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

Background

Pulmonary complications such as chest infection and pulmonary atelectasis may lead to respiratory failure, prolonged 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 the ICU remains weak. This study aimed to evaluate the effectiveness of IPV in improving outcomes in patients admitted to intensive care.

Research Question

What is the effect of IPV on ICU length of stay, oxygenation, and pulmonary complications in nonventilated patients who are critically ill compared with commonly applied chest physiotherapy (CPT)?

Methods

This was a randomized controlled trial. Of 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 analyzed for 100 participants for ICU length of stay, changes in oxygenation, respiratory rate, and radiologic findings.

Results

The median length of stay in the IPV group was 3.5 days (1.9, 5.9); in the CPT group, the length of stay was 5.2 days (3.4, 9.9). The mean difference in length of stay was 1.56 days (95% CI, 1.2-2.1; P = .002). The between-group difference (IPV minus CPT) for preintervention to postintervention peripheral oxygen saturation was 0.94% (95% CI, 0.43-1.45; P < .001). The between-group difference (IPV minus CPT) in respiratory rate was 2.1 breaths/minute (95% CI, 0.9-3.2; P < 0.001). No significant difference in radiologic atelectasis score was observed (P = .65).

Interpretation

This study showed that the IPV intervention reduced ICU length of stay and respiratory rate, with a small improvement in oxygenation compared with CPT interventions in nonventilated patients. The use of IPV intervention may improve outcomes in patients who are critically ill with impaired respiratory function.