An evaluation of a single chest physiotherapy treatment on mechanically ventilated patients with acute lung injury

Abstract

Patients with acute lung injury are notably complex to nurse and may require protracted physiotherapy intervention, which may take many forms. As de-recruitment was the single most important event that occurred in the present study population, a prescriptive chest physiotherapy approach to treating mechanically ventilated patients with acute lung should be questioned and adapted accordingly.

Nonpharmacologic Airway Clearance Techniques in Hospitalized Patients: A Systematic Review

“…37 Differences in heart rate were not significant between the groups in any of these studies. Similarly, 3 studies that assessed mean arterial pressure (one good quality study of Flutter vs usual care in mechanically ventilated ICU subjects, one fair quality study of IPV vs CPT in COPD subjects, and one poor quality study comparing CPT regimens in mechanically ventilated subjects) reported no significant group differences.…”

“…The evidence we reviewed indicates that airway clearance techniques are probably safe for ventilated ICU patients, and confer zero to small benefit to some clinical outcomes. 18,[21][22][23]28,[33][34][35][36][37] Consideration may be given to the use of airway clearance techniques for ventilated ICU patients, to reduce the risk of acquiring pneumonia, based upon 2 studies, which included 76 subjects. 23,27 Based on the current limited evidence, airway clearance modalities might not be recommended as routine prophylaxis to prevent postoperative pulmonary complications in adults.…”

“…37 The subjects were randomly allocated to either supine positioning plus suctioning (n ϭ 5, mean age 73 Ϯ 2.6 y), lateral decubitus positioning plus suctioning (n ϭ 5, mean age 70 Ϯ 7.4 y), or lateral decubitus positioning plus 6 manual hyperinflation breaths plus suctioning (n ϭ 7, mean age 70 Ϯ 16.3 y). The subjects were hospitalized with sepsis (n ϭ 7), aspiration pneumonia (n ϭ 5), community-acquired pneumonia (n ϭ 4), and pancreatitis (n ϭ 1).…”

“…28,38 Measurement of arterial blood gases, an indirect and invasive measure of the effectiveness of airway clearance interventions, was evaluated in 9 studies, all of which reported no significant difference in values between the groups: 2 were fair quality, and 4 were poor quality. 18,32,33,[36][37][38]41 A fair quality study of the Flutter device reported better values for adult ventilated subjects in the intervention group. 28 Finally, a fair quality study reported worse values for subjects with COPD treated with CPT, compared with those treated with IPV.…”

“…14,17,19,24,25,29,32,34,37,40,42,43,44 Three studies reported improved results: a poor quality study of IPV ϩ CPT versus CPT in ICU subjects, with COPD reported better pulmonary function tests in the intervention group 18 ; and a poor quality study of spirometry plus Deep breathing exercises, sustained maximal inspiration, postural drainage, manual percussion Ambrosino 32 …”