Chart — Clinical Skills
Airway Clearance Techniques Compared
Every airway clearance technique in one grid — how it works, who it suits, and its key precaution — so you can match the method to the patient instead of defaulting to manual chest physiotherapy.
Written by Apex Respiratory Editorial Team
Educational use only. This material supports respiratory therapy education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional protocols, or physician orders. Always follow facility policies and current provider orders, and verify calculations independently before clinical use.
Airway Clearance Techniques
| Technique | How It Works | Best For | Key Limitation / Precaution |
|---|---|---|---|
| Conventional CPT (postural drainage + percussion/vibration) | Gravity plus manual energy mobilize secretions | Patients needing assisted clearance; targeting specific segments | Labor-intensive; head-down contraindicated with raised ICP/aspiration; not for uncomplicated pneumonia |
| Directed cough / huff (active cycle of breathing) | Controlled breathing plus huff coughing | Cooperative patients; adjunct to every method | Requires cooperation and effort |
| PEP (positive expiratory pressure) | Exhaling against resistance splints airways open and moves secretions proximally | Self-directed clearance (CF, bronchiectasis) | Requires cooperation |
| Oscillatory PEP (Flutter, Acapella) | PEP combined with airflow oscillation/vibration | Self-directed mobilization of mucus | Technique-dependent |
| High-frequency chest wall oscillation (HFCWO / vest) | External vest vibrates the chest wall | Patients who cannot perform manual techniques; CF | Cost and availability; chest-wall precautions |
| Intrapulmonary percussive ventilation (IPV) | Delivers high-frequency mini-bursts of gas to the airway | Retained secretions; neuromuscular disease | Requires equipment and training |
| Mechanical insufflation-exsufflation (cough assist) | Positive pressure then rapid negative pressure simulates a cough | Neuromuscular weakness with an ineffective cough | Caution in bullous disease and barotrauma risk |
How to Use This Chart
Use this grid to match the airway clearance method to your patient’s condition, effort capacity, and care setting. The right technique depends on what the patient can do, not just what equipment is available.
- Match technique to ability and condition. Use self-directed devices (PEP, oscillatory PEP) for chronic outpatients who can cooperate; choose HFCWO or cough assist for patients who cannot perform manual techniques.
- Indication: retained secretions with an ineffective cough. Airway clearance therapy is indicated for patients with secretion retention and inadequate cough — it is not indicated for routine uncomplicated pneumonia.
- Head-down positioning is the key contraindication for conventional CPT. Avoid Trendelenburg (head-down) positioning in patients with raised intracranial pressure or significant aspiration risk.
Related Resources
Sources
- Strickland SL, Rubin BK, Drescher GS, et al. AARC Clinical Practice Guideline: Effectiveness of nonpharmacologic airway clearance therapies in hospitalized patients. Respir Care. 2013;58(12):2187-2193.
- Kacmarek RM, Stoller JK, Heuer AJ. Egan's Fundamentals of Respiratory Care. 12th ed. Elsevier; 2021. Airway clearance therapy.