Pattanshetty Renu B, Gaude Gajanan S
Department of Cardio-respiratory physiotherapy, KLEU Institute of Physiotherapy, JN Medical College, Nehru Nagar, Belgaum, Karnataka, India.
Indian J Med Sci. 2011 May;65(5):175-85.
Mechanically ventilated patients have an increased risk of complications leading to ventilation weaning more difficult resulting in excessive morbidity and mortality. Chest physiotherapy plays an important role in management of ventilated patients. However, these techniques have been studied on patients as a single entity or with combination of two techniques. The present study was designed to evaluate the effect of multimodality chest physiotherapy on the rate of recovery and prevention of complications in adult ventilated patients.
Out of 173 patients who were randomly allocated to two groups, 86 patients received MH and suctioning in control group and 87 patients were treated with multimodality chest physiotherapy in the study group twice daily till they were extubated. All patients were followed up for the global outcomes and complications during mechanical ventilation.
There were significant improvements in terms of rate of recovery in study group compared to the control group (P = 0.000). Complication rates were higher with 61.6% in the control group as compared to 26.4% in the study group. Duration of hospitalization was longer in the study group (16 ± 9.40 days) as compared to the control group (12.8 ± 6.12 days). Successful weaning from mechanical ventilation was noted in 58 patients in the study group and 24 patients in the control group which was statistically significant.
Multi-modality chest physiotherapy protocol has shown to prevent ventilator-associated pneumonia and enhance the clinical outcome in ventilated patients and may be recommended as a treatment option in ICU. It has also shown to enhance the weaning process and proved to be safe.
机械通气患者发生并发症的风险增加,导致脱机困难,进而增加发病率和死亡率。胸部物理治疗在机械通气患者的管理中起着重要作用。然而,这些技术仅作为单一疗法或两种技术联合应用于患者进行过研究。本研究旨在评估多模式胸部物理治疗对成年机械通气患者恢复率及并发症预防的效果。
173例患者被随机分为两组,对照组86例患者接受机械通气和吸痰治疗,研究组87例患者接受多模式胸部物理治疗,每天两次,直至拔管。所有患者在机械通气期间均随访总体预后及并发症情况。
与对照组相比,研究组的恢复率有显著改善(P = 0.000)。对照组并发症发生率较高,为61.6%,而研究组为26.4%。研究组住院时间(16 ± 9.40天)比对照组(12.8 ± 6.12天)长。研究组58例患者和对照组24例患者成功脱机,差异有统计学意义。
多模式胸部物理治疗方案已显示可预防呼吸机相关性肺炎并改善机械通气患者的临床结局,可作为重症监护病房的一种治疗选择推荐使用。它还显示可加快脱机进程且被证明是安全的。