Goñi-Viguria R, Yoldi-Arzoz E, Casajús-Sola L, Aquerreta-Larraya T, Fernández-Sangil P, Guzmán-Unamuno E, Moyano-Berardo B M
Unidad de Cuidados Intensivos, Clínica Universidad de Navarra, Pamplona, España.
Unidad de Cuidados Intensivos, Clínica Universidad de Navarra, Pamplona, España.
Enferm Intensiva (Engl Ed). 2018 Oct-Dec;29(4):168-181. doi: 10.1016/j.enfi.2018.03.003. Epub 2018 Jun 15.
Patients in intensive care unit are susceptible to complications due to different causes (underlying disease, immobilisation, infection risk…) The current main intervention in order to prevent these complications is respiratory physiotherapy, a common practice for nurses on a daily basis. Therefore, we decided to carry out this bibliographic review to describe the most efficient respiratory physiotherapy methods for the prevention and treatment of lung complications in patients in intensive care, taking into account the differences between intubated and non-intubated patients.
The bibliographic narrative review was carried out on literature available in Pubmed, Cinahl and Cochrane Library. The established limits were language, evidence over the last 15 years and age.
Techniques involving lung expansion, cough, vibration, percussion, postural drainage, incentive inspirometry and oscillatory and non-oscillatory systems are controversial regarding their efficacy as respiratory physiotherapy methods. However, non-invasive mechanical ventilation shows clear benefits. In the case of intubated patients, manual hyperinflation and secretion aspirations are highly efficient methods for the prevention of the potential complications mentioned above. In this case, other RP methods showed no clear efficiency when used individually.
Non-invasive mechanical ventilation (for non-intubated patients) and manual hyperinflation (for intubated patients) proved to be the respiratory physiotherapy methods with the best results. The other techniques are more controversial and the results are not so clear. In both types of patients this literature review suggests that combined therapy is the most efficient.
重症监护病房的患者由于多种原因（基础疾病、制动、感染风险等）易发生并发症。目前预防这些并发症的主要干预措施是呼吸物理治疗，这是护士日常的常见操作。因此，我们决定进行这项文献综述，以描述在考虑插管患者和非插管患者差异的情况下，预防和治疗重症监护患者肺部并发症最有效的呼吸物理治疗方法。
对PubMed、CINAHL和Cochrane图书馆中可用的文献进行文献叙述性综述。设定的限制条件为语言、过去15年的证据和年龄。
涉及肺扩张、咳嗽、振动、叩击、体位引流、激励肺活量测定以及振荡和非振荡系统的技术，作为呼吸物理治疗方法的疗效存在争议。然而，无创机械通气显示出明显的益处。对于插管患者，手动过度充气和分泌物抽吸是预防上述潜在并发症的高效方法。在这种情况下，其他呼吸物理治疗方法单独使用时未显示出明显疗效。
无创机械通气（用于非插管患者）和手动过度充气（用于插管患者）被证明是效果最佳的呼吸物理治疗方法。其他技术更具争议性，结果也不那么明确。对于这两类患者，本综述表明联合治疗是最有效的。
