Chest physiotherapy for the prevention of ventilator-associated pneumonia

Ntoumenopoulos, George; Presneill, Jeffrey; McElholum, M; Cade, J. F.

doi:10.1007/s00134-002-1342-2

Cited by 187 publications

(124 citation statements)

References 34 publications

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“…Certain strategies, such as chest physiotherapy, can improve secretion clearance and prevent pulmonary complications, (2) therefore potentially reducing the length of ICU stay. Early ICU discharge is particularly relevant in public hospitals in developing countries, where there are financial restraints.…”

Section: Introductionmentioning

confidence: 99%

Hiperinsuflação manual combinada com compressão torácica expiratória para redução do período de internação em UTI em pacientes críticos sob ventilação mecânica

et al. 2012

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Objective: Although manual hyperinflation (MH) is widely used for pulmonary secretion clearance, there is no evidence to support its routine use in clinical practice. Our objective was to evaluate the effect that MH combined with expiratory rib cage compression (ERCC) has on the length of ICU stay and duration of mechanical ventilation (MV). Methods: This was a prospective randomized controlled clinical trial involving ICU patients on MV at a tertiary care teaching hospital between January of 2004 and January of 2005. Among the 49 patients who met the study criteria, 24 and 25 were randomly assigned to the respiratory physiotherapy (RP) and control groups, respectively. Of those same patients, 6 and 8, respectively, were later withdrawn from the study. During the 5-day observation period, the RP patients received MH combined with ERCC, whereas the control patients received standard nursing care. Results: The two groups were similar in terms of the baseline characteristics. The intervention had a positive effect on the duration of MV, as well as on the ICU discharge rate and Murray score. There were significant differences between the control and RP groups regarding the weaning success rate on days 2 (0.0% vs. 37.5%), 3 (0.0% vs. 37.5%), 4 (5.3% vs. 37.5%), and 5 (15.9% vs. 37.5%), as well as regarding the ICU discharge rate on days 3 (0% vs. 25%), 4 (0% vs. 31%), and 5 (0% vs. 31%). In the RP group, there was a significant improvement in the Murray score on day 5. Conclusions: Our results show that the use of MH combined with ERCC for 5 days accelerated the weaning process and ICU discharge.Keywords: Physical therapy modalities; Ventilator weaning; Length of stay. ResumoObjetivo: Embora a hiperinsuflação manual (HM) seja largamente usada para a remoção de secreções pulmonares, não há evidências para sua recomendação como rotina na prática clínica. O objetivo do estudo foi avaliar o efeito da HM combinada com compressão torácica expiratória (CTE) na duração de internação em UTI e no tempo de ventilação mecânica (VM) em pacientes sob VM. Métodos: Ensaio clínico prospectivo, randomizado e controlado com pacientes de UTI sob VM em um hospital acadêmico terciário entre janeiro de 2004 e janeiro de 2005. Dentre os 49 pacientes que preencheram os critérios do estudo, 24 e 25 foram randomicamente alocados nos grupos fisioterapia respiratória (FR) e controle, respectivamente, sendo que 6 e 8 foram retirados do estudo. Durante o período de observação de 5 dias, os pacientes do grupo FR receberam HM combinada com CTE, enquanto os controles receberam o tratamento padrão de enfermagem. Resultados: Os dois grupos apresentaram características basais semelhantes. A intervenção teve efeito positivo na duração de VM, alta da UTI e escore de Murray. Houve diferenças significativas entre os grupos controle e FR em relação à taxa de sucesso no desmame nos dias 2 (0,0% vs. 37,5%), 3 (0,0% vs. 37,5%), 4 (5,3 vs. 37,5%) e 5 (15,9% vs. 37,5%), assim como à taxa de alta da UTI nos dias 3 (0% vs. 25%), 4 (0% vs. 31%) e 5 (0% vs. 3...

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Section: Introductionmentioning

confidence: 99%

Hiperinsuflação manual combinada com compressão torácica expiratória para redução do período de internação em UTI em pacientes críticos sob ventilação mecânica

et al. 2012

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“…These findings are in keeping with the use of multimodality respiratory physiotherapy in the care of critically ill patients described by Stiller. [1] Multimodality respiratory physiotherapy, a combination of techniques including positioning, chest-wall vibrations, percussions, manual hyperinflation and suction, [1,14,15] has been shown to reduce the incidence of ventilator-associated pneumonia [14] and shorten duration of MV and ICU length of stay in previous reports. [15] The selective use of manual hyperinflation in patient care is in keeping with research evidence, as this technique is associated with side-effects such as marked haemodynamic changes in the form of decreased cardiac output in some critically ill patients, and increased intracranial pressure in traumatic brain injury patients.…”

Section: Resultsmentioning

confidence: 99%

Physiotherapy practice in South African intensive care units

Lottering

Aswegen

2016

S Afr J Crit Care

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Background. Physiotherapists are integral members of the interprofessional team that provides care and rehabilitation for patients in intensive care units (ICUs). Objectives. To describe the current practice of physiotherapists in ICUs, determine if physiotherapists' practice has changed since a previous report and determine if practice is evidence based. Methodology. A questionnaire was content validated and made available electronically and in hard copy. Physiotherapists who work in ICUs in public or private sector hospitals or who are members of the South African Society of Physiotherapy were identified and invited to participate. Results. Survey response rate was 33.9%. Patient assessment techniques performed 'very often' included ICU chart assessment (n=90, 83.3%), chest auscultation (n=94, 81.8%) and cough effort (n=81, 75%). Treatment techniques performed 'very often' included manual chest clearance (n=101, 93.5%), in-bed mobilisation and positioning (n=91, 84.3%; n=91, 84.3%, respectively), airway suctioning (n=89, 82.4%), out-of-bed mobilisation (n=84, 77.8%), deep breathing exercises (n=83, 76.9%) and peripheral muscle-strengthening exercises (n=72, 73.1%). More respondents used intermittent positive pressure breathing (57 v. 28%, p=0.00), used adjustment of mechanical ventilation (MV) settings (30 v. 15%, p=0.01), were involved with weaning patients from MV (42 v. 19%, p=0.00) and used incentive spirometry (76 v. 46%, p=0.00) than reported previously. More respondents performed suctioning (99 v. 70%, p=0.00), extubation (60 v. 25%, p=0.00) and adjustment of MV settings (30 v. 12%, p=0.02) than reported internationally. Conclusion. Physiotherapy practice in ICUs is evidence based. Care focuses largely on mobilisation, exercise therapy and multimodality respiratory therapy.

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“…O desmame da VM é geralmente bem sucedido para a maioria dos pacientes 5 , embora, para 20% desses, haja falhas na primeira tentativa do teste de respiração espontânea (TRE) 5 . A VM prolongada está associada a várias complicações, como pneumonia associada à VM 6 , disfunção diafragmática induzida pela VM 7,8 , polineuropatia do doente crítico 9 , entre outras. As principais causas de dependência da VM são causas neurológicas 10,11 , por comprometimentos do sistema respiratório ou do sistema cardiovascular 10,11,12,13 , e fatores psicológicos 10,11 .…”

Section: Introductionunclassified

Incidência e fatores associados ao desmame simples, difícil e prolongado em uma unidade de terapia intensiva

2016

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Chest physiotherapy for the prevention of ventilator-associated pneumonia

Abstract: In this small trial, chest physiotherapy in ventilated patients was independently associated with a reduction in VAP. This suggested benefit of physiotherapy in prevention of VAP requires confirmation with a larger randomised controlled trial.

Cited by 187 publications

References 34 publications

Hiperinsuflação manual combinada com compressão torácica expiratória para redução do período de internação em UTI em pacientes críticos sob ventilação mecânica

Hiperinsuflação manual combinada com compressão torácica expiratória para redução do período de internação em UTI em pacientes críticos sob ventilação mecânica

Physiotherapy practice in South African intensive care units

Incidência e fatores associados ao desmame simples, difícil e prolongado em uma unidade de terapia intensiva

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