Respiratory physiotherapy is often provided to treat ventilator-associated pneumonia (VAP) in patients with acquired brain injury (ABI) due to the morbidity and mortality associated with VAP. However there are limited data on the efficacy of physiotherapy in ICU and no data on the effect of respiratory physiotherapy on outcomes in patients with ABI. This prospective randomised controlled trial investigated the effect of respiratory physiotherapy on the resolution of VAP, the duration of ventilatory support, and length of ICU stay in adults with ABI and VAP. Subjects admitted with a Glasgow Coma Scale ≤ 9, requiring intracranial pressure monitoring, and invasive ventilatory support for >24 hours, and who developed VAP, were randomised to a treatment group (six treatments in each 24-hour period whilst ventilated; n = 17), or a control group (routine medical and nursing care only; n = 16). Respiratory physiotherapy comprised positioning, manual hyperinflation and suctioning. Groups were comparable on baseline demographic variables. Four subjects (two from each group) were withdrawn as three became medically unstable and one was incorrectly randomised. Using multivariate analysis of variance with intention to treat philosophy and analysis by treatment principle, there were no significant differences for daily mean clinical pulmonary infection scores or measures of arterial to inspired oxygenation, duration of ventilatory support (mean hours ± SD) [342.0 ± 185.3 vs. 351.0 ± 174.7; p = 0.89], or ICU stay (mean hours ± SD) [384.7 ± 179.6 vs. 397.9 ± 190.7; p = 0.84]. In this sample, respiratory physiotherapy for ABI patients with VAP did not expedite recovery by reducing duration of ventilation or length of ICU stay.
Patman, S., Stiller, K., & Jenkins, S. (2006). Physiotherapy for ventilator-associated pneumonia in patients with acquired brain injury. Australian Journal of Physiotherapy, 52(1), S23.
Available at: http://works.bepress.com/shane-patman/31/