The influence of physiotherapy on ventilator-associated pneumonia in acquired brain injury patients
This prospective randomised controlled trial investigated the effect of respiratory physiotherapy on the incidence of ventilator-associated pneumonia (VAP) in adults with acquired brain injury (ABI). Subjects admitted with a Glasgow Coma Scale nine, requiring intracranial pressure monitoring, and invasive ventilatory support for > 24 hours, were randomly allocated to a treatment group (six respiratory physiotherapy interventions in each 24-hour period while ventilated), or a control group (routine nursing care only). Incidence of VAP, duration of ventilatory support, and length of ICU stay were the dependent variables. Consent was obtained from 128 subjects with 65 randomised to the treatment group. Twenty-seven subjects were excluded due to unstable neurological, cardiac or respiratory status, five due to early limiting of active management, and consent was declined in five patients. Results are presented as mean (SD) for the treatment vs control groups. Groups were similar with respect to demographic variables. Fifteen subjects were withdrawn from the study (five from the treatment group): seven due to cessation of active management, five became medically unstable and three received physiotherapy beyond that described in the treatment protocol. Using multivariate analysis of variance with intention to treat philosophy, there were no significant differences for VAP incidence [14/65 vs 17/63; p = 0.47], length of ventilation (hr) [180.9 (123.3) vs 210.2 (169.9); p = 0.27], or length of ICU stay (hr) [228.6 (122.7) vs 251.7 (173.2); p = 0.38]. Respiratory physiotherapy, in addition to routine nursing care, does not appear to prevent VAP, reduce length of ventilation or ICU stay in adult patients with ABI.
This study was supported by a 2001 Physiotherapy Research Foundation Seeding Grant.
Patman, S., Stiller, K., Blackmore, M., & Jenkins, S. (2004). The influence of physiotherapy on ventilator-associated pneumonia in acquired brain injury patients. Australian Journal of Physiotherapy, 50(3), 109.
Patman, S., Stiller, K., Blackmore, M., & Jenkins, S. (2004). The influence of physiotherapy on ventilator-associated pneumonia in acquired brain injury patients. Paper presented at the Australian Physiotherapy Association 8th International Physiotherapy Congress. Adelaide, SA, 15-18 May, 2004.