Chest physiotherapy for the prevention of ventilator-associated pneumonia

Abstract

Objective: Pneumonia is an important complication in patients who are intubated and mechanically ventilated, when it is commonly referred to as ventilator-associated pneumonia (VAP). Since VAP may be contributed to by impaired sputum clearance, we studied whether chest physiotherapy designed to enhance sputum clearance decreases the occurrence of VAP. Design: Prospective controlled systematic allocation trial. Setting: Tertiary teaching hospital ICU. Patients and participants: Sixty adult patients intubated and mechanically ventilated for at least 48 h. Interventions: Chest physiotherapy (intervention group) or sham physiotherapy (control group). Measurements and results: Control and intervention groups were well matched for age, sex, and admission PaO2/FiO2 ratio, APACHE II score, and Glasgow Coma Score. There were no differences in the duration of mechanical ventilation, length of stay in ICU or mortality. VAP was assessed daily by combined clinical assessment and the clinical pulmonary infection score (CPIS). VAP occurred in 39% (14/36) of the control group and 8% (2/24) of the intervention group (OR=0.14, 95% CI 0.03 to 0.56, P=0.02). After adjustment was made by logistic regression for other important variables (APACHE II score, duration of mechanical ventilation, presence of tracheostomy, and GCS score), chest physiotherapy was independently associated with a reduced occurrence of VAP (adjusted OR=0.16, 95% CI 0.03 to 0.94, P=0.02). Conclusions: In this small trial, chest physiotherapy in ventilated patients was independently associated with a reduction in VAP. This suggested benefit of physiotherapy in prevention of VAP requires confirmation with a larger randomised controlled trial.