Feasibility and safety of intrapulmonary percussive ventilation in spontaneously breathing, non-ventilated patients in critical care: A retrospective pilot study

Abstract

Background: Intrapulmonary percussive ventilation is used in various clinical settings to promote secretion clearance, reverse or treat atelectasis and improve gas exchange. Despite a few studies reporting the use of intrapulmonary percussive ventilation in critical care, the available data remain insufficient, contributing to weaker evidence toward its effectiveness. Also, there is a paucity of studies evaluating the safety and feasibility of intrapulmonary percussive ventilation application in critical care. This retrospective pilot study has evaluated the safety and feasibility of intrapulmonary percussive ventilation intervention in non-intubated patients admitted to an intensive care unit.

Methods: The medical records of 35 subjects were reviewed, including 22 subjects who received intrapulmonary percussive ventilation intervention and 13 subjects matched for age, sex, and primary diagnosis who received chest physiotherapy. The records were audited for feasibility, safety, changes in oxygen saturation, chest X-ray changes, and intensive care unit length of stay.

Results: A total of 104 treatment sessions (IPV 65 and CPT 39) were delivered to subjects admitted with a range of respiratory conditions in critical care. Subjects completed 97% of IPV sessions. No major adverse events were reported with intrapulmonary percussive ventilation intervention. Intensive care unit length of stay in the intrapulmonary percussive ventilation group was 9.6 ± 6 days, and in the CPT group, it was 11 ± 9 days (p = 0.59). Peripheral oxygen saturation pre to post intervention was 92% ± 4 to 96% ± 4 in IPV group and 95% ± 4 to 95% ± 3 in the CPT group.

Conclusion: Application of intrapulmonary percussive ventilation intervention was feasible and safe in non-ventilated adult patients in critical care.

Keywords: Intrapulmonary percussive ventilation; MetaNeb; chest physiotherapy; critical care; high-frequency ventilation; intensive care.

Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

© The Intensive Care Society 2020.

Figures

Figure 1.

Flow diagram represents the screening and inclusion process. IPV: intrapulmonary percussive ventilation; FiO2: fraction of inspired oxygen; CPT: chest physiotherapy.

Figure 2.

MetaNeb® System (Hill-Rom Services, USA).

Figure 3.

Change (mean ± SD) in oxygenation (SpO2 and FiO2) pre and post IPV and CPT from day 1 to 4. Figures on the left-hand side (a and b) show changes in SpO2 pre and 1-h post IPV and CPT intervention. Figures on the right-hand side (c and d) show changes in FiO2 pre and 1-h post IPV and CPT intervention. SpO2: saturation of peripheral oxygen; FiO2: fraction of inspired oxygen; IPV: intrapulmonary percussive ventilation; CPT: chest physiotherapy.

Figure 4.

Change in RASs pre and post IPV and CPT. Graphs on the left (RAS pre-IPV and RAS post-IPV) show a shift toward lower scores from pre to post-IPV intervention, whereas graphs on the right-hand side (RAS pre-CPT and RAS post-CPT) show a relatively smaller shift toward lower scores. IPV: intrapulmonary percussive ventilation; RAS: radiological atelectasis score; CPT: chest physiotherapy.