Barker Michael, Adams Sally
Guy's and St Thomas' NHS Trust, London, UK.
Physiother Res Int. 2002;7(3):157-69. doi: 10.1002/pri.252.
Acute lung injury is a lung pathology that presents frequently on the intensive care unit. Chest physiotherapy, in the form of endotracheal suction, alternate side-lying and manual hyperinflation, is usually given to patients with this condition with the intention of removing retained pulmonary secretions and recruiting collapsed distal lung units. Despite this common practice there is insufficient research on the effects of chest physiotherapy in patients with acute lung injury being ventilated mechanically. The aim of the present study was to further understanding of the effects of three modes of treatment in chest physiotherapy in an acute lung injury patient group.
This randomized, controlled trial investigated all mechanically ventilated patients with acute lung injury admitted to the adult intensive care unit at Guy's and St Thomas' NHS Trust between August 1996 and July 1997, who matched the inclusion criteria. Patients were randomized into one of three treatment groups: Group 1 (suctioned only); Group 2 (positioned and suctioned); and Group 3 (positioned, manually hyperinflated and suctioned). Baseline and 10, 30 and 60 minutes' post-treatment data were recorded for dynamic pulmonary compliance, arterial blood gases and haemodynamic variables. Results were analysed by use of an SPSS software package with a repeated-measures analysis of variance (ANOVA).
Eighteen patients fitted the inclusion criteria. Significant changes were observed in both PaCO2 (p = 0.026) and dynamic compliance (p = 0.019) over time for all three groups. The arterial oxygen to fraction of inspired oxygen ratio (PaO2:FiO2) did not alter significantly in any of the groups. With respect to other oxygenation parameters, mixed venous oxygen saturation (SvO2) showed a significant difference between the groups. Heart rate (HR) and systemic blood pressure (BP) showed statistically significant, but not clinically significant differences over time.
Patients with acute lung injury are notably complex to nurse and may require protracted physiotherapy intervention, which may take many forms. As de-recruitment was the single most important event that occurred in the present study population, a prescriptive chest physiotherapy approach to treating mechanically ventilated patients with acute lung should be questioned and adapted accordingly.
急性肺损伤是重症监护病房中常见的肺部疾病。胸部物理治疗，如气管内吸引、交替侧卧位和手法过度通气，通常用于此类患者，目的是清除肺内潴留的分泌物并使萎陷的远端肺单位复张。尽管这是常见的做法，但关于胸部物理治疗对机械通气的急性肺损伤患者的影响的研究仍不充分。本研究的目的是进一步了解三种胸部物理治疗模式对急性肺损伤患者群体的影响。
这项随机对照试验调查了1996年8月至1997年7月期间入住盖伊和圣托马斯国民保健服务信托基金成人重症监护病房的所有符合纳入标准的机械通气急性肺损伤患者。患者被随机分为三个治疗组之一：第1组（仅进行吸引）；第2组（进行体位摆放和吸引）；第3组（进行体位摆放、手法过度通气和吸引）。记录基线以及治疗后10、30和60分钟时的动态肺顺应性、动脉血气和血流动力学变量数据。使用SPSS软件包进行重复测量方差分析（ANOVA）对结果进行分析。
18名患者符合纳入标准。所有三组患者的PaCO2（p = 0.026）和动态顺应性（p = 0.019）随时间均有显著变化。三组患者的动脉氧分压与吸入氧分数比（PaO2:FiO2）均无显著改变。关于其他氧合参数，三组之间的混合静脉血氧饱和度（SvO2）存在显著差异。心率（HR）和体循环血压（BP）随时间有统计学上的显著差异，但无临床显著差异。
急性肺损伤患者护理起来非常复杂，可能需要长期进行物理治疗干预，且可能有多种形式。由于肺不张是本研究人群中发生的最重要的单一事件，因此，对于治疗机械通气急性肺损伤患者的规范性胸部物理治疗方法应受到质疑并相应调整。
