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
- 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
- Ventilator-associated pneumonia.Am J Respir Crit Care Med. 2002; 165: 867-903
- Ventilator-associated pneumonia: a review.Eur J Intern Med. 2010; 21: 360-368
- Clinical and economic consequences of ventilator-associated pneumonia.Clin Infect Dis. 2009; 49: 36-43
- 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
- Preventing ventilator-associated pneumonia: is it ultimately only a matter of gravity?.Intensive Care Med. 2012; 38: 539-541
- Prevention of ventilator-associated pneumonia with oral antiseptics: a systematic review and meta-analysis.Lancet Infect Dis. 2011; 11: 845-854
- 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
- Subglottic secretion drainage for the prevention of ventilator-associated pneumonia: a systematic review and meta-analysis.Crit Care Med. 2011; 39: 1985-1991
- 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
- Breathing and physical exercises for the use in cases of wounds in pleura, lung and diaphragm.Lancet. 1915; 186: 769-770
- Physiotherapy in intensive care: towards an evidence-based practice.Chest. 2000; 118: 1801-1813
- A survey of manual hyperinflation as a physiotherapy technique in intensive care units.Physiotherapy. 1992; 78: 747-750
- Current practice of cataract extraction and anaesthesia.Br J Ophthalmol. 1992; 76: 323-326
- Evaluation of a prototype expiratory-phase aerosol controller during simulated pediatric volume-controlled ventilation.Respir Care. 1994; 39: 617-622
- The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration.BMJ. 2009; 339: b2700
- The Cochrane collaboration's tool for assessing risk of bias in randomised trials.BMJ. 2011; 343: d5928
- Measuring inconsistency in meta-analyses.BMJ. 2003; 327: 557-560
- The effect of manual lung hyperinflation and postural drainage on pulmonary complications in mechanically ventilated trauma patients.Anaesth Intensive Care. 1998; 26: 492-496
- Chest physiotherapy prolongs duration of ventilation in the critically ill ventilated for more than 48 hours.Intensive Care Med. 2007; 33: 1938-1945
- Physiotherapy does not prevent, or hasten recovery from, ventilator-associated pneumonia in patients with acquired brain injury.Intensive Care Med. 2009; 35: 258-265
- Effect of multimodality chest physiotherapy in prevention of ventilator-associated pneumonia: a randomized clinical trial.Indian J Crit Care Med. 2010; 14: 70-76
- 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
- [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
- 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
- Insights into the increased oxygen demand during chest physiotherapy.Crit Care Med. 1997; 25: 1347-1351
- Modulating effects of propofol on metabolic and cardiopulmonary responses to stressful intensive care unit procedures.Crit Care Med. 1996; 24: 612-617
- Stressing the critically ill patient: the cardiopulmonary and metabolic responses to an acute increase in oxygen consumption.J Crit Care. 1993; 8: 100-108
- Intrapulmonary percussion with autogenic drainage and ventilator-associated Gram-negative infection: a pilot study.Neth J Crit Care. 2015; 23: 4-8
Article info
Publication history
Published online: January 11, 2019
Footnotes
Conflicts of interest: None to report.
Identification
Copyright
© 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
