The effect of chest physiotherapy on the prevention and treatment of nosocomial pneumonia for intensive care patients with acquired brain injury - preliminary results
This randomised controlled trial investigated the effects of respiratory physiotherapy on adult acquired brain injury (ABI) patients admitted to the intensive care unit (ICU). Subjects admitted with a Glasgow Coma Scale of < 9, requiring intracranial pressure monitoring, and invasive ventilatory support for > 24 hours, were randomised to a treatment group receiving six respiratory physiotherapy interventions in 24 hours, or to a control group. The incidence of nosocomial pneumonia (NP), duration of ventilatory support, and length of ICU stay were the dependent variables. Of 141 patients fulfilling inclusion criteria, consent was obtained for 105 subjects, with 53 randomised to the treatment group. Presence of exclusion criteria (eg unstable neurological, cardiac or respiratory status) accounted for 25 of those excluded and consent was declined in four patients. Groups were similar with respect to demographic variables except for age[treatment group 46.5 (19.7) vs control 38.2 (19.2); p = 0.03] and body mass index [28.1 (5.6) vs 24.5 (5.2); p = 0.02]. Thirteen subjects were withdrawn (four from treatment group) - five due to cessation of active management, four because they became medically unstable and four received physiotherapy services outside of those provided by group randomisation. Seven withdrawn subjects died. Using multivariate analysis of variance with intention-to-treat philosophy, there were no significant differences for NP incidence [treatment group 11/53 vs control 15/52; p = 0.365], length of ventilation [190.2 hr (124.9) vs 224.3 (171.6); p = 0.248], or length of ICU stay [240.5 hr (120.9) vs 256.4 (169.4); p = 0.584]. Despite a trend favouring the treatment group, there appears to be no benefit from respiratory physiotherapy in preventing NP or reducing length of ventilation or ICU stay in adult ABI patients.
Patman, S., Stiller, K., Blackmore, M., & Jenkins, S. (2003). The effect of chest physiotherapy on the prevention and treatment of nosocomial pneumonia for intensive care patients with acquired brain injury - preliminary results. Australian Journal of Physiotherapy, 49(3), 12.
The Proceedings of the Australian Physiotherapy Association's 8th National Cardiothoracic Special Group Conference, 'Inspiring Innovation, Expiring Tradition' may be accessed at: http://ajp.physiotherapy.asn.au/AJP/vol_49/3/volume49_number3.cfm
Patman, S., Stiller, K., Blackmore, M., & Jenkins, S. (2003). The effect of chest physiotherapy on the prevention and treatment of nosocomial pneumonia for intensive care patients with acquired brain injury - preliminary results. Paper presented at the Australian Physiotherapy Association 8th National Cardiothoracic Group Conference. Brisbane, QLD, 4-6 September, 2003.