Shane Patman1, Sue Jenkins, Kathy Stiller. 1. School of Physiotherapy, Curtin University of Technology, GPO Box U1987, Perth, WA, 6845, Australia. spatman1@nd.edu.au
Abstract
OBJECTIVE: To investigate the effect of respiratory physiotherapy on the prevention and treatment of ventilator-associated pneumonia (VAP) for adults in an intensive care unit (ICU) with an acquired brain injury (ABI). DESIGN AND SETTING: Two-part, prospective, randomised controlled trial. PATIENTS: A total of 144 subjects with ABI admitted with a Glasgow Coma Scale </=9, requiring intracranial pressure monitoring, and invasive mechanical ventilation (MV) for >24 h; 33 subjects were subsequently diagnosed with VAP. INTERVENTION: Respiratory physiotherapy comprised six treatments (positioning, manual hyperinflation and suctioning) in each 24-h period whilst on MV. The Control Group received standard medical/nursing care but no respiratory physiotherapy. MEASUREMENTS AND RESULTS: There were no significant differences between groups for incidence of VAP, duration of MV, length of ICU stay or clinical variables such as requirement for re-ventilation. CONCLUSIONS: In adults with ABI, regular respiratory physiotherapy in addition to routine medical/nursing care does not appear to prevent VAP, reduce length of MV or ICU stay. Due to small numbers, it is not possible to draw any conclusions as to whether or not respiratory physiotherapy hastens recovery from VAP.
RCT Entities:
OBJECTIVE: To investigate the effect of respiratory physiotherapy on the prevention and treatment of ventilator-associated pneumonia (VAP) for adults in an intensive care unit (ICU) with an acquired brain injury (ABI). DESIGN AND SETTING: Two-part, prospective, randomised controlled trial. PATIENTS: A total of 144 subjects with ABI admitted with a Glasgow Coma Scale </=9, requiring intracranial pressure monitoring, and invasive mechanical ventilation (MV) for >24 h; 33 subjects were subsequently diagnosed with VAP. INTERVENTION: Respiratory physiotherapy comprised six treatments (positioning, manual hyperinflation and suctioning) in each 24-h period whilst on MV. The Control Group received standard medical/nursing care but no respiratory physiotherapy. MEASUREMENTS AND RESULTS: There were no significant differences between groups for incidence of VAP, duration of MV, length of ICU stay or clinical variables such as requirement for re-ventilation. CONCLUSIONS: In adults with ABI, regular respiratory physiotherapy in addition to routine medical/nursing care does not appear to prevent VAP, reduce length of MV or ICU stay. Due to small numbers, it is not possible to draw any conclusions as to whether or not respiratory physiotherapy hastens recovery from VAP.
Authors: Massimo Antonelli; Elie Azoulay; Marc Bonten; Jean Chastre; Giuseppe Citerio; Giorgio Conti; Daniel De Backer; François Lemaire; Herwig Gerlach; Goran Hedenstierna; Michael Joannidis; Duncan Macrae; Jordi Mancebo; Salvatore M Maggiore; Alexandre Mebazaa; Jean-Charles Preiser; Jerôme Pugin; Jan Wernerman; Haibo Zhang Journal: Intensive Care Med Date: 2010-01-08 Impact factor: 17.440