Postoperative atelectasis and pneumonia

This prospective within-group multicentre study was designed to assess the safety and short-term effectiveness of manual lung hyperinflation in mechanically ventilated patients. Eighteen patients from the intensive care units of two tertiary institutions were included and acted as their own control. Manual lung hyperinflation treatment involved patient positioning (side-lying), suctioning and manual lung hyperinflation. Side-lying treatment involved patient positioning and suctioning alone. Patients received both treatments on the day of data collection. Results demonstrated significant improvement for static respiratory system compliance (P = 0.001) with manual lung hyperinflation treatment compared to side-lying treatment. Manual lung hyperinflation treatment also cleared a significantly greater wet weight of sputum (P = 0.039). There were no differences between manual lung hyperinflation and side-lying treatment for gas exchange (PaO2/FIO2 and PaCO2), mean arterial pressure or heart rate. In conclusion, total static respiratory system compliance and sputum clearance were improved by the addition of manual hyperinflation to a physiotherapy treatment of positioning and suctioning in mechanically ventilated patients without compromise to cardiovascular stability or gas exchange.

https://journals.sagepub.com/doi/pdf/10.1177/0310057X0002800302

An investigation of the early effects of manual lung hyperinflation in critically ill patients.

Effect of Combined Kinetic Therapy and Percussion Therapy on the Resolution of Atelectasis in Critically Ill Patients

Oxygen Transport: A Physiologically-based Conceptual Framework for the Practice of Cardiopulmonary Physiotherapy

The purpose of this study was to determine metabolic and haemodynamic changes with and without physiotherapy treatment in haemodynamically stable, intubated and ventilated patients. This was a prospective, randomised cross-over study. Ten intubated, ventilated and haemodynamically stable patients underwent a 20 min physiotherapy treatment and a 20 min period of undisturbed side lying. Mean oxygen consumption (VO2mean) was measured on a minute-to-minute basis by indirect calorimetry. Mean arterial pressure (MAP) was recorded minutely from the indwelling arterial line and cardiac index (CI) was calculated from the indwelling pulmonary artery catheter. Time to recovery to within 5% of resting VO2 was also recorded. The results showed no significant increase in VO2mean with either positioning the patient in side lying or physiotherapy treatment (p = 0.17). Time to recovery to within 5% of baseline VO2 occurred within seven minutes for all patients and there was no significant difference between either physiotherapy treatment or positioning in side lying (p = 0.63). There were no significant differences in CI (p = 0.44) or MAP (p = 0.95) during physiotherapy treatment compared with undisturbed side lying. It is concluded that physiotherapy treatment does not significantly alter VO2mean or MAP and CI in stable intubated and ventilated patients.

The effect of physiotherapy treatment on oxygen consumption and haemodynamics in patients who are critically ill.

Chest Physiotherapy in the Intensive Care Unit

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Chest Physiotherapy in the Intensive Care Unit