Feasibility and safety of intrapulmonary percussive ventilation in spontaneously breathing, non-ventilated patients in critical care: A retrospective pilot study

Abstract

Background: Intrapulmonary percussive ventilation is used in various clinical settings to promote secretion clearance, reverse or treat atelectasis and improve gas exchange. Despite a few studies reporting the use of intrapulmonary percussive ventilation in critical care, the available data remain insufficient, contributing to weaker evidence toward its effectiveness. Also, there is a paucity of studies evaluating the safety and feasibility of intrapulmonary percussive ventilation application in critical care. This retrospective pilot study has evaluated the safety and feasibility of intrapulmonary percussive ventilation intervention in non-intubated patients admitted to an intensive care unit. Methods: The medical records of 35 subjects were reviewed, including 22 subjects who received intrapulmonary percussive ventilation intervention and 13 subjects matched for age, sex, and primary diagnosis who received chest physiotherapy. The records were audited for feasibility, safety, changes in oxygen saturation, chest X-ray changes, and intensive care unit length of stay. Results: A total of 104 treatment sessions (IPV 65 and CPT 39) were delivered to subjects admitted with a range of respiratory conditions in critical care. Subjects completed 97% of IPV sessions. No major adverse events were reported with intrapulmonary percussive ventilation intervention. Intensive care unit length of stay in the intrapulmonary percussive ventilation group was 9.6 AE 6 days, and in the CPT group, it was 11 AE 9 days (p ¼ 0.59). Peripheral oxygen saturation pre to post intervention was 92% AE 4 to 96% AE 4 in IPV group and 95% AE 4 to 95% AE 3 in the CPT group. Conclusion: Application of intrapulmonary percussive ventilation intervention was feasible and safe in non-ventilated adult patients in critical care.

Effect of intrapulmonary percussive ventilation on intensive care unit length of stay, the incidence of pneumonia and gas exchange in critically ill patients: A systematic review

“…None of the studies reported any serious adverse events related to IPV intervention. A recent report of 35 critical care patients found that the application of IPV was safe in a critical care setting [34]. Furthermore, most of the studies in this review also reported that the IPV intervention was well tolerated by patients.…”

Clinical application of intrapulmonary percussive ventilation: A scoping review

“…Patient position during IPV was reported by 11 out of 25 studies. 12 , 14 , 15 , 16 , 17 , 24 , 30 , 37 , 38 , 39 , 40 In studies that described patient position, seven studies, mostly in outpatient settings, positioned patients in an upright sitting position for airway clearance, 15 , 16 , 17 , 24 , 30 , 37 , 40 while the remaining studies from ICU used a 45 ∘ long-sitting position, 14 , 38 side-lying 39 or supine position 12 (Table 1 ).…”

“… 13 , 34 The most common range of airway pressure reported in ICU ranged between 10 cm H 2 O and 20 cm H 2 O to promote airway clearance, improve gas exchange, and treat atelectasis, whereas, in studies in the outpatient setting, IPV pressure ranged from 10–30 cm H 2 O mainly for airway clearance (Table 2 ). 14 , 23 , 25 , 26 , 31 , 38 , 39 , 43 …”

“… 32 The treatment length between 2–5 days was the most common among studies in inpatient (non-ICU) and ICU settings (Tables 1 and 2 ). 13 , 16 , 23 , 24 , 26 , 35 , 37 , 39 , 43 , 44 …”

“…Changes in pulmonary atelectasis were assessed and reported by eight studies, seven from ICU 12 , 26 , 33 , 34 , 35 , 39 , 44 and one from an inpatient (non-ICU) setting. 43 Chest radiographs were used for assessment by six studies; one used a radiological atelectasis score, 39 and another used CT scans. 12 …”