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.

Background: The burden of head and neck cancer in India has been increasing in recent years. Despite evidence that physical therapy exists throughout phases of treatment for head and neck cancer patients , combined treatment of manual therapy in the form of mobilization, muscle energy technique and soft tissue mobilization techniques are rarely available for clinical practice. Hence, the present study was taken up. Aim:To study the effect of combined manual therapy in form of mobilization, Muscle energy technique and soft tissue mobilization on neck pain, quality of life, mobility in Head and Neck Cancer Patients. Settings and Design:The experimental study was undertaken in a tertiary care referral hospital over a period of three months. Materials and Methods:A total of fifteen(15) subjects including eleven (11) males and four (4) females post operative head and neck cancer subjects were given combined manual therapyin the form of cervical mobilization, muscle energy technique and Soft tissue Mobilization for duration of a week during the hospitalisation phase. Pain was assessed using Numeric pain rating Scale, Range of motion of cervical joint, shoulder joint and Temporomandibular joint, Functional assessment was done using Neck disability index and FACT H&N Questionnaire. Statistical Analysis was done using SPSS Version 0.21. Students dependent 't' test was used to analyse the pre and post treatment difference in all outcome measures. Results:The study demonstrated improvement in all the outcome measures in the study, the significant difference was seen in with pd"0.001 except cervical rotation and shoulder range of motion. Conclusion:The study demonstrated Pain reduction, Improvement in Cervical, TMJ and shoulder range of motion, Improved Quality of life and reduction in disability following combined manual therapy approach.

The development of critical patient related generalized neuromuscular weakness, referred to as critical illness polyneuropathy (CIP) and critical illness myopathy (CIM), is a major complication in patients admitted to intensive care units (ICU). Both CIP and CIM cause muscle weakness and paresis in critically ill patients during their ICU stay. Early mobilization or kinesiotherapy have shown muscle weakness reversion in critically ill patients providing faster return to function, reducing weaning time, and length of hospitalization. Exercises in the form of passive, active, and resisted forms have proved to improve strength and psychological well being. Clinical trials using neuromuscular electrical stimulation to increase muscle mass, muscle strength and improve blood circulation to the surrounding tissue have proved beneficial. The role of electrical stimulation is unproven as yet. Recent evidence indicates no difference between treated and untreated muscles. Future research is recommended to conduct clinical trials using neuromuscular electrical stimulation, exercises, and early mobilization as a treatment protocol in larger populations of patients in ICU.

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Multi-modality chest physiotherapy protocol has shown to prevent ventilator-associated pneumonia and enhance the clinical outcome in ventilated patients and may be recommended as a treatment option in ICU. It has also shown to enhance the weaning process and proved to be safe.