Pattanshetty Renu B, Gaude G S
KLE Institute of Physiotherapy, Belgaum 590010, India.
Indian J Crit Care Med. 2010 Apr;14(2):70-6. doi: 10.4103/0972-5229.68218.
Despite remarkable progress that has been achieved in the recent years in the diagnosis, prevention, and therapy for ventilator-associated pneumonia (VAP), this disease continues to create complication during the course of treatment in a significant proportion of patients while receiving mechanical ventilation.
This study was designed to evaluate the effect of multimodality chest physiotherapy in intubated and mechanically ventilated patients undergoing treatment in the intensive care units (ICUs) for prevention of VAP.
A total of 101 adult intubated and mechanically ventilated patients were included in this study. Manual hyperinflation (MH) and suctioning were administered to patients in the control group (n = 51), and positioning and chest wall vibrations in addition to MH plus suctioning (multimodality chest physiotherapy) were administered to patients in the study group (n = 50) till they were extubated. Both the groups were subjected to treatment twice a day. Standard care in the form of routine nursing care, pharmacological therapy, inhalation therapy, as advised by the concerned physician/surgeon was strictly implemented throughout the intervention period.
Data were analyzed using SPSS window version 9.0. The Clinical Pulmonary infection Score (CPIS) Score showed significant decrease at the end of extubation/successful outcome or discharge in both the groups (P = 0.00). In addition, significant decrease in mortality rate was noted in the study group (24%) as compared to the control group (49%) (P = 0.007).
It was observed in this study that twice-daily multimodality chest physiotherapy was associated with a significant decrease in the CPIS Scores in the study group as compared to the control group suggesting a decrease in the occurrence of VAP. There was also a significant reduction in the mortality rates with the use of multimodality chest physiotherapy in mechanically ventilated patients.
尽管近年来在呼吸机相关性肺炎（VAP）的诊断、预防和治疗方面取得了显著进展，但在相当一部分接受机械通气治疗的患者中，这种疾病在治疗过程中仍会引发并发症。
本研究旨在评估多模式胸部物理治疗对重症监护病房（ICU）中接受插管和机械通气治疗的患者预防VAP的效果。
本研究共纳入101例成年插管并接受机械通气的患者。对照组（n = 51）的患者接受手动过度充气（MH）和吸痰治疗，研究组（n = 50）的患者除接受MH加吸痰治疗外，还接受体位摆放和胸壁振动（多模式胸部物理治疗），直至拔管。两组患者均每天接受两次治疗。在整个干预期间，严格按照相关内科医生/外科医生的建议，以常规护理、药物治疗、吸入治疗等形式实施标准护理。
使用SPSS 9.0窗口版对数据进行分析。两组患者在拔管/成功治疗或出院时，临床肺部感染评分（CPIS）均显著降低（P = 0.00）。此外，研究组的死亡率（24%）与对照组（49%）相比显著降低（P = 0.007）。
本研究观察到，与对照组相比，研究组每天两次的多模式胸部物理治疗使CPIS评分显著降低，这表明VAP的发生率有所下降。在机械通气患者中使用多模式胸部物理治疗也显著降低了死亡率。
