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Chest physiotherapy for the prevention of ventilator-associated pneumonia: A meta-analysis

Published:January 11, 2019DOI:https://doi.org/10.1016/j.ajic.2018.12.015

      Highlights

      • Chest physiotherapy (CPT) may not reduce the incidence of VAP.
      • CPT should be individually applied to patients with mechanical ventilation (MV).
      • Multimodality CPT may be an alternative rehab program in patients with MV.

      Background

      Ventilator-associated pneumonia (VAP) remains a frequent and severe complication in mechanically ventilated patients. We undertook a meta-analysis to evaluate the efficacy of chest physiotherapy (CPT) for the prevention of VAP.

      Methods

      A systematic literature search of PubMed and Embase databases were searched up until November 25, 2018 for published studies of mechanically ventilated patients comparing CPT with controls and reporting on the occurrence of VAP. Two authors independently selected studies and abstracted data on study quality and outcomes. We pooled data using random-effects models.

      Results

      A total of 6 randomized (n = 704) controlled trials were identified. CPT did not significantly reduce the incidence of VAP (risk ratio = 1.02; 95% confidence interval, 0.82-1.26; P = .87), but reduced hospital mortality (risk ratio = 0.68; 95% confidence interval, 0.48-0.95; P = .02). No significant differences were observed regarding intensive care unit mortality, length of intensive care unit stay, and duration of mechanical ventilation.

      Conclusions

      CPT may not significantly reduce the incidence of VAP and alter other important clinical outcomes in adult patients receiving mechanical ventilation. However, the results should be interpreted cautiously owing to the heterogeneity and the limited trials. Further large-scale, well-designed randomized controlled trials are needed.

      Key Words

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      References

        • American Thoracic Society, Infectious Diseases Society of America
        Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia.
        Am J Respir Crit Care Med. 2005; 171: 388-416
        • Chastre J
        • Fagon JY
        Ventilator-associated pneumonia.
        Am J Respir Crit Care Med. 2002; 165: 867-903
        • Joseph NM
        • Sistla S
        • Dutta TK
        • Badhe AS
        • Parija SC
        Ventilator-associated pneumonia: a review.
        Eur J Intern Med. 2010; 21: 360-368
        • Amin A
        Clinical and economic consequences of ventilator-associated pneumonia.
        Clin Infect Dis. 2009; 49: 36-43
        • Nguile-Makao M
        • Zahar JR
        • Francais A
        • Tabah A
        • Garrouste-Orgeas M
        • Allaouchiche B
        • et al.
        Attributable mortality of ventilator-associated pneumonia: respective impact of main characteristics at ICU admission and VAP onset using conditional logistic regression and multi-state models.
        Intensive Care Med. 2010; 36: 781-789
        • Pneumatikos I
        Preventing ventilator-associated pneumonia: is it ultimately only a matter of gravity?.
        Intensive Care Med. 2012; 38: 539-541
        • Labeau SO
        • Van de Vyver K
        • Brusselaers N
        • Vogelaers D
        • Blot SI
        Prevention of ventilator-associated pneumonia with oral antiseptics: a systematic review and meta-analysis.
        Lancet Infect Dis. 2011; 11: 845-854
        • Gu WJ
        • Wei CY
        • Yin RX
        Lack of efficacy of probiotics in preventing ventilator-associated pneumonia: a systematic review and meta-analysis of randomized controlled trials.
        Chest. 2012; 142: 859-868
        • Muscedere J
        • Rewa O
        • McKechnie K
        • Jiang X
        • Laporta D
        • Heyland DK
        Subglottic secretion drainage for the prevention of ventilator-associated pneumonia: a systematic review and meta-analysis.
        Crit Care Med. 2011; 39: 1985-1991
        • Silvestri L
        • van Saene HK
        • Zandstra DF
        • Viviani M
        • Gregori D
        SDD, SOD, or oropharyngeal chlorhexidine to prevent pneumonia and to reduce mortality in ventilated patients: which manoeuvre is evidence-based?.
        Intensive Care Med. 2010; 36: 1436-1437
        • Macmahon C
        Breathing and physical exercises for the use in cases of wounds in pleura, lung and diaphragm.
        Lancet. 1915; 186: 769-770
        • Stiller K
        Physiotherapy in intensive care: towards an evidence-based practice.
        Chest. 2000; 118: 1801-1813
        • King D
        • Morrell A
        A survey of manual hyperinflation as a physiotherapy technique in intensive care units.
        Physiotherapy. 1992; 78: 747-750
        • Hodgkins PR
        • Luff AJ
        • Morrell AJ
        • Botchway LT
        • Featherston TJ
        • Fielder AR
        Current practice of cataract extraction and anaesthesia.
        Br J Ophthalmol. 1992; 76: 323-326
        • Keenan J
        • Salyer JW
        Evaluation of a prototype expiratory-phase aerosol controller during simulated pediatric volume-controlled ventilation.
        Respir Care. 1994; 39: 617-622
        • Liberati A
        • Altman DG
        • Tetzlaff J
        • Mulrow C
        • Gotzsche PC
        • Ioannidis JP
        • et al.
        The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration.
        BMJ. 2009; 339: b2700
        • Higgins JP
        • Altman DG
        • Gotzsche PC
        • Juni P
        • Moher D
        • Oxman AD
        • et al.
        The Cochrane collaboration's tool for assessing risk of bias in randomised trials.
        BMJ. 2011; 343: d5928
        • Higgins JP
        • Thompson SG
        • Deeks JJ
        • Altman DG
        Measuring inconsistency in meta-analyses.
        BMJ. 2003; 327: 557-560
        • Ntoumenopoulos G
        • Gild A
        • Cooper DJ
        The effect of manual lung hyperinflation and postural drainage on pulmonary complications in mechanically ventilated trauma patients.
        Anaesth Intensive Care. 1998; 26: 492-496
        • Templeton M
        • Palazzo MG
        Chest physiotherapy prolongs duration of ventilation in the critically ill ventilated for more than 48 hours.
        Intensive Care Med. 2007; 33: 1938-1945
        • Patman S
        • Jenkins S
        • Stiller K
        Physiotherapy does not prevent, or hasten recovery from, ventilator-associated pneumonia in patients with acquired brain injury.
        Intensive Care Med. 2009; 35: 258-265
        • Pattanshetty RB
        • Gaude GS
        Effect of multimodality chest physiotherapy in prevention of ventilator-associated pneumonia: a randomized clinical trial.
        Indian J Crit Care Med. 2010; 14: 70-76
        • Pattanshetty RB
        • Gaude GS
        Effect of multimodality chest physiotherapy on the rate of recovery and prevention of complications in patients with mechanical ventilation: a prospective study in medical and surgical intensive care units.
        Indian J Med Sci. 2011; 65: 175-185
        • Zeng H
        • Zhang Z
        • Gong Y
        • Chen M
        [Effect of chest physiotherapy in patients undergoing mechanical ventilation: a prospective randomized controlled trial].
        Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2017; 29: 403-406
        • Castro AA
        • Calil SR
        • Freitas SA
        • Oliveira AB
        • Porto EF
        Chest physiotherapy effectiveness to reduce hospitalization and mechanical ventilation length of stay, pulmonary infection rate and mortality in ICU patients.
        Respir Med. 2013; 107: 68-74
        • Horiuchi K
        • Jordan D
        • Cohen D
        • Kemper MC
        • Weissman C
        Insights into the increased oxygen demand during chest physiotherapy.
        Crit Care Med. 1997; 25: 1347-1351
        • Cohen D
        • Horiuchi K
        • Kemper M
        • Weissman C
        Modulating effects of propofol on metabolic and cardiopulmonary responses to stressful intensive care unit procedures.
        Crit Care Med. 1996; 24: 612-617
        • Weissman C
        • Kemper M
        Stressing the critically ill patient: the cardiopulmonary and metabolic responses to an acute increase in oxygen consumption.
        J Crit Care. 1993; 8: 100-108
        • Spapen H
        • Borremans M
        • Diltoer M
        Intrapulmonary percussion with autogenic drainage and ventilator-associated Gram-negative infection: a pilot study.
        Neth J Crit Care. 2015; 23: 4-8