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.

Background: Mechanically ventilated patients have an increased risk of complications leading to ventilation weaning more difficult resulting in excessive morbidity and mortality. Chest physiotherapy plays an important role in management of ventilated patients. However, these techniques have been studied on patients as a single entity or with combination of two techniques. The present study was designed to evaluate the effect of multimodality chest physiotherapy on the rate of recovery and prevention of complications in adult ventilated patients. Materials and Methods: Out of 173 patients who were randomly allocated to two groups, 86 patients received MH and suctioning in control group and 87 patients were treated with multimodality chest physiotherapy in the study group twice daily till they were extubated. All patients were followed up for the global outcomes and complications during mechanical ventilation. Results: There were significant improvements in terms of rate of recovery in study group compared to the control group (P = 0.000). Complication rates were higher with 61.6% in the control group as compared to 26.4% in the study group. Duration of hospitalization was longer in the study group (16 ± 9.40 days) as compared to the control group (12.8 ± 6.12 days). Successful weaning from mechanical ventilation was noted in 58 patients in the study group and 24 patients in the control group which was statistically significant. Conclusions: Multi-modality chest physiotherapy protocol has shown to prevent ventilator-associated pneumonia and enhance the clinical outcome in ventilated patients and may be recommended as a treatment option in ICU. It has also shown to enhance the weaning process and proved to be safe.

Non-invasive positive pressure ventilation in acute respiratory failure. an alternative modality to invasive ventilation at a general hospital

Non-invasive positive pressure ventilation [NPPV] is a relatively new modality of managing acute respiratory failure [ARF]. It has not been applied before in our area. The aim of this study is to verify the use of NPPV on patients with ARF at a general hospital level. All patients admitted at the Al-Amiri Hospital, Kuwait [a secondary medical center] between 1999 and 2001 with ARF and met the inclusion criteria were included in the study. The non-invasive mode of nasal ventilation was used as the respiratory support. A total of 21 patients were included in the final analysis. The major cause of ARF type 2 was chronic obstructive pulmonary disease [COPD] in 71%. The overall success rate of NPPV trials was 71.4%. In the successful trials of ARF type 2, the arterial blood gas parameters of PaCo2 [p<0.005], pH [p=0.023], and PaO2 [p<0.001] showed improvement from the first hour of intervention. Analysis of variance with repeated measurement for the arterial blood gas variables showed statistical significance of changes in favor of NPPV during initial close monitoring with p<0.001. The percentage of successful trials at the general wards was 82% versus 67% for the intensive care unit cases [ICU]. Surprisingly, failure of trials related mainly to the clinical status of the patients. Non-invasive positive pressure ventilation is an effective ventilatory support in ARF in a proper clinical setting. It may be used safely in the general hospital outside the ICU