Effect of multimodality chest physiotherapy in prevention of ventilator-associated pneumonia: A randomized clinical trial

Renu B Pattanshetty, G S Gaude, Renu B Pattanshetty, G S Gaude

Abstract

Background: Despite remarkable progress that has been achieved in the recent years in the diagnosis, prevention, and therapy for ventilator-associated pneumonia (VAP), this disease continues to create complication during the course of treatment in a significant proportion of patients while receiving mechanical ventilation.

Objective: This study was designed to evaluate the effect of multimodality chest physiotherapy in intubated and mechanically ventilated patients undergoing treatment in the intensive care units (ICUs) for prevention of VAP.

Patients and methods: A total of 101 adult intubated and mechanically ventilated patients were included in this study. Manual hyperinflation (MH) and suctioning were administered to patients in the control group (n = 51), and positioning and chest wall vibrations in addition to MH plus suctioning (multimodality chest physiotherapy) were administered to patients in the study group (n = 50) till they were extubated. Both the groups were subjected to treatment twice a day. Standard care in the form of routine nursing care, pharmacological therapy, inhalation therapy, as advised by the concerned physician/surgeon was strictly implemented throughout the intervention period.

Results: Data were analyzed using SPSS window version 9.0. The Clinical Pulmonary infection Score (CPIS) Score showed significant decrease at the end of extubation/successful outcome or discharge in both the groups (P = 0.00). In addition, significant decrease in mortality rate was noted in the study group (24%) as compared to the control group (49%) (P = 0.007).

Conclusions: It was observed in this study that twice-daily multimodality chest physiotherapy was associated with a significant decrease in the CPIS Scores in the study group as compared to the control group suggesting a decrease in the occurrence of VAP. There was also a significant reduction in the mortality rates with the use of multimodality chest physiotherapy in mechanically ventilated patients.

Keywords: Clinical Pulmonary infection Score; multimodality chest physiotherapy; ventilator-associated pneumonia.

Conflict of interest statement

Conflict of Interest: None declared

References

    1. Rello J. Therapeutic options and issues in the management of ventilator-associated bacterial pneumonia. Crit Care. 2005;9:259–65.
    1. Niederman MS. The clinical diagnosis of ventilator-associated pneumonia. Respir Care. 2005:788–96.
    1. Stiller K. Physiotherapy in intensive care: towards an evidence-based practice. Chest. 2000;118:1801–13.
    1. Pugin J. Clinical signs and scores for the diagnosis of ventilator-associated pneumonia. Minerva Anestesiol. 2002;68:261–5.
    1. Maa SH, Hung TJ, Hsu KH, Hsieh YI, Wang KY, Wang CH, et al. Manual hyperinflation improves alveolar recruitment in difficult-to-wean patients. Chest. 2005;128:2714–24.
    1. McCarren B, Alison JA, Herbert RD. Vibration and its effect on the respiratory system. Aust J Physiother. 2006:39–43.
    1. Choi JS, Jones AY. Effects of manual hyperinflation and suctioning in respiratory mechanics in mechanically ventilated patients with ventilator-associated pneumonia. Aust J Physiother. 2005:25–30.
    1. Frownfelter D. Mosby –Year Book Inc. 3rd Edi 1996. Body Positioning in Principles and Practice of Cardiopulmonary Physical Therapy.
    1. Kollef MH, Silver P, Murphy DM, Trovillion E. The effect of late-onset ventilator-associated pneumonia in determining patient mortality. Chest. 1995:1655–1662.
    1. Jelic S, Cunningham JA, Factor P. airway hygiene in the intensive care unit. Crit Care. 2008;12:209.
    1. Mackenzie CF, Shin B, McAslan TC. Chest physiotherapy: the effect on arterial oxygenation. Anesth Analg. 1978;57:28–30.
    1. Wong WP, Paratz JD, Wilson K, Burns YR. Haemodynamic and ventilatory effects of manual respiratory physiotherapy techniques of chest clapping, vibrations and shaking in an animal model. J of Appl Physiol. 2003:991–8.
    1. Mackenzie CF, Shin B, Hadi F, Imle PC. Changes in total lung/thorax compliance following chest physiotherapy. Anesth Analg. 1980;59:207–10.
    1. Ntoumenopoulos G, Presneill JJ, McElholum M, Cade JF. Chest physiotherapy for the prevention of ventilator-associated pneumonia. Intensive Care Med. 2002;28:850–6.
    1. Konrad F, Schreiber T, Brecht-Kraus D, Georgieff M. Mucociliary transport in ICU patients. Chest. 1994;105:237–41.
    1. Pryor JA. Physiotherapy for airway clearance in adults. Eur Respir J. 1999;14:1418–24.
    1. Paratz JD, Jeffrey Lipman, Mary Mc Auliffe. Effect of manual hyperinflation on haemodynamics, gas exchange and respiratory mechanics in ventilated patients. J Int Care Med. 2002:317.
    1. Singer M, Vermaat J, Hall G, Latter G, Patel M. Heamodynamic effects of manual hyperinflation in critically ill mechanically ventilated patients. Chest. 1994
    1. Choi JS, Jones AY. Effects of manual hyperinflation and suctioning in respiratory mechanics in mechanically ventilated patients with ventilator-associated pneumonia. Aust J Physiother. 2005;51:25–30.
    1. Niël-Weise BS, Snoeren RL, van den Broek PJ. Policies for endotracheal suctioning of patients receiving mechanical ventilation: a systematic review of randomized controlled trials. Infect Control Hosp Epidemiol. 2007;28:531–6.
    1. Seymour CW, Cross BJ, Cooke CR, Gallop RL, Fuchs BD. Physiologic impact of closed-system endotracheal suctioning in spontaneously breathing patients receiving mechanical ventilation. Respir Care. 2009;54:367–74.
    1. Almgren B, Wickerts CJ, Heinonen E, Högman M. Side effects of endotracheal suction in pressure- and volume-controlled ventilation. Chest. 2004;125:1077–80.
    1. Kim CS, Iglesias AJ, Sackner MA. Mucus clearance by two-phase gas-liquid flow mechanism: asymmetric periodic flow model. J Appl Physiol. 1987;62:959–71.
    1. Stiller K, Geake T, Taylor J, Grant R, Hall B. Acute lobar atelectasis. A comparison of two chest physiotherapy regimens. Chest. 1990;98:1336–40.
    1. Stiller K, Jenkins S, Grant R, GaekeT, Taylor J, Hall B. Acute lobar atelectasis: A comparison of five physiotherapy regimens. Physiother Theory Pract. 1996:197–209.
    1. Eales CJ, Barker M, Cubberley NJ. Evaluation of a single chest physiotherapy treatment to post operative mechanically ventilated cardiac surgery patients. Physiother Theory Pract. 1995:23–8.
    1. Hess DR. Patient positioning and ventilator-associated pneumonia. Respir Care. 2005;50:892–8.
    1. Grap MJ, Munro CL, Hummel RS 3rd, Elswick RK, Jr, McKinney JL, Sessler CN. Effect of backrest elevation on the development of ventilator-associated pneumonia. Am J Crit Care. 2005;14:325–33.
    1. Guidelines by Surgical Critical care and Medical Critical Care Services at Orlando Regional Medical Center-Head of Bed End Elevation in the ICU-pages 1-3 accessed from
    1. Kirilloff LH, Owens GR, Rogers RM, Mazzocco MC. Does chest physical therapy work? Chest. 1985;88:436–44.
    1. Chang DW. Textbook of Clinical application of mechanical ventilation in Chapter 14-Weaning from weaning mechanical ventilation – by. In: Chang DW, Hiers JH, editors. Delmar Thompson Learning. 2ndedi

Source: PubMed

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