Effects of Intrapulmonary Percussive Ventilation in Nonventilated Patients Who Are Critically Ill on Length of Stay, Oxygenation, and Pulmonary Complications: A Randomized Controlled Trial

Abstract

IntroductionPulmonary complications such as chest infection and pulmonary atelectasis may lead to respiratory failure, prolonged intensive care unit (ICU) stay and poor outcomes. Routine application of respiratory physiotherapy interventions is not supported by the current body of evidence. Intrapulmonary percussive ventilation (IPV) is used to treat various clinical conditions; however, the evidence to support its effectiveness in ICU remains weak. This study aimed to evaluate the effectiveness of IPV in improving outcomes in patients admitted to intensive care. Research questionWhat is the effect of IPV on ICU length of stay, oxygenation and pulmonary complications in non-ventilated critically ill patients compared to commonly applied chest physiotherapy (CPT). DesignRandomised controlled trial MethodsOf 201 patients screened, 106 were recruited. Participants with a respiratory impairment were randomly allocated to either the IPV or the CPT group. Both groups received two treatment sessions daily. Data were analysed for 100 participants for ICU length of stay, changes in oxygenation, respiratory rate and radiological findings. ResultsThe median LOS in the IPV group was 3.5 days (1.9, 5.9); in the CPT group, the LOS was 5.2 days (3.4, 9.9). The mean difference in LOS was 1.56 days (CI = 1.2 to 2.1 P = 0.002). The between-group difference (IPV minus CPT) for pre- to post-intervention SpO2 was 0.94% (95% CI = 0.43 to 1.45, P < 0.001). The between-group difference (IPV minus CPT) in respiratory rate was 2.1 breaths/minute, (95% CI: 0.9 to 3.2, P < 0.001). No significant difference in radiological atelectasis score was observed (P = 0.65). ConclusionsThis study showed that the IPV intervention reduced ICU-LOS and respiratory rate, with a small improvement in oxygenation compared to CPT interventions in non-ventilated patients. The use of IPV intervention may improve outcomes in critically ill patients with impaired respiratory function.