degree in kinesiology. He enjoys using evidence-based research to help others breathe easier and live a healthier life.

References

  • Jelic S, Cunningham JA, Factor P. Clinical review: airway hygiene in the intensive care unit. Crit Care. 2008;12(2):209.
  • Baltazar GA, Chendrasekhar A, Akella K, Chow P, Rubinshteyn V, Cohen D, Ruiz C, Genovese-Scullin DF, Patwari J, Harris L. Pulmonary Hygiene Protocol Reduces Incidence of Lobar Collapse in Severe Traumatic Brain Injury. Cureus. 2020 Dec 21;12(12)

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