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Chest physiotherapy is effective in the management of intensive care unit patients immediately after extubation

Introduction

Physiotherapists are routinely involved in the management of patients in ICUs. Despite the necessity of physiotherapists in the ICU, little scientific evidence exists as to the therapeutic efficacy of their intervention. Physiotherapists are often involved in the weaning process, in order to assist patients to maintain a good respiratory function and prevent reintubation. Preliminary results showed that the respiratory function was significantly improved with chest physiotherapy immediately after extubation [1]. No other studies have been carried out so far to support or reject the role of physiotherapists in the weaning process.

The aim of this study is to investigate the short-term effect of chest physiotherapy versus no physiotherapy following extubation, in order to provide further scientific insight of its role in this area.

Patients and methods

Twenty-four ICU patients with various diagnoses were entered into the study as soon as they were extubated. Profusely confused patients were excluded. Patients eligible for the study were randomly allocated to two groups. The first group (n = 12) was the experimental group where patients received chest physiotherapy (upper and lower limb active exercises, deep breathing exercises, chest percussion and vibrations, huffing and assisted cough), and the second group (control, n = 12) received instructions but no physiotherapy. Outcome measures, which are described in Table 1, took place immediately after extubation in both groups followed by chest physiotherapy only in the experimental group. Following treatment, patients in both groups were allowed to rest for 30 min and all measurements were repeated in order to detect differences.

Table 1

Results

Wilkoxon rank tests revealed significant differences between the two groups (Table 1). Specifically, patients in the experimental group had significantly improved vital capacity (P < 0.05) and Pimax (P < 0.05) following chest physiotherapy. No significant differences were noted in any of the other outcome measures. Furthermore, within-group comparisons revealed that patients in the experimental group had significantly increased VC (P < 0.01) and Pimax (P < 0.01) immediately after physiotherapy whereas no significant improvement was noted within the control group.

Conclusion and discussion

The results of the present study revealed that standard chest physiotherapy resulted in significant improvement of both the vital capacity and the maximum negative inspiratory pressure in ICU patients immediately after extubation. Despite the small number of patients, the presence of a control group to count for time and learning effect indicate that chest physiotherapy may have an important role in the success of weaning. Future controlled studies with more patients and additional outcome measures and categorization according to diagnosis are necessary in order to further establish an evidence-based physiotherapy practice in this area.

References

  1. 1.

    Papadopoulos M, Kyprianou T, Nanas SN, Routsi C, Roussos C: Chest physiotherapy after extubation affects vital capacity and inspiratory muscles strength. Intensive Care Med 2002,28(suppl 1):S198.

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Papadopoulos, E., Kyprianou, T. & Nanas, S. Chest physiotherapy is effective in the management of intensive care unit patients immediately after extubation. Crit Care 9, P128 (2005). https://doi.org/10.1186/cc3191

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Keywords

  • Intensive Care Unit Patient
  • Vital Capacity
  • Respiratory Function
  • Deep Breathing
  • Chest Physiotherapy