***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: To compare the short-term effects of postural drainage with clapping ( PD ) and autogenic drainage ( AD ) on oxygen saturation , pulmonary function , and sputum recovery , we studied ten patients with cystic fibrosis ( CF ) r and omly treated with PD or AD on separate days .  Pulse oximetry was monitored and sputum was collected during and for 1 h following each treatment . Pulmonary function was measured before and then 1 , 15 , and 60 min after each treatment . There was no significant difference in the amount of sputum recovered with AD ( 14.0 + /- 3.5 g ) vs PD ( 10.4 + /- 3.0 g ) and no significant differences in pulmonary function occurred . Oxygen saturation during PD fell from 93.3 + /- 0.7 % to 91.2 + /- 0.8 % ( p < 0.01 ) and required 15 min following treatment to return to baseline . Oxygen saturation did not fall during AD and increased to 94.5 + /- 0.7 % by 1 h following treatment ( baseline , 93.3 + /- 0.8 % ; p < 0.01 ) . We conclude that AD is less likely to produce oxygen desaturation and may be better tolerated by patients with CF , while producing similar benefits in sputum clearance BACKGROUND : Conventional chest physical therapy ( CCPT ) , applied by therapists using cupped h and s to perform percussion , is commonly used in hospitalized adults . However , increased work load dem and s and occupational health concerns ( eg , carpal tunnel syndrome ) limit the overall utilization of this therapy . Therefore , we conducted a study to compare the overall effectiveness of CCPT to high-frequency chest wall compressions ( HFCWC ) applied via a vibratory vest . METHODS : A single-center , r and omized trial among hospitalized intubated and non-intubated adult patients requiring chest physical therapy comparing CCPT and HFCWC .  The primary outcome measure was hospital stay . RESULTS : A total of 280 per- protocol patients ( out of an a priori estimated 320 patients required to demonstrate a 20 % relative reduction in hospital stay ) were r and omly assigned to receive CCPT ( no. = 146 , 52.1 % ) or HFCWC ( no. = 134 , 47.9 % ) . The hospital stay was 12.5 ± 8.8 days for patients r and omized to CCPT and 13.0 ± 8.9 days for patients r and omized to HFCWC ( P = .62 ) . Patient comfort was assessed using a visual analog scale ( increasing score reflects greater discomfort ) and was statistically greater for patients r and omized to CCPT compared to HFCWC ( 2.2 ± 0.8 vs 1.9 ± 0.8 , P = .009 ) . The duration of time until radiographic resolution of lobar atelectasis trended less for CCPT compared to HFCWC ( 5.2 ± 4.3 d vs 6.5 ± 5.2 d , P = .051 ) . All other secondary outcomes , including hospital mortality and nosocomial pneumonia , were similar for both treatment groups . CONCLUSIONS : This study was inadequately powered for the primary outcome of interest and hence we can not make recommendations on the preferential use of HFCWC or CCPT for intubated and non-intubated adult patients . HFCWC was associated with statistically better comfort scores . ( Clinical Trials.gov registration NCT00717873 . Background Routine turning of critically ill patients is a st and ard of care . In recent years , specialized beds that provide automated turning have been introduced . These beds have been reported to improve lung function , reduce hospital-acquired pneumonia , and facilitate secretion removal . This trial was design ed to measure the physiological effects of routine turning and respiratory therapy in comparison with continuous lateral rotation ( CLR ) . Methods The study was a prospect i ve , quasi-experimental , r and om assignment , trial with patients serving as their own controls . Paralyzed , se date d patients with acute respiratory distress syndrome were eligible for study . Patients were r and omized to receive four turning and secretion management regimens in r and om sequence for 6 h each over a period of 24 h : ( 1 ) routine turning every 2 h from the left to right lateral position ; ( 2 ) routine turning every 2 h from the left to right lateral position including a 15-min period of manual percussion and postural drainage ( P&PD ) ; ( 3 ) CLR with a specialized bed that turned patients from left to right lateral position , pausing at each position for 2 min ; and ( 4 ) CLR with a specialized bed that turned patients from left to right lateral position pausing at each position for 2 min , and a 15-min period of percussion provided by the pneumatic cushions of the bed every 2 h. Results Nineteen patients were entered into the study . There were no statistically significant differences in the measured cardiorespiratory variables . There was a tendency for the ratio of partial pressure of arterial oxygen to fractional inspired oxygen concentration ( PaO2/FIO2 ) to increase ( 174 ± 31 versus 188 ± 36 ; P = 0.068 ) and for the ratio of deadspace to tidal volume ( Vd/Vt ) to decrease ( 0.62 ± 0.18 versus 0.59 ± 0.18 ; P = 0.19 ) during periods of CLR , but these differences did not achieve statistical significance . There were statistically significant increases in sputum volume during the periods of CLR . The addition of P&PD did not increase sputum volume for the group as a whole . However , in the four patients producing more than 40 ml of sputum per day , P&PD increased sputum volume significantly . The number of patient turns increased from one every 2 h to one every 10 min during CLR . Conclusion The acute effects of CLR are undoubtedly different in other patient population s ( spinal cord injury and unilateral lung injury ) . The link between acute physiological changes and improved outcomes associated with CLR remain to be determined Background Manual chest physiotherapy ( MCP ) techniques involving chest percussion , vibration , and shaking have long been used in the treatment of respiratory conditions . However , method ological limitations in existing research have led to a state of clinical equipoise with respect to this treatment . Thus , for patients hospitalised with an exacerbation of Chronic Obstructive Pulmonary Disease ( COPD ) , clinical preference tends to dictate whether MCP is given to assist with sputum clearance . We st and ardised the delivery of MCP and assessed its effectiveness on disease-specific quality of life . Methods In this r and omised , controlled trial powered for equivalence , 526 patients hospitalised with acute COPD exacerbation were enrolled from four centres in the UK . Patients were allocated to receive MCP plus advice on airway clearance or advice on chest clearance alone . The primary outcome was a COPD specific quality of life measure , the Saint Georges Respiratory Question naire ( SGRQ ) at six months post r and omisation . Analyses were by intention to treat ( ITT ) . This study was registered , IS RCT N13825248 . Results All patients were included in the analyses , of which 372 ( 71 % ) provided evaluable data for the primary outcome . An effect size of 0·3 st and ard deviations in SGRQ score was specified as the threshold for superiority . The ITT analyses showed no significant difference in SGRQ for patients who did , or did not receive MCP ( 95 % CI −0·14 to 0·19 ) . Conclusions These data do not lend support to the routine use of MCP in the management of acute exacerbation of COPD . However , this does not mean that MCP is of no therapeutic value to COPD patients in specific circumstances Objective To investigate whether the addition of intrapulmonary percussive ventilation to the usual chest physiotherapy improves gas exchange and lung mechanics in tracheostomized patients . Design and setting R and omized multicenter trial in two weaning centers in northern Italy . Patients and participants 46 tracheostomized patients ( age 70 ± 7 years , 28 men , arterial blood pH 7.436 ± 0.06 , PaO2/FIO2 238 ± 46 ) weaned from mechanical ventilation . Interventions Patients were assigned to two treatment groups performing chest physiotherapy ( control ) , or percussive ventilation ( IMP2 Breas , Sweden ) 10 min twice/day in addition to chest physiotherapy ( intervention ) . Measurements and results Arterial blood gases , PaO2/FIO2 ratio , and maximal expiratory pressure were assessed every 5th day for 15 day . Treatment complications that showed up in 1 month of follow-up were recorded . At 15 days the intervention group had a significantly better PaO2/FIO2 ratio and higher maximal expiratory pressure ; after follow-up this group also had a lower incidence of pneumonia . Conclusions The addition of percussive ventilation to the usual chest physiotherapy regimen in tracheostomized patients  improves gas exchange and expiratory muscle performance and reduces the incidence of pneumonia Background : The indication for chest physical therapy as an adjunct to the treatment of children hospitalised with acute pneumonia remains controversial and there is a lack of robust scientific evidence for the effectiveness of this modality in these patients . Methods : A r and omised controlled trial was conducted in two tertiary hospitals in southern Brazil . Children aged 29 days to 12 years hospitalised with pneumonia between February and October 2006 were recruited ; 51 were r and omly allocated to the intervention group  ( chest physical therapy plus st and ard treatment for pneumonia )  and 47 to the control group ( st and ard treatment for pneumonia alone ) . The primary outcome was time to clinical resolution . The secondary outcomes were length of stay in hospital and duration of respiratory symptoms and signs . Results : There were no significant differences in terms of median time to clinical resolution ( 4.0 vs 4.0 days , p = 0.84 ) and median length of hospital stay ( 6.0 vs 6.0 days , p = 0.76 ) between the intervention and control groups . The intervention group had a longer median duration of coughing ( 5.0 vs 4.0 days , p = 0.04 ) and of rhonchi on lung auscultation ( 2.0 vs 0.5 days , p = 0.03 ) than the control group . Conclusions : Chest physical therapy as an adjunct to st and ard treatment does not hasten clinical resolution of children hospitalised with acute pneumonia and may prolong duration of coughing and rhonchi OBJECTIVE To compare the short-term effects of postural drainage ( PD ) , oscillating positive expiratory pressure ( using the FLUTTER device ) , and expiration with the glottis open in the lateral posture ( ELTGOL ) on oxygen saturation , pulmonary function , and sputum production in patients with an acute exacerbation of chronic bronchitis . DESIGN A prospect i ve , r and omized study . SETTING A clinical ward . PATIENTS Ten patients with chronic bronchitis exacerbation received PD , FLUTTER , and ELTGOL by the same respiratory therapist at about the same time of day on separate days and in r and om order . MAIN OUTCOME MEASURES Oxygen saturation and pulmonary function were measured before , immediately after , and 15 minutes and 1 hour after each treatment . Improvement in sputum production was measured by total sputum wet weight immediately after and for 1 hour after treatment . INTERVENTIONS PD consisted of positioning the patients in a posture that allows bronchial drainage by gravity . FLUTTER is a device that is cl aim ed to combine oscillating positive expiratory pressure with oscillations of the airflow . ELTGOL is an airway clearance technique that uses lateral posture and different lung volumes to control expiratory flow rate to avoid airway compression . The total time spent for treatments was 30 minutes . RESULTS All techniques were well tolerated , and oxygen saturation and pulmonary function did not change significantly during and after treatments . Thirty minutes after the beginning of treatment , sputum production increased significantly with all techniques , but during the 1 hour after the end of treatment , it was significantly larger with FLUTTER ( from 15.0 + /- 8.6 g to 19.0 + /- 9.3 g , p < .01 ) and ELTGOL ( from 17.0 + /- 7.0 g to 20.6 + /- 6.9 g , p < .02 ) than with PD ( from 15.5 + /- 4.0 g to 17.5 + /- 3.7 g , NS ) . CONCLUSIONS All three treatments were safe and effective in removing secretions without causing undesirable effects on oxygen saturation , but FLUTTER and ELTGOL techniques were more effective in prolonging secretion removal in chronic bronchitis exacerbation than was the PD method Chest physiotherapy is an essential part of the management of cystic fibrosis , yet comparatively few studies have investigated the commonly used forms of chest physiotherapy during acute respiratory exacerbations . Fifteen subjects with cystic fibrosis and predominantly mild pulmonary impairment completed a r and omised cross-over trial with 24 hours between treatments . The active cycle of breathing techniques ( ACBT ) assisted by a physiotherapist was compared with the ACBT performed independently by the patient . Measurement outcomes included pulmonary function tests , indirect calorimetry and oximetry parameters . Energy expenditure was not significantly different between the two treatment regimens , though significant improvements in pulmon 
    Output:
    
After removing duplicates and reading the titles and abstract s , 63 articles were selected , including 9 systematic review s. This work highlights the lack of useful scientific data and the difficulty of determining levels of evidence for manual airway clearance techniques .
Techniques were assessed principally with patients with sputum production ( cystic fibrosis , DDB , COPD , etc . ) .
It also shows the limited pertinence of outcome measures to quantify congestion and hence the efficacy of airway clearance techniques .