Physiotherapy Department, School of Health Sciences, Western Sydney University, NSW, Australia.
Phys Ther. 2022 Jan 1;102(1). doi: 10.1093/ptj/pzab254.
The purposes of this study were to evaluate the effect of positive expiratory pressure (PEP) therapy on lung volumes and health outcomes in adults with chest trauma and to investigate any adverse effects and optimal dosages leading to the greatest positive impact on lung volumes and recovery.
Data sources were MEDLINE/PubMed, Embase, Cochrane Library, Physiotherapy Evidence Database, CINAHL, Open Access Thesis/Dissertations, EBSCO Open Dissertations, and OpenSIGLE/Open Grey. Randomized controlled trials investigating PEP therapy compared with usual care or other physical therapist interventions were included. Participants were >18 years old and who were admitted to the hospital with any form of chest trauma, including lung or cardiac surgery, blunt chest trauma, and rib fractures. Methodological quality was assessed using the Physiotherapy Evidence Database Scale, and the level of evidence was downgraded using the Grading of Recommendations Assessment, Development and Evaluation approach.
Eleven studies involving 661 participants met inclusion eligibility. There was very low-level evidence that PEP improved forced vital capacity (standardized mean difference = -0.50; 95% CI = -0.79 to -0.21), forced expiratory volume in 1 second (standardized mean difference = -0.38; 95% CI = -0.62 to -0.13), and reduced the incidence of pneumonia (relative risk = 0.16; 95% CI = 0.03 to 0.85). Respiratory muscle strength also significantly improved in all 3 studies reporting this outcome. There was very low-level evidence that PEP did not improve other lung function measures, arterial blood gases, atelectasis, or hospital length of stay. Both PEP devices and dosages varied among the studies, and no adverse events were reported.
PEP therapy is a safe intervention with very low-level evidence showing improvements in forced vital capacity, forced expiratory volume in 1 second, respiratory muscle strength, and incidence of pneumonia. It does not improve arterial blood gases, atelectasis, or hospital length of stay. Because the evidence is very low level, more rigorous physiological and dose-response studies are required to understand the true impact of PEP on the lungs after chest trauma.
There is currently no strong evidence for physical therapists to routinely use PEP devices following chest trauma. However, there is no evidence of adverse events; therefore, in specific clinical situations, PEP therapy may be considered.
本研究旨在评估正压呼气（PEP）疗法对胸部创伤成人肺容积和健康结局的影响，并探讨导致肺容积和康复效果最佳的任何不良影响和最佳剂量。
数据来源包括 MEDLINE/PubMed、Embase、Cochrane 图书馆、物理治疗证据数据库、CINAHL、开放获取论文/论文、EBSCO 开放论文、OpenSIGLE/Open Grey。纳入比较 PEP 治疗与常规护理或其他物理治疗师干预的随机对照试验。参与者年龄大于 18 岁，因各种形式的胸部创伤（包括肺或心脏手术、钝性胸部创伤和肋骨骨折）入院。使用物理治疗证据数据库量表评估方法学质量，并使用推荐评估、制定和评估方法降低证据水平。
11 项涉及 661 名参与者的研究符合纳入标准。有非常低水平的证据表明 PEP 可改善用力肺活量（标准化均数差=-0.50；95%置信区间=-0.79 至-0.21）、1 秒用力呼气量（标准化均数差=-0.38；95%置信区间=-0.62 至-0.13）和降低肺炎发生率（相对风险=0.16；95%置信区间=0.03 至 0.85）。所有报告该结局的 3 项研究均显示呼吸肌力量也显著改善。有非常低水平的证据表明 PEP 不能改善其他肺功能指标、动脉血气、肺不张或住院时间。研究中 PEP 设备和剂量各不相同，且未报告不良事件。
PEP 治疗是一种安全的干预措施，有非常低水平的证据表明其可改善用力肺活量、1 秒用力呼气量、呼吸肌力量和肺炎发生率。它不能改善动脉血气、肺不张或住院时间。由于证据水平非常低，需要更严格的生理学和剂量反应研究来了解胸部创伤后 PEP 对肺部的真正影响。
目前，物理治疗师没有强烈的证据常规在胸部创伤后使用 PEP 设备。但是，没有不良事件的证据；因此，在特定的临床情况下，可以考虑使用 PEP 治疗。
