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Physiotherapy and pneumothorax

Can you practice physiotherapy sessions in case of a pneumothorax drained? If so, can it have adverse effects (make the drain bubble)?
Chest physiotherapy and airway clearance are challenging in a patient with a pneumothorax. Indeed, there may be fears that some therapies that provide positive pressure to the airways could cause or exacerbate a pneumothorax, although this is very uncommon. In addition, the patient with a chest tube can sometimes feel pain on deep inspiration that he will tend to avoid spontaneously.
Nevertheless, it is very important to continue to clear bronchial secretions at this time of greater respiratory fragility. Otherwise, respiratory status and general status may worsen rapidly. This is also why, during the occurrence of pneumothorax, we routinely prescribe a course of antibiotics to facilitate bronchial clearance by reducing pulmonary infection.
Mild airway clearance techniques are recommended, such as slow acceleration of expiratory flow in order to clear the bronchial secretions avoiding coughing. Do not hesitate to have several sessions per day. The physiotherapist should work with the patient to find the most comfortable yet effective method of clearing secretions.
This gentle physiotherapy should not have an adverse effect, particularly on how the chest drain bubbles.
Best regards.
Dr Dominique Hubert