Chest physiotherapy with early mobilization may improve extubation outcome in critically ill patients in the intensive care units

Abstract

Background: Extubation failure can lead to a longer intensive care unit (ICU) stay, higher mortality rate, and higher risk of requiring tracheostomy. Chest physiotherapy (CPT) can help patients in reducing the accumulation of airway secretion, preventing collapsed lung, improving lung compliance, and reducing comorbidities. Much research has investigated the correlation between CPT and respiratory system clearance. However, few studies have investigated the correlation between CPT and failed ventilator extubation. Therefore, this study aimed to investigate the use of CPT for reducing the rate of failed removal from mechanical ventilators. Methods: This study was an intervention study with mechanical control. Subjects were divided into two groups. The control group, which received routine nursing chest care, was selected from a retrospective chart review. The intervention group was prospectively taken into the chest physiotherapy program. The chest physiotherapy treatment protocol consisted of inspiratory muscle training, manual hyperinflation, chest wall mobilization, secretion removal, cough function training, and early mobilization. Results: A total of 439 subjects were enrolled in the intervention and control groups, with a mean age of 69 years. APACHE II score (P = .09) and GCS scores (P = .54) were similar between the two groups. Compared to the control group, patients in the intervention group had a significantly lower reintubation rate (8% vs 16%; P = .01). Conclusions:The results indicate that intensive chest physiotherapy could decrease extubation failure in mechanically ventilated patients in the ICU. In addition, chest physiotherapy could also significantly improve the rapid shallow breathing index score.

Recommendations for respiratory rehabilitation in adults with coronavirus disease 2019

“…The management should not trigger severe cough and increase the work of breathing. High-frequency chest wall oscillation, [ 23 ] and oscillatory positive expiratory pressure (OPEP) are among the recommended treatment methods. [ 24 ]…”

The Effect of High Protein and Mobility-Based Rehabilitation on Clinical Outcomes in Survivors of Critical Illness

“…There was no significant difference in outcomes between HPRO and LPRO intake alone, but the significant difference in weaning and discharge status between UC versus MRP highlights what previous studies have shown regarding the benefits of exercise and physical rehabilitation in regard to functional outcomes in critical illness. 12,14,15 This study demonstrates that these interventions can be applied to survivors of critical illness requiring PMV with similar results in improved functional outcomes. One of the goals of adequate nutrition delivery, protein in particular, in critically ill patients is to attenuate acute skeletal muscle wasting, which is a significant contributor to ICU-acquired weakness.…”

Chest physiotherapy: An important adjuvant in critically ill mechanically ventilated patients with COVID-19

“…Recent studies have confirmed that CPT in critically ill patients is able to improve respiratory function immediately after extubation ( Papadopoulos and Kyprianou, 2002 ; Wang et al, 2018 ). As suggested by the ARIR position paper ( Lazzeri et al, 2020 ), CPT may be considered in all COVID-19 patients who require mechanical ventilation, as well as during and after the extubation process.…”