Table 3.

Role of Optimal Position and Ventilation in CF ACT

Clinical Problem	Technique	Effect
Prolonged supine position	Assume upright posture	Improved: Lung compliance Oxygenation Diaphragmatic excursion Secretion mobilization.
Atelectasis due to less mobility	Mobility and exercise	Improved: Alveolar ventilation Tidal volume Respiratory rate V/Q matching Recruitment lung units Secretion mobilization Lymphatic drainage Enhanced surfactant
Critical CF with renal failure	Prone position	Improved: Arterial oxygen tension Tidal volume Dynamic lung compliance Cardiac stroke volume Sympathetic activity Urine flow
Lung secretions	Decubitus position	↑dependent lung gas exchange
Maximal FRC needed	Standing > sitting > supine	Reduced airway closure
Postop. pain	Frequencer	Frequencer requires no patient cooperation and can be placed at targeted areas in the lungs, avoiding chest tubes and other painful areas
Bronchospasm	Bronchodilators, Breath hold to ERV and use PEP to help increase FRC	Helps collateral ventilation for air to go behind mucus

Note: ↑Improve ventilation due to increase dependent lung gas exchange and thus improved mucus clearance.

Abbreviations: PEP, positive expiratory pressure; FRC, functional residual capacity; ERV, expiratory reserve volume.